3. Best Practices

A session at the Workshop in Amersfoort was devoted to a presentation and discussion of programmes developed in countries to improve the living conditions of Older Persons. Among those discussed were examples from the Best Practices Programme which was conceived by UNCHS to identify success stories in human settlements development for the Habitat II Conference in Istanbul, 1996. Over 600 examples from 80 countries were submitted according to the criteria of impact, partnerships and sustainability. The work of identifying and disseminating best practices is now a continuing UNCHS programme. In 1998, over 300 submissions were made to the Dubai International Award for Best Practices from which 10 were selected.

A brief description of several examples of Best Practices focused on Older Persons are presented below to present an opportunity for their replication in other countries. More detailed descriptions of these examples can be procured from UNCHS through E-mail: bestpractices@unchs.org, or at their Web page: http://www.bestpractices.org.

“Care with love”, a training programme for home health care providers, Cairo, Egypt

In the last few years Egypt experienced socio-economic changes that have affected the structure of urban families. This has created new situations of need for health care for the elderly. There are an increasing number of ageing persons who need short or long term non-hospital health care. Family members are rarely available, have the time or the necessary skills to provide these services at home. This brings the need for training health care providers.

“Care with Love” is a training programme developed at the Centre for Geriatric Services in partnership with the Coptic Evangelical Organization for social Services with the following objectives:

1. To provide a comprehensive curriculum for training home health care providers
2. To provide for training of trainers in home health care
3. To create new job opportunities
4. To establish referral units providing accessible and reliable services

Students are recruited from communities where the Coptic Evangelical Organization have development projects and from other NGOs and Church groups. The training process is a well-balanced mixture of theory and lab training in: Public Health and Nutrition; Body mechanics; Communication; Daycare skills; First aid and common diseases. Upon completion of the course the trainees spend a month of internship as Home Health Care Providers under close supervision and evaluation before graduation. The first training course started in 1996 with the objective of training 80 to 100 trainees with two years. For more information contact Magda N. Iskander, MD, email: cgs@idsc.gov.eg.

Urban poor elderly health workers; the Philippines

Older people are respected, but not a priority on anyone’s agenda in the Philippines. For example: there are more than 200 groups in the Greater Manila area dealing with street children, but for “street elderly” and urban poor elderly, virtually nothing. Resources are scarce and the potential of residential care for older persons is economically, culturally unattractive.

The Coalition of Services of the Elderly (COSE) was founded in 1989 as an attempt to keep the elderly poor in the community. The programme empowers them to make decisions, which determine their lives. An organized urban poor community chooses two of its members to become “Community Gerontologists (CGs). A number of the chosen ones have been involved in traditional health care through herbal medicine, as massager, midwives, etc. For three days they are trained by a doctor, dentist and a nurse with an emphasis on ailments and their prevention, especially those of older people. Upon graduation, they receive a kit with a thermometer, blood pressure and sugar measuring instruments; basic tools for examining teeth and common medicines. The two then become the health workers for their own organized elderly in their area. Thereafter, all the CGs from different areas meet once a month with the medical staff/team of COSE to discuss their experiences of the past month and upgrade their skills. Four times a month, the medical team along with the CGs visit a community to render medical outreach services. On days when there is no outreach, the COSE medical team and a rotation of CGs maintain a clinic on health care for older people.

The COSE medical team has produced in Filipino a 120 page “Health Care Manual for the Community Gerontologists and Gerodontists”. The greatest indicator of the success of the programme has come from the Government Department of Health, which recently has proposed a nation-wide health programme for the elderly and invited the COSE medical team as health trainers to participate in the formulation of this programme. Legislation is pending in Congress to establish a national commission for older persons. Original funding for the health programme came from Caritas Netherlands with supplementary aid from HelpAge International. Total cost of the first year of operation was approximately US$15,000.

A city for all: Barrier-free environment in Finland

The neighbourhood of Marjala in the city of Joensuu in eastern Finland is designed to meet the needs of wheelchair-bound inhabitants. All the homes, connections between the home and all streets, parks, etc. are being planned and built to meet this requirement.

Over the past l5 years the City has built special housing for the elderly and disabled. A set of design guidelines require that all dwellings, all shared facilities and all connecting routes allow barrier-free access and mobility. This requirement is applied to even the smallest detail in the neighbourhood so that all streets, pavements, squares, bridges, parks and green areas with their paths and promenades are built to be accessible by all. In order to guarantee the high quality of design the City Council organized a nationwide architectural competition for the master plan for Marjala.

International estimates indicate that 18 to 20 percent of the population face difficulties in mobility in the ordinary urban environment. Many neighbourhoods in Finland have been built for the kind of life that people no longer lead. The majority of inhabitants today spend 24 hours a day in the areas where they live. The elderly, unemployed or people working at home and young people are often left without adequate facilities or opportunities for shared or individual activities. The unemployed rate of Joensuu is extremely high (27% in 1995) and has increased within the last few years.

Marjala has been built so that people can work, live and enjoy their leisure time within their residential area. Cooperation between the inhabitants and the city employees creates networks, which provide support, increase the inhabitants participation and create jobs within the area.