Transcript Third Regional Intergovernmental Conference on Ageing in

Inclusion and Strengthening of Social
Services: The Case of Jamaica
Presentation by
Faith Innerarity

Introduction and Background

Advances in implementation of Brasilia
Declaration
◦
◦
◦
◦
Jamaica at a Glance
Historical context
Demographic profile
Socio-economic situation
◦ Social policy framework
◦ Coverage of older persons in the social protection
system
◦ Promoting participation


Gaps and Challenges
Conclusion and Recommendations






Jamaica is a mountainous island, which is comprised of 14
parishes and spans 11,242 sq. miles of land in the
Caribbean Sea.
It is the largest English-speaking Island in the Caribbean.
The country is classified as Upper Middle Income in the
World Bank’s World Development Indicators (GNI per capita
of US$ 4,990 in 2009)
The level of human development has been ranked as
medium range (100 out of 182 countries in 2009) by the
UNDP in the Human Development Index (HDI).
The population has been growing at about 0.5 per cent per
annum and was estimated at about 2.7 million in 2009.
While the country’s population is ageing 28 per cent is
still under the age of 14.



This year (August 6th) Jamaica celebrates 50
years as an independent nation.
Range of cultural and other events planned to
mark this milestone.
Recent seminar (April 26, 2012) hosted by
the Sir Arthur Lewis Institute (SALISES) of the
University of the West Indies provided critical
analysis of achievements in the area of social
policy since independence.
HAS SOCIAL POLICY
ACHIEVED ANYTHING SINCE
INDEPENDENCE?
Presentation by Faith Innerarity



As a post-colonial society, Jamaica’s social
protection system had its genesis in British
social policy and has evolved over time
influenced by the political economy and
international norms and trends.
Overall movement from residualism in social
protection policy to the rights-based
approach.
Paradigm shift from welfare to developmental
model in the provision of social services.
7

Residual Model (Titmuss)
- Proceeds from the premise that the market
and the family are the two ‘natural’ or
‘socially given’ means of properly meeting
the needs of the individual and that only
when these fail should welfare institutions
come into play and only on a temporary
basis.
- Seen as having its roots in the English Poor
Laws dating back to the 14th Century
8



The first attempt at providing formal social
protection in the island was represented by the
Poor Law introduced in 1682 that was similar in
nature to that which existed in England at the
time.
The law recognized three categories of poor
persons, the ‘able-bodied poor’, ‘vagrants’ and
the ‘aged sick’.
The ‘able-bodied’ persons were to be
‘rehabilitated’ so that they could work, the
‘vagrants’ were to be sent to houses of
correction, while the ‘aged sick’ were to be cared
for in their homes.
9
Period of Slavery
Labour Revolts 1930’s
Poor Laws 1682
Reflected Elizabethan Poor Laws
1597 &1601
19th Century British Political
Economy centered on Laissezfaire
Belief that poverty stemmed from
idleness
Emancipation 1838
Extreme Social hardships
Morant Bay Rebellion 1865
Passage of Poor Relief Law 1886
replacing Poor Laws
Increased expenditure on social
services and greater state
involvement such provisions
Social policy became more
integral part of public policy
making
Movement away from residual
approach
Moyne Commission Report
Passage of the Colonial
Development and Welfare Act in
1940 revised in 1945
Establishment of the Colonial
Development and Welfare Fund
Post World War II and rise of
Welfare State in developed world
Far reaching changes in the
system of welfare provisioning in
the United Kingdom
Changes in policy direction in
colonies
Old Age Pension and
Superannuation Scheme Law
passed in Jamaica in 1958
reflecting elements of Britain’s
National Insurance Act (1946)
based on the Beveridge Scheme
for Social Security which ushered
in the British Welfare State.
Developmental and Rights-Based
Approach
Ratification of International
Human Rights instruments
National Insurance Scheme Act
1965
Conditional Cash Transfer
Programme 2002



