The WHO Centre for Health Development (WHO Kobe Centre – WKC) has published the findings of the first cross-regional study to assess the available evidence of unmet health and social care needs among older people (generally aged 60 and above) in the WHO African, Eastern Mediterranean, European, South-East Asia and Western Pacific Regions. The Region of the Americas has already been assessed1.
Measuring progress towards universal health coverage (UHC) is important to ensure that appropriate action is being taken for all people and communities to receive the full spectrum of health services they need, of sufficient quality and at a cost that does not expose users to financial hardship.
This study aims to assess the evidence on the levels of and reasons for unmet health and social care needs of older people to get them on track for UHC and ensure they are not left behind. Unmet health care needs are those where a person forgoes care because of a range of barriers preventing access to health services, or they do not realize that they need services. Unmet social care needs are those where a person does not get the required assistance with activities of daily living, health services or social support that they need.
This work resulted in 11 publications: a series of five regional study reports with the details of the research methods and findings mainly for the scientific community; each of their executive summaries published separately as a digest version for decision-makers (see the regional links below); and a global executive summary that provides a concise synthesis of the regional studies. All the publications are available here.
Key findings
- Overall, currently available statistics are inadequate for substantiating the lack of access to necessary services, especially for older populations.
- Evidence on unmet needs for social care lags far behind that of health care in all five Regions.
- Unmet needs are driven by barriers such as availability, accessibility (including financial) and acceptability at a health system level.
- There are distinct regional disparities in the quantity and quality of available evidence, and little research focusing on unmet needs of older people in all except the WHO European Region.
In the WHO African Region, only one third (15/47) of Member States had published studies reporting the prevalence of unmet health or social care needs. Of these the prevalence was 32% in those aged 40 and older. Reasons for unmet health and social care needs were sociodemographic, accessibility and quality of care which includes acceptability. With the population of people older than 60 years expected to reach 67 million this year, and increase to 165 million within 25 years, the Region needs to focus on gathering data for older populations.
For the WHO Eastern Mediterranean Region, estimates of the prevalence of unmet health and social care needs in published literature and available surveys are scarce, wide-ranging and not generalizable. The unmet care needs of this Region’s ageing population have been intensified by systemic issues, sociopolitical instability and the aftermath of COVID-19. The researchers propose alternative methods of estimating these needs where direct data are unavailable.
Evidence on unmet health and social care needs in the WHO European Region was available for 44 of the 53 countries. Health care needs were unmet in nearly 41% of older people aged 60 or older; support for social care needs were absent for 56% of those aged 65 or older. An awareness of the indicators of unmet health and social care needs could enable countries to adapt their health systems to an ageing population.
The WHO South-East Asia Region has a rapidly ageing population with over 10% of its inhabitants over the age of 60 expected to double in the next 30 years. The overall prevalence of unmet health care needs of this population was estimated at 18.3%, ranging from 1.6% in Thailand to 68% in Nepal. Almost all the studies (22/24) were on unmet health care needs, and only 15 of these reported reasons as being cost, distance to the health care facility or unavailability of services.
In the WHO Western Pacific Region, only nine out of 37 countries, areas and territories had relevant studies, mostly focusing on unmet health care needs. The prevalence estimates by country ranged from 2.5% to nearly 32.8%, while for unmet social care needs, prevalence was estimated at between 2.8% and 64.5%. There was no information on reasons for unmet social care needs, while accessibility and acceptability were cited more frequently than affordability as reasons for not receiving needed health care. The Region will need to pay attention to better understanding unmet social care needs overall, and unmet health care needs in the Pacific island countries and territories.
“Our study highlights that there are opportunities for improvement,” said Dr Megumi Rosenberg, WKC technical officer, who coordinated the research. “Every Region needs harmonized definitions, indicators, and measurement and analysis methods to support monitoring of trends, and for comparisons within and between countries to assess progress towards UHC.”
“This could be achieved by standardizing survey questions and methods of analysis, adding a module on unmet needs to existing surveys, enhancing research efforts, and making data publicly accessible to identify and address barriers to care that lead to unmet needs,” she said.
This would help to improve health and social care planning, support health system reforms for older people, and improve health outcomes and wellbeing for all people of all ages.
WKC conducts research on understanding unmet care need which is essential to accelerating global progress towards UHC. For more on this research, click here.