Promoting Healthy Ageing: Collaborative Efforts in striving for Age-Friendly Cities in Nepal

The concept of healthy ageing and age-friendly cities has emerged as a key approach to enhancing the quality of life as individuals transition into their later years. It’s a holistic concept that integrates various dimensions - personal, familial, social, and professional. From health and long-term care to active participation in society and financial security, healthy ageing aims to empower older people to remain valuable contributors to their families, communities, and economies. Much like active ageing, it calls for collaborative action across multiple sectors to create a supportive environment for all (Rudnika, E. et al., 2020).

The 2030 Agenda for Sustainable Development underscores the importance of ensuring no one is left behind, including older people, as it strives to achieve sustainable development and uphold human rights universally. With a particular focus on vulnerable populations, the agenda aligns closely with the Madrid International Plan of Action on Ageing (MIPAA-2002). MIPAA provides a comprehensive framework for governments, civil society, and other stakeholders to build a society that values all ages. Complementing these efforts, the UN Decade of Healthy Ageing (2021–2030) brings together diverse sectors to improve the well-being of older people, their families, and their communities (United Nations, 2021).

In line with these global commitments, Nepal introduced a Plan of Action for Ageing in 2005 (revised 2013), to address ageing-related challenges. The Senior Citizens[1] Act 2063 BS defines senior citizens as Nepali citizens aged 60 and above. Currently, around 9% of Nepal's population falls into this age group, with projections suggesting this will rise to 20% by 2050. This demographic shift presents both opportunities and challenges, requiring innovative solutions to meet older adults' diverse social, cultural, emotional, health, and financial needs.

This article explains Nepal Red Cross Society (NRCS) and Changunarayan Municipality Bhaktapur District, Nepal, healthy ageing initiatives and provides valuable insights to the Government to formulate comprehensive policies for healthy aging and also promoting age-friendly cities in Nepal.

Age Friendly City: The Vision of Changunarayan Municipality

Changunarayan Municipality is witnessing a demographic transformation as its older population grows both in absolute numbers and proportionally. Recognizing this shift, the municipality and NRCS in collaboration with Swiss Red Cross (SRC), has been implementing the SAHARA[2] Project from January 2024 for three years. The project aims to contribute to the Municipality goal to become the first age friendly city in Nepal. This initiative aligns with the World Health Organization’s (WHO) Age-Friendly City (AFC) framework, which encompasses eight key domains: outdoor spaces and buildings, transportation, housing, social participation, respect and social inclusion, civic participation and employment, communication and information, and community support and health services.

The concept of AFC is new in Nepal. Therefore, Changunarayan Municipality and NRCS agreed to conduct an assessment that aimed to establish the groundwork for moving towards an age-friendly city by understanding the challenges and opportunities faced by its older population. The assessment report, conducted in 2023, sheds light on the lived experiences of older people and provides actionable recommendations to enhance their quality of life. Those valuable insights into the needs and challenges of older populations can be instrumental to initiate healthy ageing within an AFC policy framework in Nepal.

This initiative aligns with the World Health Organization’s (WHO) Age-Friendly City (AFC) framework, which encompasses eight key domains: outdoor spaces and buildings, transportation, housing, social participation, respect and social inclusion, civic participation and employment, communication and information, and community support and health services.

The assessment report provides recommendations on how to design a Healthy Aging and Age-friendly Cities Policy in Nepal. In particular, the following recommendations were made:

• Policy framework development: Since the assessment report aligns with the WHO's eight AFC domains which offer a ready-made framework for policy formulation at local level, the government can use the eight domains as guiding pillars of age-friendly cities. Key findings from Changunarayan, such as the need for improved infrastructure, transportation, and healthcare access, should be integrated into the National Healthy Aging Policy.
• Setting priorities for interventions: The assessment report highlights some critical gaps in infrastructure, healthcare, older people-friendly public transportation and social participation. Such priorities include the construction and retrofitting of public spaces and buildings to make them more older people friendly as well as older people-friendly public transportation and fare discounts. These benefits can be regulated through adequate policies.
• Enhancing local Government capacity: The assessment report underscores the importance of local government’s involvement in implementing AFC initiatives. The Federal Government could provide a comprehensive guideline to the Province and Local level Governments to implement age friendly initiatives as a regular programmes. The Federal Government can provide technical and financial support to municipalities like Changunarayan to replicate successful practices in other municipalities. Similarly, the federal government may ask all municipalities to develop unique guidelines for creating age-friendly environments. Likewise, capacity building has been identified as another where the local officials are trained in AFC planning and implementation based on lessons available from the in-and out of countries AFC initiatives.
• Promoting community engagement: The report reveals a lack of social participation and respect for older people in some assessment areas. It highlights the need to designing older people inclusive programmes to promote interaction between younger and older generations, reducing isolation and enhancing respect so that intergenerational communication and connections gradually improves. This can be done by encouraging municipalities to establish and empower community-based older people clubs[3] in each Wards for engagement in social, cultural, small-scale livelihood and decision-making activities.
• Scaling up healthcare initiatives: According to the assessment over 70% of older people in Changunarayan were reporting chronic illnesses. Adding geriatric care units to municipality hospitals and train healthcare workers in older peoples care, introducing mobile healthcare units to rural and underserved areas with health insurance coverage could be appropriate strategies to increase access to geriatric health care and community-based health care service.
• Expanding existing social protection and security schemes: The report highlights the need for economic engagement of seniors. The government can expand social security allowances and benefits to the most vulnerable older people to reduce economic vulnerabilities. Similarly, making conducive policies for promotion of employment for older people and encourage skill-based employment and entrepreneurship opportunities for them can contribute to their economic independence. Conducting community campaigns on the rights and entitlements of older people can help to prevent financial exploitation and abuse of older people.
• Incorporating digital literacy and information dissemination: The report highlights a significant digital literacy gap among older people. Thus, an AFC policy may include digital literacy programmes to teach older people to use mobile devices, social media, and online health platforms. Ensuring essential health and service-related information can reach older people through accessible channels like FM radio, social media, SMS, and print media.
• Policy advocacy and awareness: The findings of the assessment are linking healthy ageing and AFC needs with the two major Sustainable Development Goals (SDGs) Goal 3 (Good Health and Well-being) and Goal 11 (Sustainable Cities and Communities), to which the Government of Nepal has committed to. The findings encourage to advocate for the rights and well-being of older people by organizing national campaigns and other similar events at all levels, raising awareness about aging issues and promoting the importance of AFC policies. Engaging different policymakers, healthcare providers, and community leaders enhances the discussion of policy needs and its future implications.
• Monitoring and strengthening partnership: The report provides key information and status around 8 different AFC domains which can be used to set measurable targets for aging policy improvements. By sharing the baseline and targets with other stakeholders and community organizations, joint efforts and complementarities can leverage the impact and increase efficiency in establishing age-friendly cities. Further collaboration with organizations like WHO, Swiss Red Cross, Help Age International and other like-minded organisations is necessary to access technical expertise and funding.

