Age Demands Action in Progress on implementation of the Madrid International Plan of Action on Ageing (MIPAA)

Older people in Bangladesh experience poverty, have low food security and require targeted assistance.

Introduction of an estimated 142 million in Purpose and content 2003.1 Available data for Bangladesh In 2002 the Second World Assembly This briefing report can be follow trends which characterise the on Ageing adopted the Madrid used: International Plan of Action on Ageing demography of other Asian countries, and its challenge of ‘building a society for example the rising proportion of n by government and civil for all ages’. This focuses on reducing older people in the population. society organisations to poverty, addressing healthcare issues support advocacy for older There is a steady increase in the and introducing anti-discriminatory people proportion of the population aged legislation for older people. 60 and above. The majority of older n as a resource for national Why MIPAA is important people live in rural areas where reporting on MIPAA services, healthcare provision and n as an information source MIPAA is important because: access to clean water are more for future development of n It is an international agreement precarious. Older people in Bangladesh Bangladesh’s plan of action which commits governments morally experience poverty, have low food on ageing. and politically to include ageing in security and require targeted assistance. all social and economic development The impact of annual cyclones, floods policies, including poverty reduction and overpopulation contributes to strategies. widespread poverty affecting all ages. n It aims to ensure that people Bangladesh ranks 137 out of 177 everywhere can age with security and countries in UNDP’s 2006 Human dignity, and continue to participate in Development Index, and a 2006 their society as citizens with full rights. estimate indicates that 36 per cent of the population live on US$1 a day.2 n It emphasises the right and potential of older people to participate actively While a significant proportion of in economic and social development. this percentage is thought to be older people, their needs compete with the Older people in Bangladesh demands of other vulnerable groups Bangladesh is a South Asian country supported by stronger advocacy with a large, densely-settled population initiatives. From a World Bank perspective Bangladesh has done remarkably well in improving its social indicators in many respects.3 Achievements include increasing the national literacy rate, improving school attendance for girls and reducing the rate of population growth. However, expenditure on safety net programs programmes is fairly low and has been declining, and is less than what other countries at a similar level of development spend on such programmes. Safety net expenditures now account for less than 20 per cent of all social sector expenditures, down from about 30 percent in the late 1990s.4 Older people in Bangladesh: facts and figures

Implementing MIPAA in n In 2006, 6 per cent (8.3 million) of the population was aged 60 or Bangladesh over and this figure is predicted to rise to 17 per cent by 2050.5 Following the launch of MIPAA in n 40 per cent of older people live below the national poverty line.6 2002, there was no apparent direct response from the Bangladesh n Most older people live in rural areas with limited access to Government. However a significant health, water and sanitation and other services. step forward came in October n In a recent study 50 per cent of older people in rural Bangladesh 2006 with the production of a suffered chronic energy deficiency and 62 per cent were at risk of National Policy on Older People. malnutrition.7 Stakeholders hope this will result in mainstreaming older people’s issues n The proportion of people over the age of 60 in the labour force is 8 and meaningful recognition of older currently 66 per cent for men and 18 per cent for women. people as a vulnerable group, leading to targeted funding and plans. The National Policy has been approved Social pensions to an assigned male relative. Many by the Ministry of Social Welfare, but The government provides two main widows therefore have little financial awaits approval from the Council of social pension schemes: security and are dependent upon sons Ministers (cabinet). Practical outcomes or other family members. They lack n contributory pensions for civil have not yet been felt. opportunities to earn income and have servants9 no savings.13

Ageing policy n means-tested non-contributory In 2002 the Honorarium Programme Until 2006 there was no national policy pension for older people, the Old Age for Insolvent Freedom Fighters was to guide systematic government action Allowance. introduced. This scheme supports to support older people. Nonetheless, 100,000 soldiers (or their dependants) The Old Age Allowance reaches about since the 1970s a range of state social who fought in the Liberation War 20 per cent (1.7 million)10 of people protection measures has existed in the of 1971. More recently in 2005- age 60 and above.11 The pension is form of the social pensions and social 2006 the government established the worth 220 taka (approximately US$3) assistance which reach some older Allowances for the Insolvent Persons per month to those older people not people. Bangladesh’s 27 social safety with Disabilities Programme which covered by the public employment net programmes are administered reaches some disabled older people. scheme and who are living below the by several ministries, including the Beneficiaries of the programme also poverty line.12 Ministry of Social Welfare, the Ministry receive social cash transfers of 220 taka of Food and Disaster Management, the Other