Short commentary: What is (not) feasible to do in care for older adults in Nigeria: an application of the developmental governance framework

Citation

Agwu, P., Ene, J. and Okoye, U.O. (2024), "Short commentary: What is (not) feasible to do in care for older adults in Nigeria: an application of the developmental governance framework", Quality in Ageing and Older Adults, Vol. 25 No. 3, pp. 135-138. https://doi.org/10.1108/QAOA-09-2024-101

Introduction

Our article published in the Journal of Aging Studies, asked if filial care for older adults in Nigeria is threatened by changing social and economic realities experienced by adult offspring (Ene et al., 2022). The article was written from a place of concern affirmed by adult offspring that participated in the study, who discussed the inadvertent effects on practices and cultures of Nigerians caused by changing social and economic roles for men and women, as well as rapidly changing world views of Nigerians that are increasingly pro-Western. Scholars that have been critical of modernization and cultural penetration argue that Africans have been affected the most, as they contend the loss of core African values, one of which is filial care (Agwu et al., 2021; Ofozoba and Nwankwo, 2019). Nigeria as a part of Africa has been discussed by several scholars as facing cultural crises, manifesting in the loss, and some will say, extinction, of core values in terms of language, sexual orientations, gender roles, dressing, native practices and overall cultural ideals (Olajoke and Oluwapelumi, 2018; Omogho, 2021).

Following the foregoing, the cultural practice of Nigerian adult offspring providing care for their older adults, which is a practice Nigerians will at default consider as ideal, has remained, although not without threats. So far, there are Nigerians, especially those with international exposure, well educated, and are engaged in labourious work responsibilities, who are advocating for Nigeria’s transition to institutional care arrangements for older adults (Agbawodikeizu et al., 2023). On the other hand, there are Nigerians including those that are well educated opposing institutional care arrangements in favour of filial care for older adults (Ene et al., 2022). These conversations are springing up in the media and in parliament, without decisive steps taken yet (Mbam et al., 2022). As such, many Nigerians still rely on filial arrangements to cater to their older adults, with some persons using a paid home-care route, where a caregiver is hired to provide care for an older adult within the filial setting.

An overriding justification for the survival of filial care is the cultural belief that adult offspring owe their older parents care till they die, because they benefitted from the care of the older parents while they were young. Nevertheless, current realities as shown by evidence point to the unsustainability of filial care when it solely relies on direct care for older adults provided by adult offspring (Ene et al., 2022). Therefore, there is need to begin conversations on how best to respond to the inadvertent changes in society causing threats to filial care in Nigeria and similar countries where institutional care arrangements are not tenable and popular.

Developmental governance and care for older adults in Nigeria

The theory of developmental governance is gaining increasing traction in explaining the development realities of low- and middle-income countries (LMICs), stating that development must be context-specific and should take into consideration the unique realities of the peoples and systems in such regions (Hutchinson et al., 2020; Khan, 2012). The theory argues that development should be in synch with the realities of events in countries, which could be political, economic or institutional arrangement, among others. It kicks against the imports of practices into contexts, without first making attempts to understand the uniqueness of such contexts in terms of provision and enforcement of laws, cultural practices and values, among others. This applies to caring for older adults, where care options must first be understood in context, before attempts to rejig, redesign, reinvent, remodel or even introduce newer patterns.

What works and does not work in the context of care for older adults in Nigeria

From our research in Nigeria, adult offspring do not feel comfortable with institutional arrangements for older adults’ care. This is similar to concerns raised in another study, arguing that the cultural climate of Nigeria appears averse to institutional care for older adults but can permit day care and clubs, where older adults can gather temporarily during the day (Dokpesi, 2015). Although our study did not elicit a lot of options from the interviewed adult offspring, there was consensus on paid home-care option. By paid home-care option, they meant hiring a carer that takes care of the older adults within the home setting, especially in times when they are away for economic or social reasons. According to participants in our study, the idea was to make sure that the adult offspring are still directly involved in the care of their older parents by funding the paid care option and being available after work responsibilities to spend some time with their older parents. But then, three resolvable issues were raised for this approach to be considered. Firstly, agreement between spouses and agreement among siblings; secondly, sustainability; and thirdly, safety.

On the first, the need for Nigeria to activate and optimize its social service sector was emphasized. With the right professionals manning the social service space, e.g. social workers, psychologists, counsellors, etc. protocols and communications can be designed and disseminated publicly to prepare Nigerians for the cultural responsibility of filial care for older adults. Previous studies have harped on the need to educate the Nigerian population on ageing, its challenges and the need to prepare for such time (Agbawodikeizu et al., 2023; Ebimgbo et al., 2022). It is based on such shared understanding driven by the appropriate professionals that disagreements between spouses and siblings can be resolved, permitting the consideration of paid home-care option for older adults.

Second, a coordinating agency with a clear budget line for the care of older adults should be established and cascaded to local governments. The agency will provide for the registration of private agencies interested in care for older adults, who then will provide the frontline home-care. They can employ young people, train them using an established care protocol and facilitate their postings to the points of care based on requests. This model, beyond addressing a social concern, will as well provide jobs, especially at this time when Nigeria’s unemployment rate is over 30% and is indeed worrisome (Trading Economics, 2023).

Third, there is no doubt that a challenge with the paid home-care option will be the safety of older adults, who will be left to the care of employed carers that may be considered as strangers. However, such threats can be mitigated by ensuring that a standard protocol informed by evidence is used for training; agencies and carers are registered and should sign undertaking to heed best practices; and very responsive hotlines are made available to report poor practices and for security checks. There are documented procedures on how to achieve successful home care services for older adults elsewhere (Robinson et al., 2023).

Conclusion

Applying a developmental governance approach to appreciate the realities and uniqueness of societies can enable sensitivities that have been raised in our study and reported in this commentary when planning to develop new care responses. Care for older adults is a culturally sensitive issue and should be treated so. To optimize the care system for older adults in Nigeria, care must be taken to understand what the older adults and those that care for them need. Although paid care option might seem capitalistic, it is the most feasible in this case, given the culturally approved practice of caring for Nigerian older adults within the home setting. Based on evidence, a suggested strategy may be for the government to provide some kind of budgetary subvention to subsidize the care cost on middle- and low-income households. In the long run, government should plan to set up an insurance option to reduce the catastrophic effects of paying out-of-pocket for such a service (Johnson and Wang, 2019). Currently, Nigeria has one of the fastest ageing populations in the world (Mbam et al., 2022), which calls for thinking through how this population group can be catered to. Overall, our study, informed by the developmental governance theory, is clear about using a progressive approach that respects cultural and political-economic contexts, alongside adopting systematic procedures to achieve quality care for older adults in Nigeria.