Salina Akhter

Salina is achieving equity in access to elderly housing and care in Bangladesh, by tying the needs of high income and low-income communities. Through an innovative cross-subsidy financial model, her network of care- centers ensures that provides safe, dignified and quality housing and care services for the elderly and disabled from different socio-economic backgrounds.

Salina is achieving equity in access to elderly housing and care in Bangladesh, by tying the needs of high income and low-income communities. Through an innovative cross-subsidy financial model, her network of care- centers ensures that provides safe, dignified and quality housing and care services for the elderly and disabled from different socio-economic backgrounds.

Salina is also building the eco-system to care and support the needs of the growing aging and disabled community. She has developed an elderly entrepreneurs unit to productively engage the elderly to develop products and services that can be sold in the market. Through her partnership with the Alabama State University, she is building a cadre of caregivers who have the skills and knowledge to cater to the unique needs of the vulnerable, in her centers and outside. She is also developing unique schemes and financing opportunities for investors and caregivers to plan and invest for their retirement. More recently, she has got companies to invest for the housing and care needs of their employees. These efforts not only help place the agenda of elderly care in different stakeholders, but also helped finance and increase access to care to vulnerable communities.

Through the economies of scale and Salina’s vision to establish at least one major elderly care center in every district of Bangladesh and develop smaller units of elderly care centers in more remote and rural areas. Simultaneously to influence the quality and standards of care in the country, she is also trying to influence the Government to create construction mandates for establishing elderly care facilities, specific building codes in all major housing developments, residential and commercial facilities.

As per the 2011 the population census 7.4 per cent of Bangladesh’s population is elderly. This percentage of elderly population is projected to increase by 17.0 per cent in 2050.

While we witness an increase in the number of aged, the traditional methods for old age security (such as the joint family system) are fast disappearing. Urbanization, migration, move to nuclear families and growing burden of care is leaving the elderly and disabled to fend for themselves.

This problem affects the aging and disabled citizens across different social-economic backgrounds. On one hand, poverty and intermittent incomes prevent a majority of the population them from being able to save or secure housing for their old age. On the other hand, elders especially those from middle and high-income families though living with their children due to social and cultural pressures, are not properly cared for. Enhanced life span, health issues and rising medical costs further increase their vulnerability and dependency. 50% of the people that seek social housing in Bangladesh are abandoned either, because they are considered to be a burden or due in some extreme cases family members taking ownership of their assets. As a result of these factors, the old-age dependency ratio is expected to be almost triple (from 5.4 to 16.2) in Bangladesh during the next half century (i.e. from 2000 to 2050). This creates a massive social crisis where the existing support system is insufficient to ensure adequate housing and care for the elderly.

Existing charity based old age homes (which are typically only in urban areas) are not financially poised to cater to the growing need for housing and care for the aging and disabled community. With increased life expectancy, there is also a need to shift from the existing paternalistic approach of care to one that provides them a safe, meaningful and dignified life. Skilled and empathetic caregivers who can provide for the medical and psycological needs of the vulnerable will be central to achiveing this.

There is an urgent need for scalable models that can cater to the unique and diverse needs of the aging community. Recognizing the need, the Government very recently took up initiatives for elderly support system which includes development of housing projects. Salina looks at this as an opportunity to demonstrate and advocate proper management, construction techniques to suit the needs of the elderly.

In order to ensure that housing and care needs are accessible by the elderly with all socio-economic backgrounds, she set up five centers in different geographical settings: rural, urban and semi-urban areas. Her organization, Subarta Trust, has an active search and referral process to identify vulnerable and/or abandoned people, especially disabled, or the elderly

To ensure equity and scale in access, Salina has designed for the first time a cross subsidy model for elderly care. She saw opportunity in leveraging the purchasing power and the caring needs of the middle and high-income elderly to support the financially vulnerable. She has developed a slab system of fees that is levied based on the economic capability of each individual. Individuals with higher socio-economic backgrounds can opt for a package ranging between TK5000 (partially subsidized) up to TK30000 per month and get appropriate service quality and care. The surplus from this is used to support others who cannot pay and in most cases abandoned individuals. However, Salina ensures that all her residents receive a basic quality care. This includes accommodation, dedicated caregiver, nutrition & health monitoring. d. Currently she accommodates about 28 clients with 6 non-payee individuals. In addition to these residential services, Salina also provides at home care for 150 non-residential elderlies. In the pilot project of SPV, Salina has designed a facility for a total of 350 residential elderly people; this includes about 132 people living in comfortable cottages to more economic suit styled rooms in the central building.

Building on the experiences and insights from these centers and to put in place an integrated model to provide safety, service and dignity for the elderly from all backgrounds, Salina launched the Swapnolok Peace Valley (SPV). She has attracted 16 individual investors, each investing about TK6,000,000 to invest in 16 cottages that they could use in their retirement or be leased to the trust in the interim to provide care to the elderly. In addition she has attracted a developer to construct a 13-floor common building which would have a central clinic, research center, training center and 6-floors of economic accommodation for the elderly. She is in talks with the developer to finance the construction of the central building in exchange of a percentage ownership of the economic rooms; only to be used in accordance to the Trust’s policy for elderly care.