Jamaica’s population is ageing rapidly.
In 2010, the estimated number of persons
sixty years and over constituted 11.1 per cent
of the total population (299,500 persons).
Between 2010 and 2050, the elderly is
expected to double both in absolute numbers
and as a percentage of the population.
Year
No of elderly 60+ years
% of total population
299,500
11.1
348,392
12.4
453,177
15.8
528,688
18.4
614,902
21.8
2010
2020
2030
2040
2050
Source: Statistical Institute of Jamaica (Demographic Statistics 2010, Projections 2010)
Indicators of Ageing 2010, 2030 and 2050
Indicator
2010
2030
2050
Median age
27
33.6
41.7
2.5
6.8
% Over 80 years 1.8
Source: Kristin Fox, Report to ECLAC 2012
 There
is a predominance of
females among older persons:
 In 2010 the ratio was 55 per cent
females (163,900) to 45 per cent
males (135, 600) or 100 females to
82.7 males.
Age
0
1
5
10
15
20
25
30
35
40
45
50
55
60
65
70
Male
70.94
71.38
67.86
62.96
58.06
53.33
48.88
44.53
40.17
35.77
31.43
27.24
23.23
19.51
16.24
13.25
Female
75.58
76.04
72.47
67.55
62.62
57.74
52.95
48.3
43.69
39.15
34.65
30.32
26.16
22.28
18.77
15.42
Both Sexes
73.25
73.7
70.15
65.24
60.33
55.33
50.91
46.41
41.92
37.45
33.04
28.78
24.71
20.92
17.53
14.39
Source: Demographic Statistics STATIN 2002. **Additional years
18
 Life
expectancy at birth for the
period 2010-2015, is
estimated at 76.0 for females
and 69.7 years males.
Prevalence of Poverty: Jamaica 2006-2009 (%)
Jamaica (% of individuals)
By Region
KMA
Other Towns
Rural Areas
By Gender (%)
Male
Female
By Household Head (%)
Male
Female
All Households
By Age Group (%)
0-5
6-18
19-24
25-59
60+
Memoranda items:
Number of poor
Poverty Line (All JA) J$/annual
Food Poverty Line (JA) J$/annual
Mean Per capita Consumption J$/annual
Mean
Per
capita
Consumption
(1990
prices)
2006
2007
2008
2009
14.3
9.9
12.3
16.5
9.4
9.2
19.8
6.2
4.0
15.3
7.0
10.7
17.0
12.8
10.2
22.5
14.6
13.9
11.2
8.8
13.3
11.3
17.7
15.4
9.9
10.8
10.3
7.2
8.0
7.6
7.9
9.1
8.5
11.4
12.8
12.0
18.6
17.0
14.0
11.9
12.1
11.2
12.2
10.2
7.9
10.8
15.7
15.2
13.9
9.7
10.3
19.3
20.8
16.7
12.7
17.2
380,824
74,349
59,908
139,597
9,531
264,907
80,090
52,712
165,761
10,508
330,531
104,737
68,933
214,015
10,377
444,771
110,100
72,463
205,693
9,578
Source: Social Protection Diagnostic
Study May 2011
20
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
2006
2007
KMA
2008
Other Towns
2009
Rural Areas
21
Percentage of population who are elderly by sex and
area of residence: Jamaica 2009
Male
%
Female
%
Total
%
KMA
10.8
13.3
11.7
Other Towns
11.3
12.7
11.8
Rural
12.6
12.5
12.6
Total
11.8
12.3
12.2
Source: STATIN. JSLC 2009
Percentage of elderly and total population below the
Poverty Line
Jamaica 2007 – 2009
Year
Percentage
of the elderly
below the Poverty Line
Percentage
population
below the Poverty
Line
2007
11.1
9.9
2008
12.8
12.3
2009
17.7
16.5
STATIN. JSLC, 2007, 2008, 2009

National Policy for Senior Citizens adopted by
Parliament in 1997:
◦ Reflects Vienna Plan of Action on Ageing 1982
◦ Incorporates developmental and rights-based
approach

National Policy for Persons with Disabilities
adopted in 2000:
◦ Based on UN Standard Rules for Equalization of
Opportunities for Persons with Disabilities

