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Global Health Econ Sustain Improving health of older adults in rural Uganda

1. Introduction The health of aging populations in low- and middle-
income countries (LMICs) has received considerably less
1.1. An aging world attention than in high-income countries. However, in the
The world is aging. Currently, one in 11 people is over past decade, there has been a growing body of literature on
the age of 65 years; by 2050, this proportion will rise to the functional capacities of aging populations in LMICs,
one in six, and the absolute number of older adults will including SSA (Bachani et al., 2018; Brinkmann et al.,
double (United Nations, 2020). Demographic projections 2021; Payne et al., 2017; Wang et al., 2019). The African

suggest that in Sub-Saharan Africa (SSA), the number of studies are recent, usually involving randomly selected
individuals aged 60 and older will increase from 46 million subgroups of larger community databases, and are quite
in 2015 – 157 million in 2050 (Aboderin & Beard, 2015). heterogeneous (more middle-income than low-income,
Even in Uganda, one of the youngest national populations e.g., South Africa), defining aging differently (e.g., over
in the world, the number of individuals aged 60 years 40, 50, or 60 years). None tie identified disability with
and older is projected to increase from 1.3 million in the provision of services. In addition to assessing the
2010 – 5.5 million in 2050. As in many developing countries, functional status of elders in their catchment areas, these
90% of older Ugandans live in rural areas that are poor, and other studies demonstrate that in rural SSA, families
lacking public services and economic opportunities. Many with older adults are often stretched thin: when elders are
live in abject poverty, on <US$ 2/day, with little access disabled or sick, family caretakers forego remunerative
to health care (Wamara & Carvalho, 2019). Ssenssamba work. When the illness is chronic, an ever-increasing cycle
et al. (2019) have specifically cited the lack of geriatric care of “iatrogenic poverty” starts, often leading to destitution
services in Uganda. and deteriorating health family wide (Harling et al., 2020).
In this article, we describe the development of a 1.3. The origin of the Kisoro Elders Project: The
unique, community-based, and data-driven program in Kisoro VHW program
rural Africa that delivers basic, cost-effective geriatric care
by trained village health workers (VHWs). The program Kisoro District in southwest Uganda has a population of
stands as a potential care model for low-resource rural approximately 300,000 people in the district capital and 513
settings worldwide, especially in areas where supervised villages, 86% of whom are subsistence farmers (Statistics
community health workers are already active. UBo, 2014). The Kisoro VHW program, established by
Kisoro District Hospital (KDH) in 2007 in partnership with
1.2. The reality of health care for elders in rural the community-based organization Doctors for Global
Uganda Health (DGH) Uganda, has been providing preventive
Older rural Ugandan adults have traditionally lived in services, clinical care, and health education to 52 villages
small, widely separated family compounds of 2 – 10 (out of 153 villages) in two surrounding subcounties (out
small houses where family members take care of each of 14 subcounties) for 17 years. The population of older
other from birth to death. However, several modern adults comprises approximately 7% of the total population
developments have left more older adults on their in the 52 villages (see geriatric health assessment [GHA]
own: Urbanization, with younger adults moving into in the result section, which assessed 49 villages, 3,615
the cities for work as family land has been repeatedly older adults out of the total population of 49,613). This
subdivided for generations; loss of the middle generation proportion is higher than the African average of 5%,
to HIV/AIDS, leaving older adults to parent their possibly due, at least in part, to a high rate of urbanization
grandchildren; and the erosion of traditional respect of middle-aged adults. VHWs, like their neighbors, are
and reverence for the family patriarchs and matriarchs, farmers, mostly women with a primary school education
who no longer command the resources they once did (higher than the average adult in the village). They were
and are increasingly the target of domestic, financial, elected to become VHWs and are broadly respected by
and emotional abuse. Safety nets for older Ugandans their communities. Most have served for over a decade.
are virtually non-existent: the National Social Security A team of six clinical supervisors, clinical officers
Fund and Public Sector Pension Fund each cover only or nurses from KDH, mentored by DGH’s global health
7% of older adults. The demonstration Social Assistance physicians on the faculty of the Albert Einstein College
Grants for Empowerment are modest payments only of Medicine in New York, provided the initial training
available to individuals aged 85 years and older (Wamara covering six domains of health: child wellness, women’s
& Carvalho, 2019). With few exceptions, families are the health, non-communicable diseases, sanitation and
only sources of social support for older adults (Iraguha, hygiene, acute illness, and community health. A rigorous
2023), and family bonds are loosening. training period, spanning 6 days/month for 1 – 2 years,

Volume 2 Issue 2 (2024) 2 https://doi.org/10.36922/ghes.3000