Scaling up healthcare initiatives: According to the assessment over 70% of older people in Changunarayan were reporting chronic illnesses. Adding geriatric care units to municipality hospitals and train healthcare workers in older peoples care, introducing mobile healthcare units to rural and underserved areas with health insurance coverage could be appropriate strategies to increase access to geriatric health care and community-based health care service.

First steps in creating an age-friendly environment

Within the ACF framework and based on the findings of the assessment, the NRCS and Chunagarayan municipality have initiated some initiatives within the framework of the SAHARA project:

1. A joint orientation and kick-off has been conducted with different stakeholders including the Chagunarayan Municipality officials, Red Cross chapter and subchapter committee members and volunteers, older people clubs, and other government and non-government counter parts in the district, in order to build on existing strengths and use existing resources.
2. Necessary guidelines and manuals were adopted from the Red Cross/Red Crescent healthy ageing kit (IFRC xxx).
3. Senior citizen clubs were formed, or existing clubs in Chagunarayan Municipality were reformed. Senior citizen clubs give a common forum for people to learn and exchange and socialize. Clubs contribute to improve psychosocial well-being by facilitating learning and sharing among the older people. The project supported the review of a guideline which will help to more systematically operate the older people clubs.
4. Implementation of basic training activities: To ensure that volunteers and staff should have minimum understanding about the AFC domains and its gradual implementation, a training has been designed and implemented. Now the trained staff and volunteers have conceptual clarity about their role in each of the eight ACF pillars identified by the Changunarayan municipality.
5. Outreach activities: Health camps conducted by the municipal hospital have started. They promote the physical and psychosocial well-being of the older people. Ambulatory service including oxygen, blood transfusion service, and ambulance are also provided for the needy older patients. Many older people who were referred for further treatment also benefitted from tertiary level health care services.
6. Home visit: Home visits provide emotional support and security to people in difficult times. Those older persons who are unable to walk receive home visits by health workers from nearby health posts or Red Cross volunteers. Through these home family members/caretakers are informed and taught on older people’s care and needs. They also identify senior persons who have not obtained a health insurance card or a social security card, and the project team facilitates access to these entitlements through the local administration office. A total of 1,188 older people including 754 female were so far visited at their homes by health workers to provide basic health services.
7. Inclusion of healthy ageing in local school curriculum: The project strives to close the intergenerational gap and works to involve young people in older people's issues. Intergeneration dialogue and inclusion shall be part of the local school curriculum. This curriculum review process will be complete soon and activities will be conducted starting from the next education session (April-May 2025).
8. Creating awareness through local media: The local FM radio, NRCS and Municipality social media page are used to create awareness about older people, their entitlements and to disseminate health and non-health related messages.

Inclusion of healthy ageing in local school curriculum: The project strives to close the intergenerational gap and works to involve young people in older people's issues.

Nepal as a leader in age-friendly urban and rural development

The Changunarayan AFC Assessment Report offers a rich repository of data and actionable insights. By leveraging its findings, the Nepal Government can create inclusive, evidence-based policies that not only improve the quality of life for older adults but also its position in Nepal as a leader in age-friendly urban and rural development. With a collaborative approach and sustained commitment, Nepal can ensure that its aging population thrives with dignity, respect, and security.

References

• Rudnicka, E. et al. 2020. The World Health Organization (WHO) approach to healthy ageing. https://pubmed.ncbi.nlm.nih.gov/32747042/
• United Nations Decade of Healthy Ageing (2021–2030). In: United Nations General Assembly Seventy-Fifth session. Agenda item 131: Global health and foreign policy. New York(NY): The United Nations; 2020 (https://documents.un.org/doc/undoc/gen/n20/363/87/pdf/n2036387.pdf)
• The WHO Age-friendly Cities Framework. https://extranet.who.int/agefriendlyworld/age-frie...

1. Senior citizen and older people is use as alternate in the article.

2. SAHARA Project (Shared Action for Healthy, Active, and Respectful Aging)

3. The clubs are called ‘Jestha Nagarik Milan Kendra’ in Nepal.