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Context: Perspectives from sub-Saharan Africa (SSA) have featured little in the expanding global debate on long-term care (LTC) policy thus far – despite SSA countries’ embrace of global commitments on the development of equitable and sustainable LTC systems. Objective: Building on insights derived from ongoing analyses of relevant literature and policy frameworks, stakeholder engagement, as well as personal experience, this commentary examines the lack of a fit-forpurpose policy architecture on LTC in SSA at both regional and national levels. Method: The analysis assesses the nature and drivers of this policy impasse and pinpoints an agenda for research to help overcome it. Findings: LTC in SSA is provided overwhelmingly by families, with available evidence pointing to inequitably distributed deficits in the quality of such care and negative impacts on unpaid family carers. Governments have forged a spectrum of frameworks that speak to questions of LTC. Yet fit-for-purpose provisions that consider a need for expanded organized care and support provision to reduce quality deficits and costs on carers are widely lacking. The impasse may be rooted in a lack of awareness of relevant evidence, as well as in political views that resist organized care provision as an imposed western model that counters African values and as a distraction from priority child-, youth- and gender-focused development agendas. A concerted research effort that examines the compatibility of organized LTC provision with African family norms and its relevance for broader social and economic development in SSA is required to address the policy impasse. Limitations: This overview is an exploration of the agenda, leading to suggestions for ways forward, and not an empirical research report.

Toward a Fit-for-purpose Policy Architecture on Long-term Care in Sub-Saharan Africa: Impasse and a Research Agenda to Overcome it