Vision 2030 National Development Plan (2009-2030):
◦ Crafted using participatory and consultative approach involving
over 30 technical working groups from all spheres of society
representatives of retired persons associations.
◦ Stated goals include provisions to create secure future for
vulnerable segments of the population, ensuring in particular,
that older persons and persons with disabilities are fully
integrated within society, have access to appropriate care and
support services and are treated as valuable human resources.
◦ Explicitly recognizes the importance of planning for the changing
demographic landscape and that older persons are within the
“most vulnerable” category of social groupings.
◦ Clearly aligned with MIPAA and Brasilia Declaration

Factors central to the social protection reform
process and the decision to adopt the
conditional cash transfer (CCT) model:
◦ Recognition of the need for a more systematic and
equitable mechanism for the targeting of
beneficiaries for non-contributory social assistance
programmes.
◦ Policy shift from a welfare to developmental mode
for greater effectiveness.
◦ Achieving greater administrative efficiencies.
26
CCT Programme Of Advancement Through Health and Education (PATH)
Target 2002:
236,000
8%
2%
14%
Children 0-17
Pregnant & lactating
Elderly (> 60yrs)
5%
Persons with Disabilities
Adult poor (18-59 yrs.)
71%
27
PATH Registered Beneficiaries
February 2012
Benefit Category
Number
Children (0-18 years)
302,623 (76.8%)
Adult Poor/Poor Relief
18,577 (4.7%)
Disabled
10,243 (2.6%)
Elderly
60,616 (15.4%)
Pregnant/Lactating
Total
1,955 (0.5%)
394,014



Constant lobbying by social workers and
advocacy groups on behalf of older persons.
Dialogue on universalism versus means
testing in social policy.
Global economic and financial crisis resulted
in multilateral and bilateral assistance to
broaden scope of social assistance to include
older persons and persons with disabilities
(additional 10,000).



From the standpoint of redistributive justice
PATH has been fairly successful in
redistributing benefits from higher
consumption groups to the poor based on its
targeting mechanism.
Confirmed by Targeting Assessment
(Mathematica Policy Incorporated 2003)
Diagnostic Study Social Protection System
2011.
30
90
80
70
60
50
40
30
20
10
0
KMA
Other Towns
Rural Areas
Q1
2006
Q2
2007
Q3
2008
Q4
Q5
2009
31
1
0.8
0.6
0.4
0.2
0
0
0.2
0.4
PATH
0.6
Poor Relief
0.8
1
Consumption
32
Age
Cohort
No. in
Cohort a/
Government Health Insurance Programmes
JADEP b/
NHF/Card b/
NI GOLD d/
No.
%
No.
No.
%
%
60-64
68,463
59, 716
87.2
25,896
37.82
7,662
11.19
65-69
65,255
40,836
62.58
25,835
39.59
17,019
26.08
70-74
59,674
41,572
69.66
24,713
41.41
18,876
31.63
75+
104,668
71, 024
67.86
56,373
53.86
41,260
13.84
Total
298,060
213, 148
71.51
132,817 c/
44.56
84,817
28.46
33
Sex
Female
Male
Total
JADEP
No.
130,865
82,283
213,148
NHFCard (all age groups)
%
61.40
38.60
100.00
No.
152,671
87,927
240,598
%
63.45
36.55
100.00
34
Distribution of NHF Beneficiaries by Sex (March 31, 2010)
Sex
JADEP
NHFCard (all age groups)
Female
Male
Total
No.
%
No.
%
130,865
82,283
213,148
61.40
38.60
100.00
152,671
87,927
240,598
63.45
36.55
100.00
Source: Based on data from the National Health Fund




General applicability but of particular value to
the elderly.
Progress in realization of right to health care
for older persons.
Increased access accompanied by range of
resource constraints because of
underfunding of the health services (shortage
of drugs longer waiting time).
Strategy for financing of public health sector
required to ensure accessible and quality
health care for elderly.
40
35
30
25
20
15
10
5
0
Jamaica
KMA
Other Towns
Rural Areas
2006
Q1
2008
Q2
Q3
Q4
Q5
2009
37

No user fee policy for public hospitals has
intensified debate on the merits of
universalism versus the targeted approach in
the delivery of social services.



