Tanzania - Older People's Right to Health

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Tanzania - Older People’s Right To Health

Ms Teresa Minja, Tanzania Social Protection Network

Paper prepared for the panel discussion: The right to health: in conversation with older people, 2^nd August 2011, Second Working Session of the Open-ended Working Group on Ageing, 1 – 4 August 2011

Introduction

The Universal Declaration of Human Rights (1948), Article 25(1) states that “Everyone has the right to a standard of living adequate for the health and wellbeing of himself and that of his family, including food, clothing, housing, medical care and necessary social services…”

There are now more than 11.4 million Tanzanian’s living below the basic needs poverty line, and a substantial proportion of these are older people. Today 4.66 % of Tanzania’s population, are older people over 60 years old, the majority of whom are estimated to be among the poorest. Population projections indicate that by 2050 11% of the population will be over 60. Approximately 90% of older people live in rural areas of the country. Older people, people living with HIV (PLWHA), orphans and vulnerable children (OVCs) and people living with disabilities, particularly women, are most vulnerable to the multiple effects of poverty, including food insecurity, and limited access to health and education. Their extreme poverty is often compounded by exclusion and discrimination. [1][1]

The intergenerational poverty cycle is exacerbated by HIV/AIDS, which has resulted in older people caring for their sick and dying children and their grandchildren. In Tanzania 14% of all children are orphans, of which 53% are cared for by grandparents.[2][2] Families struggle to meet the cost of schooling with the result that increasing numbers of orphans and vulnerable children (OVCs) are unable to access primary education.

In Tanzania the National Ageing Policy issued in 2003, states clearly that older people are to receive free medical services. Older people’s right to health is protected under this statement. But we find older people often being denied this right due to circumstances beyond their control.

This paper will discuss the extent to which the right to health is accessible and available to older people in Tanzania and make recommendations on how to improve their enjoyment of this right.

Accessibility

· In the National Strategy for Growth and Reduction of Poverty (NSGRP) I it was planned that the furthest health facility would not be more than 5 km from any household. This has not been achieved. Due to the poor infrastructure, especially in the rural areas many older people are unable to accesses health services. We hope this target may be achieved in NSGRP II.

· Due to poor infrastructure, lack of reliable transport and acute poverty, a substantial number of older people cannot afford to pay their fare to get to hospital even though some arrangement would have been made for them to receive free medication. Worse still, the main diseases facing older people require attention of a fully qualified medical doctor at either a district or regional hospital. Unfortunately these hospitals are very far from where the majority of older people live. The implementation of the Government’s intention for a mobile/ outreach service has not started in any district although it was ordered by the Prime Minister in 2010. We also expect an improved network of health facilities so that older people do not have to walk long distances to get health services.

· There is also the problem of identity. In Tanzania, old age is defined as over 60 years old. Some older people visiting health facilities could not establish their ages, hence they were not getting free health services. Under the NSGRP, local governments have been urged to issue identity cards to all older people to enable them to access free health services. So far very few districts have done so.

· In Tanzania, the Government has directed that older people receive free health services from all government owned health facilities. However from the View’s of People Report 2007, only 15% of older people were able to access free health services, as against 100% planned in the National Strategy for Growth and Reduction of Poverty (NSGPR 2005). This has been revised and we hope the target might be achieved by 2015.

· Older People in Tanzania are very poor. As a result many of them cannot afford to buy medicines. We are now fighting to get a universal non-contributory pension for all older people. When this comes through, which is expected probably next year, it will bring some relief.

· Privately owned health facilities cover 40% of all medical services in Tanzania, however they are not compelled by any policy to provide free treatment to older people. This denies access to medication for poor older people who live near to these private/ religious owned health facilities. Special arrangements need to be set by the Government to allow older people to access free medication at these private health facilities. Such arrangements exist for pregnant mothers and children under five years, but not for older people.

Availability

· Currently, older people are visiting health facilities but the drugs they need are not available. Statements like “there are no medicines for old people” or “we only have medicines for your grandchildren” or “how much longer do you want to live” are still common in some areas.

· In many parts of the country, drugs for the diseases that affect people in advanced age are not given priority when health facilities are placing drug orders from the Medical Store Department. As a result it is very difficult to find such drugs especially in the dispensaries and health centers and district hospitals. This is unfair. Tere is a need for sensitizing health personnel to include such drugs on their priority list.

· There is also inefficiency in the system for ordering drugs and other hospital equipment from Medical Stores Department. Hospitals, health centers and dispensaries complain of their orders not being met by the Medical Stores Department. In my view, prescribed medicines have to be purchased from drug shops in the event that the MSD cannot deliver them in time.

· Because free medication is not available in most cases, older people have to buy the medicines prescribed privately. In Tanzania most health service facilities are under Local Government Authorities. A few authorities have established a Community Health Fund. This is a system where a member of a family contributes an agreed amount and the central Government contributes the same amount. With this fund four members of the family can be treated for one year. Where this system exists, older people have been able to receive good treatment even where it meant buying the medicines from drug suppliers.

· Countrywide, there is a shortage of trained health personnel, doctors, nurses and health workers, especially in age-related illnesses. Although the Government has ordered that special rooms be allocated for treating older people, the implementation of this directive has faced many challenges some of them are as follows:

1. Acute shortage of medicine

2. Shortage of staff

3. Lack of medical staff with geriatric knowledge, particularly in rural areas

4. Reluctance of some medical staff to allow older people to access Medication without paying money

5. Lack of fare to travel to hospital to access services

6. Low priority for the drugs related to diseases that affect people at advanced age.

Recommendations for Action

1. Our National Aging Policy (NAP 2003) provides for free health services to older people over 60 years of age. But since this is just a policy, it does not oblige health care providers to give free treatment to older people. The Government is yet to enact a law that will enforce implementation of the National Aging Policy. Age care organizations in the country are requesting the Government to speed up the process of enacting such a law.

2. As stated earlier, older people were not aware of their health rights, few were visiting health facilities. Currently older people are becoming more and more aware of their health rights and going to hospital for treatment. It is therefore very discouraging to note that there is still an acute shortage of the drugs they need. In this context older people are requesting to be represented on the MSD Board to ensure adequate age-related drugs are stocked and supplied to health facilities. Older people should also be represented on all health committees at wards and district council levels.

3. The Government should train more staff in geriatric care, and assure that referral hospitals have specialists in geriatric care.

4. There is a need for the Government to increase the budget allocated to the health sector to 15% as per the Abuja agreement, and increase supervision to minimize the shortage of drugs that is related to corruption.

Conclusion

In Tanzania a lot has yet to be done on the part of the Government to ensure provision of free and quality health services to all older people. The accessibility of healthcare for older people’s and availability of quality health services all hinge around the organizing and mobilizing of older people and their communities to stimulate an engaging demand for quality health services; sensitizing service providers and health facility officials to positively respond to the health rights of older people and ensuring that the local government plans and budgets have resources for enabling appropriate lasting health services to older people and their families.

I appreciate this conference because it puts older people’s health agenda in the open.