government initiatives include per month. Ministry of Women’s and Children’s the Widow’s Allowance Scheme set up While these government schemes Affairs and the Ministry of Freedom in 1998. The transfer is also 220 taka make a difference to the lives of Fighters’ Affairs. The eligibility criteria per month and benefits approximately beneficiaries, there are millions of for receiving assistance from a specific 650,000 widows. Widows are older people who require assistance ministry’s funds make it likely that among the most vulnerable people but are not yet targeted. The civil many older people have fallen through in Bangladesh. A woman’s marital society organisation Resource the social safety net. status is crucial for her survival and Integration Centre of Bangladesh wellbeing. Once a woman is widowed (RIC) and HelpAge International Poverty or divorced, she is often denied access have worked in partnership to address Poverty reduction among older people to resources, including her husband’s the gaps in coverage of the Old Age is a key MIPAA objective. wealth. Assets may be distributed Allowance. The collaboration has among other family members or 2 resulted in the formation of Older Citizens Monitoring groups. These Case study: Kadvan participatory groups work actively to Kadvan is a widow living in Taktapara village, Bagmara improve the selection of pensioners for of district. She has no land or assets and no-one to the allowance scheme and delivery of 14 support her. She has a disabled son to support and she begs for social cash transfers at the local level. money to feed him. She hates begging but there are no other options. She has not yet received an Old Age Allowance nor a Older people’s perspectives Widow’s Allowance. Kadvan is destitute. She asks: ‘How long During the research older people should I wait to be awarded the Old Age Allowance?’.15 prioritised improved access to the Old Age Allowance to strengthen financial security. They acknowledged n Vulnerable Group Development majority of older people are unable or choose not to access free services, the government’s efforts, but they also n Food for Work Programme voiced criticism of the programme’s relying on self-care practices or paying implementation, which they feel n Income Generation for the for private healthcare. results in inequitable and limited Vulnerable Group Development Older people’s perspectives coverage of older people. n Challenging the Frontiers of During the research older people In recent discussions, older people Poverty Reduction/Targeting the Ultra 16 put health security high on their list stated that local government Poor. of needs and lobbied for improved officials sometimes do not select the access to quality healthcare and free Older people’s perspectives most vulnerable for the Old Age medicines. Allowance. This might be because Older people interviewed during the of favouritism or lack of knowledge research wanted access to interest- Future priorities for about constituents. For example, free credit. Many of the Bangladesh implementation of MIPAA younger widows are frequently micro-finance institutions exclude selected over more vulnerable older older people from borrowing, yet The Bangladesh Government has widows for the Widow’s Allowance. In research from other countries indicates implemented a range of measures some communities, older people have that older people diligently repay small which benefit older people. However organised themselves into associations loans. Older people also expressed the coverage is not systematic and and nominate the most vulnerable, for a need for family and community many vulnerable older people are government approval, based on their support in the form of a place to live not reached by the government’s local knowledge. and a place for older citizens to meet current schemes. The impact of the and interact socially. Social isolation is National Policy on Older People is Older people also cite collecting a particular problem for older women. not yet known, but mainstreaming of the funds from the bank as another Constraints on freedom of movement older people’s issues is a fundamental challenge. Many older people and public exposure mean that many starting point leading to dedicated have to wait for up to four to six older women lack social networks funding outcomes. hours according to some residents. outside the home and experience Sometimes they return home with Currently the scale and specific nature feelings of neglect and loneliness. no money because bank officials say of older people’s needs are defined. A they are ‘too busy’ to deal with them. Health key priority in line with MIPAA goals Older people’s groups have started to is to gather disaggregated statistics Access to free, quality healthcare is lobby the banks which has resulted and information within the 60 and a MIPAA priority for older people. in the banks agreeing to deal more over age range, which incorporates In 1978 the Bangladesh Government promptly with older citizens collecting the views of older people themselves. introduced a policy of Universal allowances and to set aside special Older people participating in this Health Care. Currently, the Ministry times for them to come. Distance research stressed the importance of of Health and Family Welfare from banks also leads to physical and Older Citizens Monitoring group’s (MOHFW) is responsible for health financial hardship. Older people’s involvement in influencing government policy and implementing the Health, groups have intervened to ask banks responses to improving financial Nutrition, and Population Sector for the facility to collect money from security and social support for people Programme. Under this programme the nearest local bank rather than 60 and above. Including