Contending views have been particularly
strong in terms of the Abolition of the User
Fees in public health facilities;
Supporters of the policy point to the
increased access for the poor and the
inefficiency of the former system of fee
collection;
Critics have highlighted the increased strain
on the human and other resources in the
public health system and the drain on the
national budget.
39
Programmes
PATH
Poor Relief
Health Fee Waiver
JADEP
NHF
Concentration Concentration
Indices 2008 Indices 2009
-0.34
-0.38
-0.31
-0.31
-0.15
-0.15
0.14
0.09
0.11
0.11
40
Category
Year
2006
Male
Female
2007
Total
Male
Female
2008
Total
Male
Female
Total
Employed 191,559 208,592 400,151 203,880 215,697 419,557 197,759 210,658 408,417
Self8,609
Employed
Total
15,195
23,804
9,536
17,096
26,632
10,042
18,540
28,582
200,168 223,787 423,955 213,416 232,793 426,189 207,801 229,198 436,999
41
Population Cohort
60-64
65-69
70-74
75 and over
Total
Size of Cohort a/
68,463
65,255
59,674
104,668
298,060
No. NIS Pensioners b/ % NIS Pensioners
7,662
11.19
17,019
26.08
18,876
31.63
41,260
13.84
84,817
28.46
a/ Statistical Institute of Jamaica (STATIN), End of Year population 2009
b/Ministry of Labour and Social Security (MLSS) – No. NIS Pensioners as at March 2010
42
Distribution of NIS Pensioners by Age Group and Sex (2010)
Population
Cohort
Size of Cohort a/
Male
Female
No. NIS
Pensioners b/
Male
Female
60-64
33,400
35,000
917
65-69
31,300
33,700
70-74
28,000
75 and over
Total
% NIS Pensioners
Male
Female
6,745
2.75
19.27
6,633
10,386
21.19
30.82
31,100
8,884
9,992
31.73
32.13
41,400
61,700
16,918
24,342
40.86
39.45
134,000
161,500
33,352
51,465
24.89
31.87
Source: a/ STATIN End of Year Population; b/ National Insurance
Scheme, MLSS
NIS Retirement Ages 2010-2015
Retirement Age
Calendar Year
Females
Males
2010
60
65
2011
61
65
2012
62
65
2013
63
65
2014
64
65
2015
65
65
Source: Ministry Paper 41/2010 Reform t the National Insurance
Scheme
Number and percentage of elderly employed by
age group: Jamaica 2009
Age group
Currently employed
(years)
Nos. a
%
60-69
74007
52.40
70-79
28113
28.00
80+
7716
13.40
aSurvey
data raised to provide national estimates
Source: STATIN, 2009, unpublished data reported by Kristin Fox 2012
Social Protection Coverage Gap in Income Support for
Elderly (2010)
Number/
Percentage
Population 60 years and older
No. NIS Pensioners 60 years and older
No. PATH Beneficiaries 60 years and older
Number persons 60 years and older covered by NIS and PATH
Number persons 60 years and older not covered by NIS or PATH
299,500
84,817
58,133
142,950
155,110
Percentage population 60 years and older covered by NIS and PATH
47.73
Percentage population 60 years and older not covered by NIS or PATH
52.27
Distribution of Social Protection Spending by Age Group:
Jamaica (2010-2011)
Age Group
Spending
J$000
% Total GOJ
Spending
% GDP
% Spending
On Social
Protection
%
Poverty
0-18
8,837
1.5
0.8
22.8
46.6
8,837
54.0
(0-5)
931
0.2
0.1
2.4
12.1
931
5.7
(6-18)
7,906
1.3
0.7
20.4
34.5
7,906
48.3
19-24
1,024
0.2
0.1
2.6
9.8
1,024
6.3
25-59
5,046
0.9
0.5
13.0
30.8
5,046
30.8
60+
23,894
4.0
2.2
61.6
12.8
1,468
9.0
Sub-Total
38,800
6.5
3.5
100.0
100.0
16,374
100.0
Households
9,166
1.5
0.8
Social Assistance
19,772
3.3
1.8
Social Insurance
28,194
4.8
2.6
Public Pension Plan
14,689
2.5
1.3
Total
47,966
8.1
4.4
593,064
100.0
53.9
Memo:
Total GOJ Expenditure
GDP
1,100,223
100.0
Spending Excl.
Pubic Pensions
J$000
%
Spending
On Social
Assistance
Sub-Regional Comparison of Social Protection
Public Spending (% of GDP)
Country
Social
Insurance
Social
Assistance
Social
Protection
Education
Health
Social
Sectors
Year
Jamaica
Average
Antigua &Barbuda
Dominica
Grenada
St. Kitts & Nevis
St. Lucia
2.6
2.4
3.6
3.4
1.8
2.7
1.3
1.8
1.8
1.6
2.2
1.6
1
1.6
4.4
4.0
5.2
5.6
3.4
3.7
2.6
6.3
6.3
3.9
5
5.2
6.4
7.5
2.5
4.1
3.2
4.6
5.9
3.6
3.3
13.2
14.5
12.3
15.2
14.5
13.7
13.4
2009/10
St. Vincent & the
Grenadines
1.4
2.5
3.6
9.9
4.1
17.6
2002
Source: World Bank ; Jamaica Social Protection Assessment Study 2011
2009
2000
2001
2000
2000/01


