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					The Madrid International Plan of Action on Ageing (MIPAA) recognizes that
“enhanced and focused international cooperation and an effective commitment
by developed countries and international development agencies will enhance and
enable the implementation of the International Plan of Action”. (para. 123)

The Plan of Action reaffirms the role of the United Nations Department of
Economic and Social Affairs (DESA) as the focal point on ageing for the UN
system and its role in facilitating and promoting the Plan of Action, including, inter
alia: designing guidelines for policy development and implementation; and
advocating means to mainstream ageing issues into development agendas.
(para. 127)

One of the key objectives of the new Plan of Action is to promote a
developmental approach to population ageing through the mainstreaming of
older persons into international and national development plans and policies
across all sectors. The Plan specifically states that mainstreaming ageing and
the concerns of older persons into national development frameworks and poverty
eradication strategies is “a necessary first step in the successful implementation
of the Plan” (para. 116)

Accordingly, DESA has initiated activities to facilitate action by Member States in
implementing the Madrid Plan, believing that a mainstreaming approach to
ageing will be not only more effective in delivering results, but also more cost
and resource efficient for all stakeholders.

In December 2003, DESA organized an Interregional Consultative Meeting on
National Implementation of the Madrid International Plan of Action on Ageing,
(LINK TO REPORT HERE) in Vienna, Austria.                Representatives from
Government and civil society were present from Bolivia, Egypt, Jamaica, Kenya,
Kyrgyzstan, New Zealand, Senegal and Vietnam. Discussions and working
groups centered on:

    a. identifying issues and obstacles to national implementation;

    b. producing strategy guidelines to mainstream ageing issues into national
       development agendas; and

    c. contributing to the development of a framework for technical assistance to
       help build national capacity for the implementation and follow-up of

Participants analyzed where their countries stood vis-à-vis the development and
implementation of ageing policies and the inclusion of ageing into wider national
development policies. They then identified the capacities that are lacking or
need strengthening to move national implementation of MIPAA forward.
Since the Vienna meeting, missions have been fielded to Senegal, Kyrgyzstan,
Egypt and Kenya.

A project has now been approved to enhance implementation of the Madrid Plan
of Action at the sub-regional level by building upon the experience of the
countries participating so far to neighbouring countries.

Overall Objective:

To enhance stakeholder capacity to integrate (mainstream) ageing issues in
national development frameworks through policy formulation and programme
planning, implementation, monitoring and evaluation.

Expected accomplishments:

   1. enhanced the capacity of ministers/high level policy makers, advisers,
      programme planners/executive officers and pressure groups in policy
      formulation, programme planning, implementation and monitoring through
      formal skill building in needs assessment, policy formulation, programme
      planning/monitoring skills as well as one-to-one advice coaching and on-
      the-job training.

   2. Devised & tested a methodology including context related good practices
      for technical guidance on effective implementation of MIPAA within a
      broad development perspective through sub-regional networks in West
      Africa, Central Asia and the Caribbean.

   3. Launched a multiplier effect for extensive knowledge sharing and capacity
      building through the sub-regional team of trainers;

   4. Set up and sustained an internet-based network for further capacity
      building/advice, exchange and learning through field tested models and
      good practices.

   5. Published a learning tool for use by Member States and civil society
      organizations offering implementation methodologies based on the
      outcomes of country assessments and implementation and discussions
      and lessons learned from Interregional meetings.

Main activities:

   1. Needs assessment: Undertake advisory missions. The end of the needs
      assessment mission will be „sanctioned‟ by a stakeholder
      debriefing/discussion on the results and the proposed steps forward;
   2. Building capacity: launch two consecutive initiatives in each of Senegal,
      Kyrgyzstan, and Trinidad and Tobago, including:

       a. A preliminary formal training.          This will involve one day
          advocacy/sensitization (policy makers and the media) followed by five-
          days formal competency-based training (programme managers, focal
          points, advisers) on ageing issues and social inclusion issues as well
          as the potential for a sub-regional network; and

       b. A training of trainers (ToT) involving national programme
          planners/advisers as well as one/two representatives for the proposed
          countries in the sub-region (see diagram).

