i6 Ageing International December 1995

Status Report from

South Africa

by Monica Ferreira, Frances Lund and Valerie Meller

outh Africa has been a divided country with its people previously classified on the basis of color in four racial groups: blacks (Africans), whites, coloreds (people of mixed origins) and Asians. Black people constitute 75% of the country's population of 41.2 million. Half the black population

is younger than 19 and only 3.3% is age 65 or over. Nationwide, 1.7 million, or 4.5%, of the total population is 65-plus. The life expectancy at birth of black males is 61 and of females 66 years.

South Africa is classified as an upper-middle income country al- though it has characteristics of both developed and developing coun- tries. The four main racial groups have historically had different ac- cess to the country's resources. Along with the unequal opportuni- ties for and major constraints on black, colored and Asian people has been the unequal development of these groups. Older blacks are today more disadvantaged in most areas of their lives than other elderly groups--particularly in education, income and health.

From 1948, the government 's apartheid policy was to restrict inter-

hal migration to keep people of color out of the cities. Although the migrant labor system permitted black men to work in the mines near cities, their wives and children had to remain behind rural areas and the men had to re- turn to their rural home when they retired from work) Rural Africans who were not migrant laborers earned subsistence-level incomes, mainly as agricultural work- ers, while in urban areas blacks mainly held unskilled jobs, with the women in domestic service.

The poor social and economic situation of black peo-

South Africa

Capital (Administrative) Pretoria 1995 Population 43 million 2025 Population 69 million

1995 Life expectancy at birth 65 Economy Upper-middle Income

(US$2,696 to $8,355)

Source: World Bank, 1994

pie in South Africa today has its ori- gins in the Dutch and British colo- nial occupations; the inequalities and injustices that divided South Africa's people for three hundred years be- came entrenched under the apartheid regime. International sanctions and disinvestment since the mid-19805, combined with South Africa's educa- tional policies and restricted access to jobs, have resulted in a high rate of unemployment in the country. Massive urbanization since the lift- ing of restrictions on population movement has led to the mushroom- ing of informal settlements on the outskirts of urban areas. These settle- ments have poor infrastructure and services and have also been seriously plagued by violence and crime.

Although there has been a mea- surable rise in the standard of living

17 December 1995 Ageinglnternational

of many black Africans since the 1980s, particularly in the more settled urban areas, poverty remains perva- sive, especially in the rural areas.

Older black South Africans have lived through the full 40 years of apartheid. What may the disadvan- taged elderly expect in the future?

The New South Africa Since the first free elections in April 1994, remarkable social changes are taking place in the country. The new government of national unity has devised and is seeking to implement its Reconstruction and Development Program (RDP), which is aimed at redressing inequali- ties in the social and economic fabric of society and cre- ating a healthy and enabling environment in which all people may function optimally. The program priorities are to address the backlogs in housing and education, to create job opportunities, and to provide expanded in- frastructure and health care. However, the RDP is tar- geted at improving the situations of women, children and the youth; the elderly are not viewed as a priority.

Nevertheless, there is a climate of social policy re- form in the country. The Ministry of Welfare is develop- ing new policies regarding services for the aged. It has recognized that the present system, with its emphasis on residential care for whites, is inequitable and unaf- fordable. Sixty percent of the total social welfare budget is spent on the elderly. South Africa has a universal pub- lic pension system that is non-contributory and means- tested. It pays a monthly pension to eligible women at age 60 and to men at age 65. Sixty-seven percent of so- cial pensions are paid to blacks. Although the new gov- ernment will continue to carry out its responsibility to provide health and social welfare services to poor, desti- tute, very old, and frail old persons, new policies will emphasize community-based support and care pro- grams, with the family as a core support system.

What are some of the inequalities that older black Africans currently experience as a result of past apartheid policies and how may these be redressed?