HelpAge International (HAI), global network
that advocates for the rights of older persons.
HelpAge has been very active in Jamaica
monitoring and supporting the government’s
commitment to the Madrid International Plan
of Action on Ageing.
Between 2007 and 2012, HelpAge has
implemented several projects in communities
across Jamaica, including, Disaster Risk
Management, HIV Surveys, Poverty Alleviation
and the Older Citizens Monitoring Project.


Older Citizens Monitoring is essentially a
process which promotes dialogue and
interaction between older people, civil society
organizations and governments in order to
develop policies and practices that benefit
disadvantaged older people.
Concept was developed by HelpAge
International to ensure that signatories to the
Madrid Plan of Action on Ageing institute
policies and programmes to ensure
implementation.

Older Citizens Monitoring approach was first
piloted by HelpAge in five developing
countries in Asia (Bangladesh), Africa (Kenya
and Tanzania), and Latin America and the
Caribbean (Bolivia and Jamaica).

The model focuses on:
◦ inclusion;
◦ providing information about services and how to
access those services;
◦ monitoring access to and delivery of services; and
◦ promoting dialogue between people at the
grassroots level (the poor in particular) and public
officials responsible for policy formulation and
programme implementation


OCM model in essence seeks to empower
poor older people and their communities to
identify problems with access and delivery of
services to which they have an entitlement
and to dialogue with key decision-makers to
bring about improvement in their situation.
Underlying principles are participation,
efficiency, self-reliance and sustainability

The main objective of the Older Citizens
Monitoring Project in Jamaica (2007-2010)
was to monitor effectiveness of JADEP, NHF,
and PATH in providing access to social
protection benefits by older persons.


In relation to the HAI/OCM’s core objective
of improving the access of older persons to
available social assistance benefits,
participants were of the view that this was
achieved in terms of the number of persons
for whom registration to NHF and JADEP was
facilitated through the project.
However, the consensus was that no
appreciable increase in access to PATH was
recorded largely because of the rigours of
means-testing for entry into the programme.


Objective to develop advocacy skills among
older persons to empower them to dialogue
with government officials and representatives
of other public institutions and the media, in
respect of their rights and interests, was
considered to have been realized by
stakeholders.
There were very outstanding Older Citizens
Monitors who rose to prominence in their
communities as a result of their involvement
in the project.

Many project participants felt greatly
empowered as a result of the Information
Fairs which provided contact with a range of
institution such as the Ministry of Labour and
Social Security (NIS and PATH
representatives), the Registrar General’s
Department (Birth certificates and other
documents) and the Tax Registration and
Administration Division of the Inland Revenue
Department (Tax Registration Number
application).

Capacity building in partner agencies was a
major outcome of the project especially in
relation to the networks developed with state
institutions, foremost among these being the
National Council for Senior Citizens (NCSC)
with its considerable knowledge and
experience in dealing with issues related to
older persons.