   3. Expansion to sub-regional level: The main investment will be in the
      participants who will then become the “nerve centre” for the sub-regional
      activities and networking. Once the first capacity building initiatives are
      implemented, the project will then launch similar initiatives in the countries
      of the sub-region through formal training followed by a training of trainers
      (ToT). Where applicable, national officers from the original countries who
      have the capacity will be enlisted as partners in the delivery of training in
      the sub-region;

   4. Sub-regional web-based networking: facilitate the set up of a web-
      based network to allow for exchange of information and capacity building

   For further information: Rosemary Lane –

   Executive Summary Kyrgyzstan mission, September 2004


The population of Kyrgyzstan is estimated by the United Nations to reach 5,278
million in 2005 and 6,235 million by 2020 although the population growth rate is
slowing. The percentage of the population over 60 years of age was 9% in 2000
and while dropping to 8.1% in 2005, will see an increase to 10.9% by 2020. Life
expectancy at birth was 67.5 in the period 1990-1995 followed by a slight dip to
66.9 from 1995-2000 and is currently 68.6 and is estimated to reach 72.4 by
2015. Coupled with the falling fertility rate, Kyrgyzstan is clearly ageing, albeit at
a slow pace. Life expectancy is increasing thus ageing will become a major
issue unless there is a clear vision coupled with an integrated strategy focusing
on the horizontal and vertical vectors of intervention at the policy and operational
level. Failing that, older persons‟ exclusion will deepen, their vulnerability will be
exacerbated and intergenerational issues will increase.
Demographic profile
Medium variant

                Indicator                     1990          1995          2000          2005        2010
Population (thousands)                            4 395         4 562         4 921         5 278       5 621
Male population (thousands)                       2 149         2 236         2 413         2 590       2 761
Female population (thousands)                     2 245         2 327         2 508         2 688       2 860
Population sex ratio (males per 100                95.7          96.1          96.2          96.3        96.6
Percentage aged 0-4 (%)                            14.3          12.5          10.6          10.2         9.4
Percentage aged 5-14 (%)                           23.2          24.1          23.3          20.4        18.6
Percentage aged 15-24 (%)                          18.1          18.5          19.3          20.6        20.1
Percentage aged 60 or over (%)                      8.3           8.5           9.0           8.1         8.2
Percentage aged 65 or over (%)                      5.0           5.8           6.0           6.5         5.8
Percentage aged 80 or over (%)                      1.0           0.9           0.8           0.9         1.3
Percentage of women aged 15-49 (%)                 45.9          48.5          51.3          53.6        54.2
Median age (years)                                 21.6          22.1          23.2          24.4        26.1
Population density (per sq. km)                      22            23            25            27          28

Demographic profile
Medium variant

                 Indicator                  1990-1995     1995-2000     2000-2005     2005-2010
Population change per year (thousands)               34            72            71            69
Births per year, both sexes combined                123           110           112           110
                                                    33            36            36            37
Deaths per year, both sexes combined
Population growth rate (%)                         0.75          1.51          1.40          1.26
Crude birth rate (per 1,000 population)            27.5          23.2          21.9          20.1
Crude death rate (per 1,000 population)             7.5           7.6           7.1           6.8
Total fertility rate (children per woman)          3.45          2.89          2.64          2.32
Net reproduction rate (per woman)                  1.59          1.33          1.23          1.08
Infant mortality rate (per 1,000 births)           40.8          43.2          37.0          33.1
Life expectancy at birth, both sexes               67.5          66.9          68.6          70.2
combined (years)
Life expectancy at birth, males (years)            63.2          62.8          64.8          66.8
Life expectancy at birth, females (years)          71.8          71.1          72.3          73.5
Kyrgyzstan is ranked 110 out of 177 countries in the 2002 Human Development
Index with a GDP rank of 143. The GNI is US$ 270, which ranks the country as
the second poorest former Soviet country. Spending in the social policy arena
has fallen since independence. For example, public expenditure on education as
a percentage of GDP has fallen from 8.3% in 1990 to 3.1% between 1999 and
2001. Expenditure on health has fallen from 4.7% in 1990 to 1.9% in 2001.
(UNDP, 2003) According to World Bank figures, spending on social security and
social insurance has also fallen from 8.6% of GDP in 1992 to 6.3% in 2001.
While pensions account for 4.7% of GDP, pensions have been markedly reduced
in real terms after the economic crisis of 1998 so that the average pension
amounts to $10 per month which is significantly below the poverty line (World
Bank, 2004). External debt poses a major problem for the country and it is, along
with Tajikistan, considered to have the highest aid dependency in the region
(DFID, February 2004).

