HelpAge International is supporting groups of older people in Bangladesh, Bolivia, Jamaica, Kenya and Tanzania to monitor their governments’ implementation of the Madrid International Plan of Action on Ageing 2002.

This grassroots monitoring is revealing some sharp discrepencies between policy and practice, as well as generating a sense of solidarity among older people.

The groups began by analysing the local and national policy environment, and identifying key concerns.

In all five countries, they chose to monitor access to health and income-security entitlements.

By gathering evidence of gaps in service provision, and presenting it to local and district authorities, the groups are starting to influence budgets and government action.

Bangladesh

Older people are monitoring access to health services and two financial support mechanisms, the Old Age Allowance and the Widow’s Allowance, in two pilot areas – a peri-urban area of Dhaka and a remote rural area.

HelpAge International’s implementing partner is the Resource Integration centre (RIC).

Teams from the older citizens' monitoring (OCM) project have identified who is eligible and who is actively receiving income-security benefits. At a village level, they are petitioning for the most vulnerable to receive the allowance.

In 2005, central government increased both the size of the allowance (from US$2.5 to $2.6 per month) and its coverage (from 1 to 1.32 million people).

This is at least partly due to advocacy work by the project at a national level.

Local banks have also made it easier for older people to collect the allowance.

"We were sleeping… before this organisation we were lambs, now we are lions," says Bhimkanthi, the committee chairman of the OCM project.

Bolivia

Groups of older people in five urban and rural areas are monitoring three strands of the health-care scheme: the finances, administration and service delivery.

They are recording the number of older people registered for health-care insurance, along with the health budget allocated by central government to local government.

As a result of the scheme central government has increased funding to local government for health insurance, resulting in greater numbers of older people securing benefits.

The local government in the El Alto and Potosi districts has given HelpAge International authority to register older people for health insurance.

The OCM groups are influential in local policy development and have developed strategic alliances with the media, resulting in regular TV and radio coverage.

"We are working for more than 17,000 older people in this city and I can’t forget my responsibilities," says Elsa Baranado, 65, of the Sucre group.

Jamaica

Groups of older people in three rural communities are monitoring the following schemes: PATH, a cash-benefit scheme for the most needy, and two subsidised drugs schemes – the Jamaica Drugs for the Elderly Programme (JADEP) and the National Health Fund (NHF).

HelpAge International’s implementing partner is the St Catherine Community Development Agency (SACDA).

The number of people receiving benefits under all three schemes has increased.

In St Catherine's Parish, five out of nine pharmacies are now participating in the JADEP programme. This reduces the distance and costs (up to US$5 to collect a $10 benefit) faced by older people needing to secure drugs.

The government's Social Policy Evaluation Unit has asked SACDA to help develop indicators to track goals relating to older people’s issues.

Kenya

There are few health-care entitlements in Kenya and this has made it more difficult to implement the project.

Older people in an urban slum area of Nairobi and a rural area are monitoring their access to health services. They expect to see improved attitudes from medical staff, reduced waiting times at hospitals, and greater availability of drugs locally. All of these factors are being monitored by the project.

The implementing partner is HelpAge Kenya.

So far, the project has resulted in the Ministry of Health providing $2,650-worth of drugs annually to Misyani Health Centre in one of the project areas, and a separate allocation of relief food for older people.

Tanzania

Older people in two areas of Tanzania are monitoring the delivery of health services to older people in line with government commitments.

The implementing partners are Arusha Retired and SAWATA (Help the Elderly).

The project has had a huge impact on the lives of older people in the project areas and beyond.

Charges for consultations and drugs at health centres have reduced dramatically. For example, between August 2004 and March 2005 in Buigiri district, the percentage of older people being charged dropped from 80% to 13% and the percentage paying for prescribed drugs has dropped from 100% to 10%.

Government officials have asked SAWATA to establish a system to "authorise" older people to be treated free of charge by doctors.

Older people's committees established through the project are discussing wider issues with the authorities, including famine, elder abuse, and school fees for children orphaned by HIV/AIDS.

Older people gave their input to the national poverty-reduction strategy (MKUKUTA) which, for the first time, includes a social-protection goal aimed at reducing vulnerability in old age.

All 8,000 vulnerable older people in Munduli district have been granted free health care, based on the pilot project in the Mosquito river ward. This is funded by the Community Health Fund.