Securing Health Care for Older People in Rural Area: Assessment and Appraisal of Long-Term Care in Community-Based Setting

One of the most important demographic trends facing Indonesia is population aging. In 2010, people aged 60 years and above was 18.1 million, or 7.6 percent of the total population, and it is projected to increase to 15.8 percent, by 2035. In the context of health sector, the system should respond to this process for health and long-term care, including the funds available for health care and the expenditure required. However, to date, the pattern of increasing number of ageing population in Indonesia has not been noticed by specific programs for elderly. The healthcare system still focuses on battling infectious diseases such as malaria, tuberculosis, diarrhea and dengue fever. Resources have not been allocated proportionally to the larger and increasingly threatening burden of chronic non-communicable diseases such as heart diseases, stroke, diabetes, cancer and hypertension particularly in older people. Moreover, Indonesian social insurance program, which are intended to covering all population, is not designed to anticipate an ageing population. The lack of a sufficient health care system based on community setting increases the vulnerability of older people to poor health and quality of life, mostly due to the threat of chronic illness from non-communicable diseases, and lack of financial support for accessing quality health services especially in the rural area. A critical question is whether Indonesia is ready for such profound change and the implications of this change for health system and government for ageing population in rural area. To address this question, this study is proposed.

 

The study will be conducted in two phases; i) assess the aging community needs regarding health care for older people in rural area and its potential barriers and challenges, ii) evaluate the effectiveness of existing the community-based long-term care in rural area by using economic evaluation approach. The first phase had been carried out by employing a quantitative survey and a total of 412 older persons were selected by using cluster random sampling.  

 

The study found that older people who live in rural areas faced several health problem such as chronical diseases (45.1%), limitations on phisical functioning (73,5%), limitations on activities daily living (54,9%), and mental health problems (40,5%).  The study also found that quality of life among the older people was determined by their chronical disease status, economic status condition, and marital status as living with partner. Moreover, mental health problems of the elderly were influenced by family structure, chronical diseases, and their participation in integrated health post for older people program or Posyandu lansia. The study also point out the perception of needs in elderly activity center and home-based care center among community-dwelling older people.

 

Keywords: older people, health care, rural community, Indonesia