older people older people are entitled to use the travelling to a large town. in the decision-making process will national healthcare services and are help the Bangladesh Government draw Older people also think the most likely to access them at the up relevant and targeted policies and government allowances are not sub-district Thana Health Complex programmes. enough. level, and at Union Health and Family Welfare Centres as well as hospitals. A range of stakeholders recognise Social assistance and relief However evaluations indicate state the value of a collaborative approach Five key programmes deliver social health services lack quality and involving government, civil society and 17 assistance in Bangladesh: accessibility. This results in only 8 older people themselves in planning per cent of rural people using state and implementing programmes and n Cash for Education healthcare and indicates that the projects to benefit people 60 and above. 3 1 Country Profiles for Population and Reproductive Health, Policy Developments and Case study: Monica Indicators 2005, produced jointly by UNFPA and Population Reference Bureau Monica is a committed member of an Older Citizens Monitoring 2 Kabir, Ferdous, Cederholm, Khanam, Streatfield and Wahlin, Mini Nutritional group. She values the existing state support for older people but Assesment of Rural Elderly People in believes the government could do more. ‘I think older people Bangladesh: the impact of demographic, socio- economic and health factors (2006), Public issues are rarely discussed in our national political agenda. It is Health and Nutriton, Cambridge University still a minor issue.’ Monica is keen to avoid being a burden on Press 3 World Bank Country Overview 2006 her children. She says: ‘The government can take initiatives by 4 World Bank, Social Safety Nets in increasing the amount of Old Age Allowance and by creating job Bangladesh: An Assessment (January 2006), http://siteresources.worldbank. opportunities for the older people who are able to work. Older org/BANGLADESHEXTN/Resources/FINAL- people themselves can also improve their lives by uniting and printversion_PAPER_9.pdf raising their demands to the government authorities.’ This is why 5 Bangladesh Bureau of Statistics (BBS) 6 The national poverty line is set at 20,000 she advises older people to form older people’s committees in every takas or US$ 300 per year. union of Bangladesh. 7 Kabir, Ferdous, Cederholm, Khanam, Streatfied, and Wahlin, Ibid 8 Population ageing wallchart, United Nations Department of Economic and Social Affairs, Recommendations Inclusion in society and visibility 2006 in government 9 Public Servants (Retirement) Act, (1974), These recommendations are based Government of Bangladesh on participants’ comments during n Priority: Actively promoting the 10 Bangladesh Bureau of Statistics (BBS), data consultations held in Bangladesh from 2000. inclusion of ageing issues in school and 11 The eligibility age was recently raised from in advance of the national budget. university textbooks. 60 to 65 years of age Participants included older people 12 HelpAge International in partnership with n Introducing a national tax with the Resource Integration Centre (RIC) runs the from RIC project areas, representatives Older Citizens Monitoring project to build revenue dedicated to the needs of older the capacity of groups of older people to of other NGOs and organisations monitor the implementation of the Old Age working with older people, electronic people. Allowance scheme. See www.helpage. org/Worldwide/AsiaPacific/Keyprojects/ media journalists and the Director n Raising awareness of MIPAA goals Oldercitizensmonitoringproject. General of the Department of Social 13 HelpAge International and others (2000), at national and district government Uncertainty Rules Our Lives: the situation of Services, Ministry of Social Welfare. levels through a series of workshops in older people in Bangladesh 14 Ibid Financial security 2008. 15 Abridged from editorial of Prothom Alo, 26 n Giving local government the January 2006 n Priority: Increasing access to the 16 Barrientos and Smith, Social Assistance in Old Age Allowance from age 60 by a responsibility to register older people. Low Income Countries Database (March 2005), DFID. minimum of 18 per cent by 2009, from n Collecting of disaggregated data on 17 Healthcare in Bangladesh, www.csd.ssvl. 1.7 million to 2 million people. kth.se/~csd2006-team6/files/weeklyreport/w11/ people 60 and over. healthcare%20in%20Bangladesh.pdf n Increasing the Old Age Allowance from 220 to 500 taka (approximately ‘I do not go to see HelpAge International has US$3-7) by 2009. a vision of a world in which the doctor because all older people fulfil their n Increasing the number of recipients potential to lead dignified, and the value of the Widow’s it requires large healthy and secure lives. Allowance. sums of money that HelpAge International is a n Improving the allowance global network striving for distribution systems to reduce issuing I cannot afford. So, I the rights of disadvantaged problems and delays. take herbal medicine, older people to economic and n Increasing access to interest-free physical security; healthcare micro-credit for older people. which I learned from and social services; and support in their caregiving Health security my parents.’ role across the generations. n Priority: Providing free healthcare Monica, an older citizen. Registered charity number: 288180 and medicine to older people on Prepared by: Penny Amerana presentation of ID card. Cover photo: Resource Integration Centre August 2007 n Increasing the number of doctors with expertise in geriatric issues. Security in emergencies n Priority: Preparing flood shelters for older people through disaster programmes.