It is clear from this brief overview of Government expenditure that social
conditions are deteriorating in Kyrgyzstan with an overall declining expenditure in
the social sector that hits vulnerable groups the hardest. This is exacerbated by
the exclusion of older persons from development policy and projects which might
give a large proportion of them the tools to help themselves.


During the Interregional Consultative Meeting on National Implementation of
MIPAA held in Vienna in December 2003, the representatives of Kyrgyzstan
noted that ageing issues are only visible within a general policy sphere largely
titled toward macro economic policy. As in all former Soviet countries, pensions
are the most visible policy issue. Civil society partners report that aside from a
pensioners‟ association totally focused on pension rights, there is no strong lobby
for ageing. UNDP analysis of the policy environment suggests that a great deal
of funding went to Kyrgyzstan during the early and mid 1990s just after
independence and a fair amount of reform took place within the Government in
terms of structure. However, the Soviet influence on the functioning of
Government still hampers progress ie. power is still vested in the executive
branch of Government rather than the Ministries. Help Age International has
recently established a presence in Bishkek for an 18-month project working to
strengthen NGOs on ageing. In sum, if initiatives are to be successful, it will
require a serious amount of analysis, planning and discussion to ensure that the
policy environment is understood, and the right stakeholders are involved and
“on-board” with the philosophy and initiative hence this mission.

   1. Overall objective:

Carry out a needs assessment and undertake planning with stakeholders for a
capacity building exercise
    2. Specific objectives

These aimed to:

    a. Familiarize the team with the national policies and programmes on ageing
       through discussions with government officials and senior staff in the
       Ministry of Labour and Social Protection, Health and Finance Ministries as
       well as Statistics Commission and regional/local structures including the
       Mayor‟s offices and municipalities;

    b. Discuss the national development framework and assistance with specific
       reference to ageing with UN agencies including UNDP and WHO;

    c. Assess the non-governmental perspectives on social issues including
       ageing ;

    d. Undertake field visits to selected rural areas to meet with organizations
       of/for older persons and local government officials

    e. Carry out a rapid analysis of the needs assessment results and a
       programme for a stakeholder seminar on priority setting for the effective
       integration of ageing/older persons‟ issues in national policy and
       development frameworks.

    f. Assess feasibility of building national capacity to deal with ageing through
       formal/informal training;

    g. Conduct a one-day priority setting and preliminary capacity building
       exercise with relevant stakeholders and plan for future activities.


To fulfill the objectives and enhance the practical knowledge base about older
persons‟ real situation beyond official acknowledgments that older persons
represent a priority, the team1      adopted an interactive and participatory
methodology including:

1. formal meetings with (i) relevant government officials at central, regional and
   local levels; and (ii) international agencies such as UNDP, WHO, (iii) NGO‟s
   such as Help Age International, Interbilim, Association of Social Protection for
   the Population, and the Fund for Tolerance International. Consequently the
   team followed the path through the full administrative structure from the
   central through to the regional, district and local level (smallest

 The team was composed of Rosemary Lane, Social Affairs Officer, DSPD, Jazgul Skanderbekova, Ministry of Labour &
Social Protection, Ludmilla, Interpreter/translater & Fatiha Serour, Interregional Adviser, DSPD.
   denominations). This facilitated an understanding of the approach and
   linkages and, at the same time, unraveled the system‟s strengths and
   weaknesses while highlighting people‟s coping mechanisms.

