In Sri Lanka, 12.3% of the population is aged 60 or older, making it the country with the highest proportion of older adults in South Asia. The Western Province has the highest percentage of the country’s elderly at 31.7%, while the Northern Province has the least at 4.8%.
In 15 years, more than one in four - or 25% of Sri Lankans - will be over 60. The demographic transition from a youth bulge to an aging society creates several economic, health and social challenges.
First, the number of workers retiring will increase, while the number of people entering the workforce will decrease, resulting in lower productivity, lower taxes, lower national income, lower growth, and lower savings. Yet, a higher number of retired workers translates into increased burden for the public sector pension scheme, which now consumes almost 2% of the country’s GDP and will already become fiscally unsustainable in less than a decade.
Second, an aging population will put pressure on the country’s healthcare sector, which is already facing severe difficulties as a result of Covid-19. Indeed, the healthy life expectancy in Sri Lanka is 67.0 years which, based on an overall life expectancy of 77.3 years, translates into 10 years of healthy life lost with increased morbidity and disability that may require specialised and comprehensive care.
The aging population also means there will be growing demand for aged-care services in the near future. This is crucial given that there is now limited availability of eldercare facilities: six public sector run elder care centers and 324 private or community run centers. Improving the quality and governance of these facilities will also be crucial.
Third, there is weak social protection for the elderly. For example, and while well-targeted, the cash transfer program for the elderly has limited coverage. In addition, private sector pension and savings schemes are fragmented and have limited coverage (most of the two-thirds of workers in the informal sector are excluded) and benefits. Relatedly, the social pension only covers half of those who are eligible, leaving many vulnerable workers without income in their retirement. Due to the unavailability of a systematic social security system, older people continue to work, often informally.
All of which explains that poverty rates among the elderly are estimated to be higher than that of any other age group in Sri Lanka.
“Should pandemics change how we address age and ageing?”
The answer is a resounding yes.
The elderly population has been among the most-affected groups during the COVID-19 pandemic. For example, older adults are more likely to develop complications and die due to Covid-19. In fact, by the end of August 2021, over 75% of deaths due to Covid-19 in Sri Lanka were people aged 60 and above.
The lockdown and travel restrictions have also affected access to routine and preventive care, which may well result in increased risk of morbidity and mortality among this population in the coming years.
To better meet the needs of the elderly during pandemics, the Government can focus on strengthening the hospital referral system from primary to secondary, tertiary and specialized care services, not only for acute inpatient care, but also for geriatric and palliative care. The government should also consider developing a system for community-based social care of the elderly, linked to the primary care health system and welfare programs.
The government should also continue to invest in developing a more robust and resilient social protection system, which provides increased and enhanced income support for all eligible elderly Sri Lankans through the reform of welfare programs and the country’s pensions schemes. Finally, through reforms in the education system, it is important for the Government to prepare the future workforce for jobs in the eldercare sector, including in such areas as geriatric medicine, elder caregiving, healthy aging, and eldercare centre administration.
Since the onset of the Covid-19 pandemic, the World Bank has supported Government efforts to address the specific challenges affecting the elderly. For example, through the Covid-19 Emergency Response and Health Systems Preparedness Project (ERHSP), the Government supported 629,303 elderly Sri Lankans through the delivery of cash and in-kind assistance to help them cope with the economic effects of the pandemic. We also provided operational support and engaged in technical and analytical work on health, education and social protection system strengthening and pandemic preparedness.
We stand ready to build on this work and support the Government to increase its efforts to protect and promote the human capital of elderly Sri Lankans to promote an inclusive and resilient Covid-19 recovery.
The writer is the Practice Leader for Human Development, World Bank.