Overcoming social exclusion and promoting dignity of older people in a post-war country

Abstract

Introduction: Bosnia and Herzegovina (BiH) is a post-war society with a huge destruction of infrastructure; lack of housing, health care, job opportunities; and the most important, there are a lot of victims of war including internally displaced people and returnees. Many communities are in the process of re-establishing their life and social ties. Persons aged 65 and above comprise 14.19% of the total population in BiH. Nearly 60% of them are not covered by regular old-age pension benefits or any other scheme. This low coverage represents a serious problem and makes population vulnerable to poverty and social exclusion. Strategies and action plans that address the needs of the elderly population have not been developed. The system of home based care is practically absent, and the majority of seniors have no access to health care and social services. Description: In 2013, the Swiss Red Cross started a project with the aim to increase the health and wellbeing of vulnerable elderly and disabled people in Tuzla Canton, Bosnia and Herzegovina. The project inspired over 700 older adults and elderly to form 20 initiative groups, focusing on mutual help, assistance to vulnerable, participation in decision making on issues related to their lives. The project has a two- fold approach: development of a home based care system, and integration and participation of the elderly with the view of building up age friendly environments. People from different regions learn from each other, realizing they are not alone in their endeavor and have peers with whom they can lobby one day in the future on a regional or national level, i.e. work together on establishing an AA network, which will be the main axis of sustainability. Alongside the process of enhancing older people’s participation in defining and analyzing problems in their communities, collective decision making, promoting teamwork and delegating responsibilities, the project helps build confidence in their abilities and contribution in community development. AA groups are becoming a recognized and integrated part of the society. In line with this, AA group members take part in volunteering for the home-based care component of the project. AA groups are also partnering with different social care service providers of their particular interest, such as the Red Cross, whose professional staff and AA volunteers provide visiting services. AA volunteers pay house visits for talks, walks, bringing groceries and paying bills. The overall health of AA members is monitored through health promotion activities organized in their groups, by both the project, Red Cross and local health facilities. Aim of Change: Active ageing is considered to be instrumental in improving social determinants of health and mutual support. The theory of change of the project: empowered older adults and elderly people have higher self-esteem and social capital, and are able to overcome after-war crisis, influence decisions and improve their everyday life. Impact: The results of the project prove the theory of change developed by the project. Nearly two thirds of members of initiative groups are feel more self-reliant now, have more friends and know more people in community, more actively participate in community events, and help other people. As they become more visible and reputable, they are able to influence decisions of local municipalities. Examples of successful advocacy include: correction to working hours of local health post, prices of public transport and garbage removal; adapted access to public local community facilities and preventing closure of secondary school. Activities organized by initiative groups influence the whole life of communities were people affected by war were neglected and encapsulated in their problems: more people in need are served by volunteers and neighbors, communities have place where people can come and regain social ties and feeling of neighborhoodness, younger generations better understand older people and organize joint activities, local media features issues related to ageing. Conclusion/Recommendation: Results obtained by the project prove that empowerment of older people and support to their involvement into community life significantly increase their self-esteem, inter-connectedness, resilience, and ability to influence decisions related to their needs. It leads to improved social determinants of health. It also permits to integrate older volunteers into home care and mutual support, as well as to better understand needs of older vulnerable people. The project approach provides integrated community based social care for older people who are willing to donate their knowledge, expertise, experience and free time for the greater cause of preserving dignity, and delivering a change that matters to people.