2. field visits to villages and districts around Bishkek, Balaikshi and Osh. This
   facilitated an interactive exchange with older persons themselves, whether
   they were actively involved in community initiatives or living in care homes.

3. Stakeholder Priority setting Seminar: The team conducted a one-day
   seminar to:

   a. share results of the needs assessment; and

    b. discuss the way forward, by setting priorities for an ageing policy and an
integrated approach to older persons‟ issues.


At the end of the mission, the team organized a stakeholder seminar to discuss
the needs assessment results and plan the next steps forward. The seminar was
attended by about 25 people representing line ministries, the mayor‟s office and
NGOs as well as the Minister for Labour & Social protection. The morning was
devoted to plenary sessions to:

a. review the provisions of the Madrid Plan of Action;

b. share the preliminary findings of the needs assessment; and

c. discuss the mainstreaming concept, methodology and tools.

This was followed by working groups focusing on the above questions to
determine the:

1. Vision & approach for the future: the establishment of a working group
   (Coordination council) to advise on and formulate a policy on ageing was
   recommended and informally/provisionally endorsed by the Minister of Labour
   & Social Protection. As far as membership is concerned, recommendation to
   maintain the stakeholder representatives who participated in the seminar as
   they have become knowledgeable about the issue and will, therefore, make a
   more effective contribution to the work of the group. In addition, the
   Coordination Council would focus on:

      Including ageing issue into the common strategy of integration of older
      persons into the development programmes at all levels.
      Enhancing the synergy between the projects and rationalize resources;

      Avoiding duplication of activities;

      Including/integrating ageing issues into the different programmes (“Save
      the children” + elderly people = interaction of generations);

      Monitoring of inclusion and reporting;

      Launching an information/education campaign through mass media,
      publications, round tables, stakeholder meetings and reports.

2. Potential policies & programmes

Focusing on the socio-economic context, the group recommended:

      Older persons‟ active participation in the society‟s development;

      Labor activity

      Access to knowledge and education

      Intergenerational issues;

      Poverty eradication;

      Older persons and HIV/AIDS

      Mental health


       Living conditions

      Comprehensive approach to solving ageing issues

3. Stakeholders, capacities & resources:

      stakeholders were listed as : Active elderly people, donors, state
      structures, NGOs, mass media, business circles;

      Resources included: Human resources,; informational resources; financial
      and technical resources; support from governance bodies (state, UN),
      commitment of the society;
     Capacity building included: professional training of medical personnel
     within the system of Health Care; training; learning from practical
     experience;      technical    assistance;      training,   international
     experience/consultancy, successful mechanisms of others adapted to
     local conditions


  In summary, the key issues highlighted by the team‟s needs assessment and
  agreed by the stakeholder seminar are:

     Lack of “vision” and overall strategy on issues of ageing and older
     Weak capacity within the Ministry of Labour and Social Protection to
     formulate and promote an integrated stategy;
     Lack of targeting as older persons are viewed from a welfare perspective
     and as a homogenous group;
     UN offices in Kyrgyzstan also lack a social inclusion perspective of older
     persons which means they are not included in country development
     frameworks or similar strategies.


  Against this background, it is recommended to:

     1. Support the setting up of the- National working group of stakeholders
        comprised of participants at the stakeholder seminar, plus any other
        representatives deemed necessary. If requested, DESA will assist
        with drafting the terms of reference for the group and additional
        technical support;

     2. Guide the Working group to work towards formulation of a national
        policy on ageing and DESA will provide technical support in this

     3. Conduct a capacity building exercise by DESA, including strategic
        thinking and planning for the Ministry of Labour and Social Protection
        and other key stakeholders from other line ministries and civil society
        to assist in mobilizing coordinated action with the Government on the
        social inclusion of older persons.