Use of existing community-based
organizations at the operational level for
implementation was a distinct advantage in
the project design because of the tremendous
social capital which these agencies brought in
terms of engagement with the communities
and the trust which existed.

The intergenerational nature of the activities
of the partner organizations was also a very
positive factor for the project and a very
important strategy for longer term impact.

Vast majority of older persons who
participated expressed the view that one of
the areas in which the project had the most
significant impact was the social interaction
fostered through the strengthening of
existing senior citizens clubs or the formation
and establishment of new groups.


Allowed seniors to overcome exclusion,
isolation and loneliness by participation in a
range of recreational and other social
activities.
This outcome of the project must be
highlighted as studies of older person in
Jamaica have identified loneliness as one of
their main problems. See for example, Denise
Eldemire Shearer (1997), The Jamaican
Elderly: A socio-economic Perspective and
Policy Implication.


Stakeholders at the community level pointed
to the assistance to some of the most
marginalized and vulnerable older persons
through the senior citizens clubs as a major
achievement under the HAI/OCM project.
Project demonstrated importance of social
capital – social networks - in access to social
protection


Women were the main participants in the
HAI/OCM Project, accounting for 67% of the
overall number of beneficiaries.
In terms of registration on the social
assistance programmes and all the other
support services provided under the project,
they also constituted the largest percentage
of beneficiaries.
Distribution of HAI/OCM Programme
Beneficiaries by Gender
Male
Male as
% of
Total
Female
Female
as % of
Total
Total
Service
as % of
Total
Ranking of
Beneficiary
Access in
the Project
Overall Total
Beneficiaries
558
32
1166
67
1724
100
n/a
JADEP
PATH
NHF
Bus Pass
TRN
RGD
NIS
Other support
services/
Innovations by
Partners
131
14
65
48
68
134
4
65
29
36
27
34
43
26
33
34
311
24
172
91
90
375
8
124
74
63
72
65
56
73
66
65
442
38
237
139
158
509
12
189
25
2
13
8
9
29
0.70
11
2nd
7th
3rd
6th
5th
1st
8th
4th
Source: HAI Caribbean Office, IFKO End of Project Final Report

Limited male participation in senior citizens
clubs and its wide range of social, health,
educational, welfare, and other activities to
promote active ageing and the well being of
seniors, has long been observed by the
National Council for Senior Citizens.
Participation in Golden Age Clubs by Sex : Jamaica
March 2010
Membership
Male
Female
Total
6,285
20,464
26,749
2,015
3,542
5,557
Total No. Members 8,300
24,006
32,306
2,845
3,897
Category
Active Members
Shut-ins
Volunteers
1,052


Low male participation rates in senior citizens
clubs partially reflect the demographic
structure of the population in which women
outnumber men in the older age groups;
More importantly, however, men appear to
have other interests and preferred modes of
social interaction.



Launch of the Caribbean Community of
Retired Persons (CCRP) in Jamaica in 2010
Highly influential membership
The CCRP recently recognised several older
persons who have influenced national and
regional development in various spheres.

Economic Security – Some progress has been
made in the strengthening of the social
protection system for older persons but a
significant coverage gap remains in the
contributory social insurance scheme and
means-testing limits access to noncontributory social assistance benefits.
70

Health – Equitable access to quality health
care remains a challenge for significant
numbers of older persons in spite of range of
state provisions including abolition of user
fees in public hospitals and health centres.

Enabling Environment - Important advances
have been made in respect of greater public
participation of older persons and in the
promotion of positive images of ageing but
the legislative and regulatory framework to
protect the rights of older persons needs to
be strengthened.






Assessment and review of National Policy for Senior
Citizens in keeping with key international
commitments.
Strengthening of the legal and socio-economic
framework to safeguard rights and improve the
quality of life of older persons.
Further strengthening of the social protection system
to close the coverage gap.
Improvement in health financing.
Application of a truly gendered approach which takes
into account the vulnerabilities of not only older
women but also older as a guiding principle.
Build on best practices.
Thank
you!