To guarantee basic rights for older citizens now and in the future in a sustainable way, organizations working with and for older people need convincing evidence. In response to this concern, a group of researchers from Tanzania and Switzerland (University of Dar es Salaam, Ifakara Health Institute, University of Zanzibar, University of Basel and Swiss Tropical and Public Health Institute) have been conducting qualitative research among older persons in Tanzania and Indonesia for more than a decade. HelpAge International Tanzania agreed to facilitate a workshop in Dar es Salaam from 4 to 5 April 2013 to disseminate their findings. Through the HelpAge network, 42 practitioners, policy makers, service providers, researchers, from civil society organizations, the private sector and government organizations convened. The Swiss National Science Foundation sponsored the workshop.
The workshop had three aims: 1) to share and discuss research findings from three projects on ageing, health and care in Indonesia and Tanzania (mainland and Zanzibar); 2) to stimulate a discussion of best practices to improve the home care for older people, and 3) to consult on existing tools for assessing the home care for old people and stimulate further collaboration.
Key research findings
The findings from all three research projects highlighted the heterogeneity of older people aged 60+, the diverse experiences of old age, the importance of flexible and elastic home care arrangements, and the need of linking home care with professional health care services. The category of “old people aged 60+” has to be unpacked because older persons are heterogeneous in terms of age, gender, wealth, education, physical health and even with regard to their experience of old age. Moreover, “old age 60+” is not a fixed condition but a dynamic process, marked by often slow and sometimes very sudden changes in physical and mental well-being, but most often shifting between having and not having the strength of caring for themselves.
Care arrangements have to be flexible and elastic, especially in response to critical health moments: People living in the same household may have to take over certain tasks; people from outside need to come in to provide care; and older people may be moved to those who are able to provide care. The value of solidarity created by marriage and kinship thus has to be cherished. In rural and urban Tanzania, most older couples look after each other, as long as they are physically and mentally able to do so. If the wife dies, old men often marry younger wives. If the husband dies, old women commonly receive support from their daughters, sisters and granddaughters. While female relatives provide practical and emotional care, male relatives give support in physical, financial, logistic and administrative matters.
Although family members may try their best to care for older persons, they lack knowledge in geriatric care. Housemaids may support relatives in caring for elderly persons but they also lack professional training. Even among medical staff in the health facilities, only few have special training in geriatrics. Access to high quality medical care is the exception rather than the rule, even in the cities. Ill or frail older persons face difficulties in reaching a health facility by public transport, and only a few can afford a taxi or a private car. Once they reach there, they should receive free health care but only few older persons benefit from the government’s exemption policy. Even if diagnosis and consultation are free, the elderly patients struggle to pay for the prescribed medicine. After visiting a health facility, patients’ knowledge about their health problems may have increased but nothing can be done due to a lack of measures and means.
Examples of best practices from Indonesia (Dr. Piet van Eeuwijk) and Tanzania (Dr. Athuman A. Pembe) presented different types of professional care provided to elderly by faith-based and government institutions. In Indonesia, nurses played a major role in old age care provision at home. In Tanzania, the DMO of Magu District, with support from the District Council, was able to make improvements in the capacity of health care staff to provide services to old people such as counseling, eye care and other conditions related to old age and in the provision of infrastructure to support friendly services for old people. Through the Council Comprehensive Health Plan 2012/2013, a total of 11,223 identity cards for older people to receive free health services were issued.
Other initiatives in Indonesia (Dr. Piet van Eeuwijk) and Tanzania (Edmund Leverian for Kwa Wazee) are directed at old people’s mutual support groups. Important activities include rotating credits or cash transfers, regular meetings to share experiences, learning activities (e.g. on hygiene, diet, herbal medicine and gardening), home visits and support in accessing health facilities, praying (in Indonesia) and physical exercises including performances of traditional dances (in Indonesia) and self-defence (in Tanzania).
Consultation on home-care assessment tools
The aim of the second day of the workshop was to consult the participants about methods and tools to assess old people’s home care. In the previous projects in Indonesia, in Rufiji and Mbagala/Dar es Salaam and now in Dar es Salaam and Zanzibar, the researchers have developed and continuously refined their interview instruments. They suggested discussing the latest version of the tool with the participants who have a lot of experience and expertise with and for older persons.
The participants formed three groups and brought their insights back into the plenum. The overall feedback was that home-care assessment tools can generate much needed evidence but they should be clearly targeted. For monitoring and evaluation purposes, an easily understandable and applicable version would be most suited.
For the research teams:
Andrea Grolimund, Brigit Obrist, Jana Gerold, Sandra Staudacher, Piet van Eeuwijk and Vendelin T. Simon.