Background

Globally, life expectancy at birth has increased by more than 30 years over the last century (Roser, 2015). A major difference between population ageing in the more developed and the still developing regions of the world is that ageing in the latter largely takes place against a backdrop of considerable economic, infrastructural and personal strain, with the family seen as the main (if not the only) source of care. Longevity, even when achieved, often means a life of compromised health with scant access to general (let alone appropriate or specialised) care and similarly constrained financial resources. These additional years, which in the more developing parts of the world do not necessarily translate into healthy longevity, challenge individuals, families, civil society and the state in terms of the social and health care of its older members. However, though much has been achieved in terms of prevention and treatment, accompanying the longevity revolution is an added imperative: understanding and developing a culture of care that is sustainable, affordable, compassionate and universal is critical (Aboderin and Hoffman, 2012).

Despite remaining younger than all the other world regions, Sub-Saharan Africa (SSA) is seeing its older populations similarly growing in absolute numbers – its current population of 44 million aged 60 and over is expected to increase fourfold to 160 million in 2050 (UNPD, 2012). Although people age in a diverse range of settings across the continent, most care for older people in SSA is provided by families, typically in settings of entrenched poverty and infrastructural constraints. Yet, debate on the experience of caregiving for older people and its implications for policy in the region is virtually non-existent, and there is very little active discussion and exploration of what the relative care roles and responsibilities of families, the state and other sectors ought to be.

In contexts of poverty (youth unemployment) and HIV/AIDS in particular, concern (especially in southern Africa) has focused on the economic and social costs of care provided by older to younger generations (Barrientos et al, 2003; Madhavan, 2004; Ardington et al, 2010). Yet little attention has been paid to questions of care for older people. Who will care for the carers?

Introduction

Currently, Kinshasa counts eight retirement homes (Fr. Sg. home de vieillards, hospice), the oldest of which dates from 1943. Five of these homes were built during colonial times (the Democratic Republic of Congo gained its independence in 1960), while three others were added over the years: one (in the neighbourhood of Kingabwa, and attached to the parish of St Kizito, with which it shares its name) was built during the early 1970s by the Congolese Catholic Church; another one, also in the early 1970s, was constructed by the Catholic association Soeurs des Pauvres de Bergamo (Kingasani), and the most recent hospice, financed with Catholic money, was started by a Congolese woman (Kingabwa). These homes differ significantly in capacity: most can accommodate 30 residents, while two could easily house 80 residents. However, none of these retirement homes is fully operational. During fieldwork (2011–13), there were about 120 indigents (the common appellation for retirement home residents) living in these homes. In a city of more than eight million inhabitants, this is a very small number. Generally, these spaces have not been the focus of academic study; nor are many Kinois (inhabitants of Kinshasa) familiar with the retirement homes. Nevertheless, there is a constant flow of movement between city and retirement homes, and vice versa (see Photo 2.2). The city's possibly best-known hospice (on Avenue Cabinda, opposite the national broadcasting services) has turned into a recreational space where journalists and local celebrities drink and eat in malewa (small outdoor restaurants) developed on the retirement home's premises. The land on which the home is located is also constantly invaded by soccer-playing youth. The children drink from the water pump and refresh themselves under the gaze of older people, while neighbours fetch water for household use. The residents of this and other hospices send children on errands, or sell cigarettes and personally made goods to visitors and passers-by (see Photo 2.1). In addition, after work hours (usually after 5 pm), indigents venture out of the retirement home and start begging on the street. These are only a few examples of the constant interaction between older residents and the city at large.