Exploring Community-based Social Innovations (CBSIs) for Healthy Ageing

Background

Community-based social innovations (CBSIs) are initiatives that seek to empower older people to improve self-efficacy in caring for themselves and their peers, maintain wellbeing and promote social cohesion and inclusiveness. While they have the potential to improve care and autonomy for older people, as well as transform healthcare systems, more evidence is needed on CBSIs to improve our understanding of best practices and service delivery models that engage communities and span a spectrum of health and social services.

Goals

RAND Europe was commissioned by the World Health Organization Centre for Health Development Kobe (WKC) to conduct a study on CBSIs for healthy ageing.

The study aimed to identify how these innovations function across a number of rapidly ageing countries and the policies, programmes and health system factors underpinning their success. In particular the study focused on the following features of CBSIs:

• the core roles, services and functioning (including feasibility of scale up) of community based social innovations for healthy ageing that seek to support older people becoming a resource for their own health and well-being,
• their linkages with sustainable partnerships to deliver health services, strengthen social systems, and
• the nature of enabling policies, programmes, financing and interactions with the health/social delivery system.

Methodology

To explore these features of CBSIs, our study had two major components:

1. Case studies of CBSIs: In order to examine the effectiveness of ongoing CBSI interventions in middle-income countries (MICs), we developed a series of country case studies, in collaboration with in-country partners. Selected case studies then became the focus of primary data collection, which sought to understand each CBSI in depth, including how it operates, how it links to other health and social care services and what benefits it brings for participants.
2. Systematic review: To complement the data being generated from the case studies on MICs, we also conducted a systematic review of relevant literature on CBSIs for healthy ageing in upper middle and high income countries.

The findings of the case studies and wider research have been disseminated widely through academic papers, conferences and policy briefs with the aim of informing policy and planning to ensure greater sustainability and integration of services.

Findings

CBSIs’ impact on healthy ageing

• The main health benefits for individuals and communities are often psycho-social. Older persons found that the CBSI activities provided a medium for them to interact with peers, be of help and live an active lifestyle. This in turn helped beneficiaries avoid social isolation and loneliness, which can have a number of mental health benefits.
• CBSIs can help contribute to people-centred services, by empowering and engaging communities and helping to build social networks to support older persons.
• While some CBSIs have physical health impacts, evidence for this is limited, as this is not their primary aim and is therefore less likely to be monitored.

Sustainability and scale-up of CBSIs

• Many CBSIs are low-cost and rely on either volunteers or older people as agents of change, meaning that most models are relatively sustainable. However, challenges still exist around increased demand on services, while the reliance on volunteers could also be a disadvantage for long term sustainability.
• To scale up or expand activities, CBSIs may need to develop strategies for securing long-term funding.
• The role of leadership and key individuals as ‘product champions’ appears to be a significant factor in the success of CBSIs.
• While linkages to the immediate health and social care system appear to be limited across the CBSIs, many considered strategic partnerships as an important factor in a CBSI’s sustainability.

Recommendations

For policy implementation:

• A greater understanding of CBSIs at a national level could be ensured by undertaking a mapping exercise employing the typology created in this study. This could facilitate a better understanding of the opportunities for engagement with CBSIs for both public and private sectors.
• Capturing the societal costs of CBSIs, such as the time and resources given by volunteers, older people and family members, will be important to consider in addition to the range of benefits they offer.
• A policy environment conducive to moving CBSIs away from a continuous pilot stage through dedicated funding streams should be created. This could be in the form of national funds or credit schemes for CBSIs.
• Policymakers could foster spaces to ensure knowledge translation and networking between various actors, for example as part of already established events dedicated to ageing.

For CBSI implementation:

• CBSIs should look for opportunities to collaborate with community groups operating in the same geographical area. This could help to avoid duplication of efforts, and may support wider advocacy for older people’s rights.
• CBSIs should build strategic partnerships with local policymakers or academia beyond the health and social care system, depending on their own objectives.
• Promoting intergenerational activities, where applicable, may be an important feature in the sustainability of CBSIs and may help to reduce the stigma of ageing in middle-income countries.
• Monitoring and evaluation (M&E) processes that are low-cost, effective and not burdensome should be embedded in CBSIs. These could help CBSIs demonstrate progress to donors, for example by evaluating the impact of activities on older people’s health.