     4. Launch a multiplier effect to neighbouring countries including
        Kazakhstan, Uzbekistan, Tajikistan and China through training of
        trainers and a sub-regional network, further testing the methodology,
        learning the lessons for potential replication in other sub-regions.
Executive Summary Senegal Mission, April 2004



The training aimed to:

a. Familiarize participants with the plans of action on ageing, disability and
   youth and coach them into understanding the true value of global
   commitments to vulnerable groups at both international and national

b. Impart skills & competencies for effective situation analysis,
   conceptualization and implementation as well as monitoring of social
   inclusion programmes;

c. Specifically strengthen the capacity of programme managers/focal points
   and representatives of the civil society for a more effective implementation
   and monitoring of the Madrid and the disability plans of action and their
   corresponding national plans, ensuring a closer monitoring and evaluation
   process for continuous learning and programme/policy adjustment.


About 25 participants were selected out of the group that participated in the
strategic planning exercise. The rationale behind this decision was the need

a. Link practical planning work (in the second training) with the goals &
   objectives devised in the strategic plan (ensuring linkages and mutual

b. Capitalize on the „grooming‟ process that occurred in the first training
   session to improve the training environment and participants‟
   receptiveness (thus optimize our investment);

c. Select those who indicated a sound understanding of issues, good
   analytical skills and readiness to take on the challenge of social inclusion
   further and beyond lip service.

The training programme was designed to move from the global to the national
perspective. It facilitated a logical sequence, progressing from the Madrid
Plan of action, mainstreaming concepts and generic guidelines to the national
policies, programmes and institutional framework for the integration of
vulnerable groups. After the initial steps including introductions, expectations
and pre-workshop assessment, the workshop started with the training
objectives and programme. This covered the:

a. Global framework including an introduction on the context and key
   elements of the Madrid plan of Action. The knowledge acquired through
   these key elements was reinforced by a presentation on the framework for
   policy formulation to mainstream ageing as well as disability and youth.
   The presentation and discussion insisted on the need to look at policy and
   programme formulation in a vertical and horizontal manner to mainstream
   such issues without losing the specificity as, when and if needed. This
   session clearly indicated a lack of knowledge of global texts/commitments
   and real understanding/grasping of the issues at stake and the process
   (methodology, approach) needed for fulfilling such commitments.

b. National context: officers and focal points responsible for relevant areas of
   concern in social integration provided short presentations on policies and
   programmes targeting older and disabled persons, youth/children and
   women (these having been identified as the most important „vulnerable‟
   groups in the strategic planning training). This facilitated a cross-cutting a
   cross-cutting view (across all ministries) of the policy and practice followed
   by each institution/structure to determine the rationale and inter-linkages.
   These interactive sessions proved extremely beneficial not only from a
   learning and exchange point of view but also for laying the grounds for the
   practical work that ensued. Within the national context, a brainstorming
   session was devoted to inter-generational issues with specific reference to
   changes in the Senegalese society including the linkages between issues
   affecting each generation and the reciprocal impact.

c.    Conceptual framework: the second day was devoted to the
     mainstreaming rationale and tools. This started with an introduction
     sharing previous experiences with the mainstreaming approach, adapting
     its application to social inclusion of marginalized groups. In doing so, this
     session introduced generic mainstreaming guidelines. The ensuing
     discussion indicated that, despite many efforts targeting a mainstreaming
     of ageing and disability, the practical implementation framework
     constrained effective mainstreaming due to lack of resources exacerbated
     by and institutional instability (regular ministerial re-shuffling shifting
     responsibility for vulnerable groups to different ministries). This session
     was followed by working groups tasked with the responsibility to further
     develop and adapt the generic guidelines to the national context
     (contextualize them). The presentations of the working groups gave an
     opportunity for further discussions and clarifications on mainstreaming but
     also indicated the need for additional time on the mainstreaming
     methodology (see lessons learnt).
d. Practical framework (National Plan): strengthened with these conceptual &
   analytical skills as well as some tools, participants were organized into 3
   working groups respectively for ageing, disability and youth. Female
   participants representing the gender programme were integrated into the
   groups and entrusted with the responsibility of ensuring that each group‟s
   work mainstreams a gender perspective. These working groups aimed to
   review the National Social Development Plan (1997-2001) and determine
   if the situation of these groups is (i) simply mentioned, referred to „en
   passant‟ or analysed using recent/reliable data; and (ii) addressed or
   mainstreamed (in an explicit manner and indicating the specificity). The
   groups presented the results of their works, emphasizing the gaps in and
   coherence between the situation analysis, goals, objectives and
   programmes. The working groups were then tasked with the re-writing of
   those sections to fill the gaps, ensure coherence and effectively
   mainstream ageing, disability, and youth issues. The plenary discussions
   provided yet another opportunity for a deeper analysis and understanding
   of these issues and the complexities of the mainstreaming approach.

