Published in the International Journal of Care and Caring, the research is one of the first studies to examine care poverty in a sub-Saharan African context, highlighting how poverty, limited services and changing family structures are affecting the wellbeing of older people in rural communities.
The study, ‘Understanding care poverty among older people in rural Uganda’, involved interviews with government and community stakeholders, focus groups with caregivers and in-depth interviews with older people living in two rural districts. Researchers found that both formal and informal care systems were often underfunded, fragmented or entirely absent, leaving many older people without adequate support.
Lead author Diana Nabbumba, who completed this work as part of her doctoral studies, said population ageing is increasing pressure on already limited support systems.
"Our research shows that care poverty in rural Uganda is not simply about families being unwilling to provide care. The reality is that many families are doing everything they can in extremely challenging circumstances and struggle to meet the needs of older relatives because of poverty, limited services and broader social and environmental pressures."
The research found that older people commonly depend on family members for help with daily activities including bathing, preparing food, collecting water and firewood, managing medications, accessing healthcare and emotional support. However, caregivers often face their own challenges, including food insecurity, drought, limited employment opportunities and poor transport infrastructure.
A key finding was the significant impact of demographic change. Migration of younger family members to urban areas, combined with the long-term impacts of HIV/AIDS and conflict, has reduced the availability of family caregivers in many communities. In some cases, older people were caring for orphaned grandchildren while simultaneously managing their own declining health and increasing support needs.
Co-author Rachel Winterton, Director of the John Richards Centre for Rural Ageing Research, La Trobe Rural Health School said the findings highlight the close relationship between material poverty and care poverty.
"When formal care services are limited, families become the primary source of support. However, this study shows that caregivers are often facing significant hardship themselves, making it difficult to provide the level of care older people need."
Researchers documented examples of both absolute care poverty, where no meaningful support was available, and relative care poverty, where support existed but was insufficient to meet an individual's needs.
The study also found that caregiving responsibilities were strongly gendered. Women were more likely to undertake personal care activities such as feeding, toileting and hygiene support, while men more commonly assisted with transportation, farming and shopping.
Importantly, the research suggests conventional measures of care may not fully reflect the realities of ageing in rural, low-income settings. Tasks such as fetching water, collecting firewood and maintaining small farms were identified as essential forms of care but are often overlooked in international care frameworks.
"Our findings suggest that existing understandings of care need to be adapted to better reflect the realities of ageing in rural communities in developing countries," Diana Nabbumba said. "Without greater investment in care services and support for family caregivers, many older people will continue to experience significant unmet care needs."
The authors say the findings provide important evidence to inform ageing, health and social policy and highlight the need for more comprehensive approaches to supporting older people in resource-constrained communities.
Learn more about the John Richard's Centre for Rural Health Research.