Profile of Older Blacks A multidimensional survey of 997 black Africans age 60 and older who lived in metropolitan areas and 400 who lived in two deep-rural areas of former apartheid homelands yielded a telling profile of their circum- stances shortly before the birth of the new South Africa. 2 More than seven in 10 subjects were receiving the government old-age pension (OAP). Very few had

made financial provision for old age; the vast majority had not been in a position to do so because of labor- market segmentation and the absence of a contributory pension fund for black employees at their workplace. Rural dwellers had a lower education level, poorer health status, and fewer received a government pension than their urban counterparts. However, more urban dwellers were depressed--especially women, felt less respected by the family, and were far less satisfied with their living arrangements than were rural dwellers (See Table I). It is thought that older blacks who live in urban areas may feel distanced from traditional values and systems and experience feelings of alienation.

Kin Support The social support of black elders through family net- works and kinship ties is a main area of focus in African gerontology. The role and position of elders in the family have traditionally been prescribed by se- niority principles that are the basis ofintergenerational mutual support systems which afford economic and so- cial security in old age.

It has been suggested that the values and systems that in the past sustained older Africans within an interde- pendent kinship system and closely-knit age-integrated communities are being weakened by modernization. The structure and role of the extended black family ap- pears to be changing to that of an urban-based nuclear family. In some cases adult children who migrate to the city leave elderly parents behind in a rural area, bereft of kin support. Grandchildren are often left with grand- parents to be reared by them. In such cases, the adult children send remittances home to support the care of the young children.

The impact of modernization and urbanization aside, families still appear to be the primary providers of care to black elders. Family eldercare comes in a variety of forms, including shelter, personal care, companionship and monetary transfers. The nature of the care is closely tied to the older person's living arrangements and the household structure. The multidimensional survey found that 92% to 93% of older blacks lived in a multi- generational household. 2 The mean number of co-resi- dents was six and, in more than 80% of cases, the older person headed the household (Table 1).

The survey also found that, on average, older blacks have four living children and more than four-fifths feel that their children respect them, although over three- quarters feel that younger people today show less re-

I8 Ageing International December 1995

Table 1. Selected Social and Health Indicators of Older Black South Africans (percentages)

Indicator Urban Rural (997) (400)

Socioeconomic No formal education 50 79 Receives a social pension 77 7 t Perceived adequacy of income 32 28 Made provision for old age 18 7

HeaRh Status Good health (self reported) 29 24 High level of mobility (self reported) 54 49 Ailments do not interfere with ADL 41 34 Symptoms of depression

Men 6 6 Women 16 10

Health Care Has insurance coverage 4 1 Visits a state facility 15 24 Visits a private doctor

Pays own bills 52 45 Children pay bills 18 17

Family Support Lives alone/with spouse 5 6 Lives in multigenerational household 92 93 Head of household 82 84 Satisfaction with living arrangements 49 65 Receives financial support from children 68 66 Gives financial support to children 59 60 Feels respected by family 78 84

spect to elders than in the past. Interestingly, fairly similar percentages of older blacks give financial sup- port to their children as receive it (Table l).

Health Care Health-care services for older black Africans have been characterized by inaccessibility, especially in the rural areas, because of both poor public transport systems and professional barriers. There are limited health care services to meet the specific needs of older persons generally and virtually no psychogeriatric services for black people.

South Africa has a private, fee-based health care sys- tem that covers the population, but no universal public health care. Few older blacks have health insurance cov- erage for reasons similar to their inability to make pro- vision for old age--a lifetime of low wages and the

absence of employer-based health insurance schemes for blacks. Despite having no coverage, fewer than a quarter seek medical treatment from a state health care facility; more than two-thirds visit a private doctor and 75% pay the doctor's bill themselves, while children pay the medical bills of the remainder (Table 1).

Subjective Well-being The subjective well-being of older blacks in South Africa is central to assessing their quality of life. Subjec- tive well-being allows individuals to judge their own life circumstances. The multidimensional survey mea- sures of life satisfaction found that older blacks' life sat- isfaction was mainly influenced by basic factors such as health, housing, and income. Self-reported good health significantly contributed to their subjective well-being. A lack of money, poor health, poor access to health care, memory loss, depression, and a fear of being robbed were the most serious problems affecting the quality of life of more than three-quarters of older blacks.