Under this model, both the investors and developer have the freedom to re-sell, lease, sponsor individuals or even stay themselves provided they meet the criteria for occupancy. Any transfer of ownerships must be approved by the Trustee where the owners must be a member of the Trust. In managing the facility, Salina is applying a cross-subsidy model for operation expenses. Currently with her 28 elderly people, she is sponsor fully up to 12 elderly people. In SPV, the same concept will apply where the central building would be used as a service center providing a minimum basic service to the elderly; where economically affluent people would be able to customize their packages according to their lifestyle. The Trust will use the proceeds from the fee-paying occupants and use their monthly fees to subsidize those that are not able to pay.

Salina is also building a cadre of skilled caregivers in Bangladesh. She strategically targets and trains destitute women who have their own dependents to become caregivers in her centers and outside. The partnership with Alabama State University to train them, also allows the women to seek job opportunities outside Bangladesh. To further support and incentivize this new cadre of caregivers, Salina set up a center which houses the elderly dependents of her caregivers and a center for their children, providing accommodation and education. The client pays TK5000 a month for salary and additional TK5000 “zakat” (sum which affluent Muslims are required to pay in Bangladesh towards charity) for services to the caregiver. This zakat goes to the trust fund to not only take care of the caregivers’ dependents and also towards their own retirement savings- thus bringing retirement planning for the first time to low income communities. Now with a dedicated training center, she aims to train about 40 caregivers a year.

In allocating the elderly, Salina follows individual profiling which includes their health, psychological, intellectual, cultural and religious backgrounds. She ensures that there is a healthy environment for each individual without any conflicts. She has also developed a process to engage the elderly into activities to keep them engaged and for economic returns. She has setup an elderly entrepreneur unit – where the elderly are involved with making products and services. Recently she has signed two projects with BRAC to produce baby wrapping. Some of her elderly entrepreneurs also participated in the National SME Fair 2013 to showcase their handicrafts products. Salina is currently working to design comfortable clothes for the elderly which will not only be used for her centers but also be sold in the market since currently there is no proper clothing for elderly in Bangladesh. In addition, she is also designing proper measuring utensils for diabetic patients.

Once the SPV is fully functional, she plans to actively engage the Government in appreciating the sensitivity and importance of elderly care. She plans to influence proper building codes for facilities for the elderly. She is already engaging the private sector to understand the importance of investing towards their elderly employees. She believes that whether through CSR, employee retirement schemes or even return-based investments, the private sector will play a vital role in scaling the idea.

While she intends to build at least large center in each of the seven divisions in Bangladesh; she wants to ensure that there is an equal distribution of smaller centers in all the districts, both in urban and semi-urban areas so to ensure that her centers are accessible by most. With the Government also investing on elderly housing, Salina plans to engage to provide valuable insights on the need for proper construction codes and management of these facilities.

Salina was only seven years of age when a visit to the local zoo inspired her to start poultry business. Putting aside her pocket allowance, she invested in a few chickens. Within four years, Salina became a major player and among the first few women in this business with 1500 chickens in her poultry.

However, her father passed away when she was in junior high school and she was married by the time she finished her high school. With her own family to look after and a husband who is a struggling artist, Salina converted her paternal home rooftop to a larger poultry farm. Unfortunately, at the peak of its business in 1988, the poultry was destroyed by the storm and flood.

Later, after a long period as a full time mother, she decided to go into the handicrafts business. Her work grew and her designs were selected by a travelling American designer among 10 other handicraft designs to supply products to the US. Within a few years, Salina’s textile venture flourished and she was receiving international orders, including from Japan. She was also selected as the female entrepreneur of the year in 1999 by a leading media company. During this period, the textile industry was flourishing and she wanted to build on the already positive financial returns she was receiving. To expand her business further internationally she decided to partner with a US based company. However in 2000, she ran into trouble with her partner who was involved in negotiating terms with potential buyers including pricing that Salina was not aware of. In the same year, her new born had a pre-mature death.

After a brief break to recoup from these setbacks, Salina began to recognize that some of her employees from the textile business were still attached to her. This was also so, because Salina had already started a saving scheme for them to provide a secure accommodation post their retirement. She also had a lot of elderly people visiting her business and together with the elderly dependents of her employees; she took lease part of her paternal home and converted it to a care center.

During this time her family had migrated to the UK but Salina decided to stay back and explore this opportunity further. While her visit to the UK, Salina visited a few elderly care centers and decided to bring back some of the best practices there. By the year 2001, she had leased her entire family home and with growing demand began the process to lease new facilities. Since then she has piloted and expanded her work to provide quality care for the elderly.