e. Practical framework (ageing and disability plans of action). While
   preparing for the training in Dakar, the DESA team found out that two
   inter-ministerial commissions met in October & November 2001 to
   respectively focus on issues affecting disabled and older persons,
   formulating specific policy and programme actions to address such issues.
   The discussions that followed the presentation on the general context
   indicated a very slow (if existent) implementation process of such actions.
   Working groups were thus organized around the policy and programme
   actions targeting ageing and disability to speed up the process through the
   development of an implementation plan with SART objectives, measurable
   indicators and clear responsibility at the operational level within each
   responsible ministry. The trainees were organized into 3 working groups
   and entrusted with the task of (i) finalizing the re-writing of the National
   Social Development Plan to ensure effective mainstreaming of an ageing,
   disability and youth perspective; (ii) reviewing the inter-ministerial
   commissions‟ plan respectively for ageing and disability to determine
   coherence between situation analysis and objectives. Both working groups
   were given the opportunity to:

     i.    identify sections of the plan of action that needed to be changed
           and what changes they would make to ensure coherence;

     ii.   identify actions that have already been implemented and assess
           results/effects as well as justify their assessment;

    iii.   devise an implementation and monitoring plan with measurable
           indicators to ensure effective implementation in a mainstreamed
             fashion by high level officials within ministries as well as operational
             ministerial staff or focal points.

The final output was agreed upon as a monitoring tool for the focal points who
agreed to prepare a report on progress by November/December 2004 with the
technical support and guidance from DSPD/DESA. Such report would also
strengthen the Minister‟s position when seeking further political support and/or
resources to fulfill her mandate.


   Like in the strategic plan, this was a participatory training using the
   techniques and methods of experiential adult learning that seeks to capitalize
   on participants work experience to specific target and meet their capacity
   building skills. Rather than „doing‟ the work for them, they were coached into
   doing it themselves, undergoing a self-assessment of their strengths and
   weaknesses to improve their performance. The original hesitations about
   identifying the gaps (both systemic and human) were slowly overcome as the
   training methodology succeeded in re-assuring participants about the long-
   term benefits of their mutual constructive criticism. Moreover, this
   methodology will allow participants who have the communication and
   interpersonal skills to replicate the training within their offices and at the
   provincial/district level.


   The training succeeded in:

      a. Coaching 25 participants into an in-depth knowledge of global and
         national commitments to social inclusion in general and the
         mainstreaming of ageing and disability issues in particular;

      b. Building and/or strengthening the capacity of 25 government officials
         and civil society representatives in situation analysis, conceptualization
         and implementation as well as monitoring of social inclusion

      c. Preparing a Social development plan that effectively mainstream
         ageing, disability and youth issues ensuring coherence between
         situation analysis, goals/objectives, activities and monitoring;

      d. Devising an effective implementation and monitoring plan of the
         recommendations by the inter-ministerial commissions for ageing and
         disability, ensuring the horizontal and vertical linkages and
          responsibilities for implementation at the „political‟ and operational

      e. Consolidating and/or strengthening the linkages between the various
         ministerial/operation levels for more effective mainstreaming an ageing
         and a disability perspective.

A full report incorporating all working groups‟ outputs was put together gradually
as part of the training. It is being consolidated and will be made available in
French to DESA and the Ministry of Social Affairs.

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