Social Welfare Provision The provision of social welfare services in South Africa has been a partnership between the government and vol- untary welfare organizations that have received subsi- dies from the public sector for their activities. Apart from residential care facilities, the government subsidizes ser- vice centers, many of which operate lunch clubs.

However, the emphasis in service provision for older persons has been on full residential care--for whites. Eight to 11% of older whites live in such a facility, compared with .05% of older black Africans. Research has consistently shown though that older black Africans do not want to enter a home for the aged and that adult children prefer to have their parents live with them. 2'8 More recently, it has been noted that older blacks who migrate from a rural area to a city may find that they are unable to rejoin kin in a nuclear household, and then join the ranks of the homeless or find their way to transit camps.

Over the past two decades, the voluntary sector has undertaken numerous innovative projects for the welfare of older black Africans. An example is the lunch club movement that was started in the former Transvaal province. Hundreds of black Africans who live in poor townships go to a lunch club for a nutritious meal at nominal cost and also receive social and health support. There is a strong emphasis at these clubs on self-help, community development and income-generating activi-

19 December 1995 ~eing International

ties, e.g. the production and sale of handiwork. Other examples of voluntary-sector projects are a research and action project in- volving grandmothers in the educare of pre-schoolers, and a training and support program for home-based carers of older adults developed in the Kwa- zulu-Natal region by university researchers in collaboration with voluntary organizations. 4' s

The churches have been an important source of support to older Africans, providing day care, home delivery of meals, and other forms of home-based support. However, churches to which black Africans belong have had fewer material re- sources, as their communities are poorer. The many activities provided by the African inde- pendent churches were unsup- ported in the past by the government since they were not constituted in a form that the legislation recognized.

103-year-old Mr Ilendrik Mogale, who lives in rural kwaNdebele, Sooth Africa. Photo: Mark Wolhoter

Social Security A counter-balance to the lack of formal provision of social and health services for older black Africans is the social security system. The pension system was originally designed for whites but was expanded over the years to include all South Africans. Previously, the amounts paid to social pensioners were racially dis- criminatory. The former government committed itself to parity in the amount of the benefit over a five-to- seven-year period and this was achieved in 1993. At present the amount paid monthly to pensioners is equivalent to US$120.

South Africa is the only country in Africa that pays a universal pension on a non-contributory basis. The social assistance scheme is remarkably good compared to most developing countries, although the amount may be deficient in terms of real income. In rural areas, the OAP is two or three times greater than the rural per capita income. The receipt of a pension is often the first, or at least the most important, secure source of income that older blacks and their house- holds will have.

Although the OAP is claimed by individuals, in poor (typically three-generation) households it is largely consumed as a house- hold asset. Research has demon- strated how the OAP goes more to women than men; reaches into deep-rural areas; often se- cures credit for the household at the local store; contributes to the education expenses of grand- children; ensures respect for the beneficiary; and secures the right of the older person to stay in the home and be cared for by the family. 6'7

There is growing concern about the extent of dependence on the OAP as a form of gener- al social assistance, as well as a growing recognition of the need for individuals to make provision for retirement during their working lives. Plans for a

compulsory national insurance scheme have been made public but this will not be a realistic way of addressing the needs of the unemployed, or of the marginal infor- mally employed.

Windows of Opportunity What can older black Africans expect in the new South Africa? Challenging windows of opportuni ty exist alongside several threats to their well-being.

Ironically, the greatest threat may be the existence of the social security system itself. In the first post-election budget of R143 billion (US$38.5 billion), social securi- ty accounted for about R13 billion (US$ 3.5 bi l l ion)- around 9%. The overall welfare budget, of which the OAP comprises about 80%, was the second fastest growing item in the period 1991 to 1994. At present, all government spending is being scrutinized for possi- bilities of reallocating funds from existing resources to the Reconstruction and Development Program. The universal pension system has become highly visible and its sustainability is likely to be reconsidered.

