Over the past several decades, Sub-Saharan African countries have achieved notable improvements in public health, reflected in rising life expectancy. While this demographic shift represents a major success, it also introduces pressing challenges: the region is expected to experience the fastest growth in its older population globally by 2050. Yet formal systems for long-term care (LTC) remain underdeveloped. Most older adults continue to rely on informal, family-based care networks, which are increasingly strained by climate change, economic instability, food insecurity, and high unemployment. Recognizing these challenges, the World Health Organization has called for the development of structured LTC systems in the region. However, building entirely new care infrastructures may not be feasible, as many governments operate under severe fiscal constraints and rely heavily on external funding for health and social welfare. A key question arises: how can sustainable care for older adults be supported in the absence of strong state-led systems?

To date, sixteen Sub-Saharan African countries have developed national policies on aging. However, in many of these contexts, the implementation of these policies remains limited or inconsistent. In response to these gaps, a wide range of non-state actors, including local communities, charitable organizations, religious institutions, and volunteer groups, have emerged to fill the void in elderly care through grassroots or bottom-up initiatives. These efforts often operate with minimal state involvement but play a vital role in meeting the day-to-day needs of older adults who would otherwise be left behind.

Despite their growing presence, limited systematic evidence exists on how these grassroots initiatives function, the extent of their impact, how they are accepted within communities, and whether they offer scalable models for other settings. As the region confronts the dual pressures of aging populations and limited public welfare infrastructure, understanding these models becomes increasingly urgent. This study responds to these gaps by conducting a scoping review of grassroots elderly care initiatives across Sub-Saharan Africa. While it pays particular attention to the sixteen countries with national policies on older persons, the review casts a wider net to capture emerging community-driven models of care beyond formal policy frameworks. It maps the actors involved, services provided, sources of funding, and the enabling or constraining factors they face. The aim is to identify transferable lessons and models that can inform both policy and practice in low-resource settings.

Complementing the review, the study also presents a qualitative case study from Malawi, one of the sixteen countries with a national aging policy. It focuses on a community-led initiative in rural Lilongwe that provides residential care to older adults, particularly those without family support. The initiative engages residents in small-scale farming, which generates income used to fund food, healthcare, and daily operations. Interviews with older residents, caregivers, and staff reveal how care is being redefined in the absence of strong state systems. By linking this case to broader regional findings, the study shows how grassroots efforts can shape care systems. These bottom-up responses offer context-sensitive models that can complement national efforts and inform sustainable LTC approaches across Sub-Saharan Africa.

Public health professional with experience in both qualitative and quantitative research methods. My previous work focused on infectious disease prevention and control in Malawi, where I collaborated with health authorities and development partners. In 2022, I moved to Sweden to pursue a Master’s degree in Public Health. While there, I worked part-time in an elderly care facility, which sparked my interest in the growing but often overlooked needs of older adults in Malawi. This experience inspired my current doctoral research on elderly care systems in Sub-Saharan Africa.

I am currently a PhD candidate in the GROW , a Marie Skłodowska-Curie Doctoral Network that includes 51 researchers across seven universities in the Netherlands. Each of us conducts research in our home countries. My study focuses on how elderly care is structured, delivered, and coordinated in Malawi, with particular attention to bottom-up, community-led models and the role of civil society in filling gaps left by underdeveloped state systems. My work aims to generate insights that can inform policy and improve care outcomes for older persons in Malawi and other resource-constrained settings.