The language of the RDP is development and eco- nomic growth, not expansion of welfare and care. Advocates for the rights of older persons to be inte- grated into new development programs are met with

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Ageing International December 1995

the response, "The elderly already get enough from the old-age pension".

Where then are the opportunities for improving older black South Africans' quality of life? First, there is the new climate of human rights in the country, which encourages advocacy of issues affecting older persons and their empowerment. Second, the new na- tional welfare ministry has proposed amendments to legislation that will enable the less formal welfare or- ganizations serving the aged to apply for financial sup- port for community-based activities.

Third, the nine new provinces are moving towards implementing a district health system, based on a pri- mary health-care approach. The emphasis will be on affordable, appropriate and accessible health care for all citizens. The primary health-care approach could provide an opportunity for the introduction of flexible forms of intermediate care for older persons, bridging the gap between living at home, supported care, and full residential care.

Fourth, an interesting potential point of convergence between health, welfare and education is the develop- ment of educational materials that could impact im- proved services for older black Africans. On the one hand, there will be a growing emphasis on community- care policies, driven by the primary health-care ap- proach, the increasing size of the older population, and the spread of the AIDS epidemic. To be effective, caters in the community have to be supported, and part of this support depends on the development of health educa- tion materials. There could be a convergence between the huge national literacy and adult basic education movements and the need for materials relating to the care of elderly people. This would be one way of build- ing on and strengthening the potential that exists in the hundreds of formal and informal clubs and organiza- tions for older black Africans.

Finally, the design and implementation of intergen- erational projects in the fields of education, training and care could feed the goals of all generations and ensure that older persons are included in family-assis- tance programs.

Conclusion In their lifetime, older blacks have experienced dis- crimination and disadvantages that have discouraged healthy life-styles and economic and subjective well- being. The family support system and a non-contribu- tory pension system have helped overcome some of the

negative effects. South Africa's Reconstruction and Development Program, which tends to favor youth over the elderly, poses a threat to existing service pro- vision but also promises greater empowerment of the elderly and the benefits of a community-driven com- prehensive family care system. •

References

1 Msiler, V. "Quality of Life in Retirement: A Case Study of Zulu Return Migrants." Social Indicators Research, 1988, v. 20, pp. 621-58.

2 Ferreiea, M., Meller, V., Prinsloo, F.R. and Gillis, L.S. Multidimensional Survey of Elderly South Africans, 1990-91: Key Findings. Cape Town, HSRC/UCT Centre for Gerontology, 1992.

3 Chinkanda, E.N. Attitudes of Black People in Urban Areas with regard to the Aged and Care for the Aged. Pretoria, Human Sciences Research Council, 1987.

4 Mailer, V. A Role fop Black Seniors in Educare. Pretoria, HSRC Publishers, 1990.

s land, F. and Madlala, N. Caring for Elderly People. Pietermaritzburg, University of Natal Press, 1990.

6 land, E "State Social Benefits in South Africa." InternationalSocial Security Review, 1993, v. 46, No. 1, pp. 5-25.

7 APdington, E. and land, F. "Pensions and Development: The Social Security System as a Complementary Track to Programmes for Reconstruction and Development." Development South Africa. (forthcoming)

Monica r e r r e t r a , PhD, is the Director of the HSRC/UCT Center for Gerontology at the University of Cape Town. She is the editor of the Southern African Journal of Gerontology. Her major research interests lie in cross-cultural studies on aging in Africa.

Frances Lund, M.Soc.Sc., is a social policy analyst and a researcher in the Center for Social and Development Studies at the University of Natal in Durban. Her major interests are rural development, social secu- rity, and the management of change.

Valerie Moiler, PhO, is Professor in the Center for Social and Development Studies aL the University of Natal and heads the Quality of Life and RDP Monitoring Unit. Her main geronto- logical research interest is quality of life studies and their application to the lives of older per- sons in society.