Better Health for Older People Tanzania Case Study

Better Health for Older People, Tanzania Case Study Presented at the International Association of Gerontology and Geriatrics 2 nd Africa Region Conference 6 -8 December 2016, Nairobi, Kenya #olderpeoplecount

Brief Outline • Project Title: Better Health for Older People in Africa is a regional project implemented in Ethiopia, Tanzania and Mozambique • It and aims to improve access to health and care services for poor older women and men in their homes, making them less vulnerable to illness and worsening poverty. • • • Project Period: 2014 -2017 Donor: DFID Home Based Care (HBC) is a significant component of the BHOP Programme. This component primarily targeted people living with HIV/AIDS but has since expanded its scope to respond to new demands created by a declining HIV/AIDS prevalence and increasing NCDs #olderpeoplecount

Working with health stakeholders it works to: • Ensure a healthy active older age by supporting all clients regardless of their health status, maintain their functionality for as long as possible. • Establish NCDs as a key health priority (for example, through the Program’s influence NCD medication for older people is now on the Essential Drug List). • Support older people’s care within families and communities. • Enable age-friendly access to medical and other services. #olderpeoplecount

BHOPA as an integrated approach • Support OP’s access to income through (kitchen gardens and fish ponds, etc. ) to enable poor older people earn a living and access affordable nutritious food. #olderpeoplecount

Management and Coordination • 36 HBC Coordinators mostly registered nurses or clinical officers are appointed to support and supervise the volunteer community HBC providers • • They monitor and review their HBC activity reports. • Information generated by HBCs is discussed at OPFs meetings at village levels, Local Council CHMTs and at annual National Health Stakeholders meeting The monitoring information collected are reported to the Mo. H through the HBCs reporting forms #olderpeoplecount

Operation who provides what care to whom • Operating in 4 districts of Mainland Zanzibar the programme supports about 4, 551 older people/clients at different stages of the HBC services, 1, 109 f whom have been part of all three cycles of the program (gone through 3 years). • Care is provided by 425 (227 females) trained HBC volunteer providers (aged between 45 to 70 yrs) who, either directly or through linkages with other services, ensure that client physical, emotional, social and spiritual needs are addressed. #olderpeoplecount

Scope (cont’d) • Programme selects volunteer HBCs through the involvement of Older People’s Forum, community leaders and village health committee leaders • It draws its credibility from its consultative approach ensuring community volunteers do not have too far to travel to provide care as they live in the project area. • HBC providers are trained using the national HBC standards outlined in the National Guideline for Home Based Care Service Providers to ensure quality of care. • Training is conducted by trained trainers accredited by the Ministry of Health and is run for one week and another week for follow-up. #olderpeoplecount

Scope (Cont’d) • The HBC provider visits the home and introduces himself/herself and explains how the HBC progrmame operates • Involves the client/older persons and the family care givers in the planning of the care programme • The HBC Provider accompanies the older person for a mandatory health screening to the nearest facility • Using skills used from the training the HBC also screens cognitive ability and functionality • Vulnerability check is conducted to identify opportunities for linking the individual to other social care mechanisms such as IGAs and psycho-social and active ageing programmes operated by the programme #olderpeoplecount

Scope (Cont’d) Types of Care Services Provided • Management of bed sores • Simple physical exercises Assistance with activities of daily living such as eating, feeding and bathing • Medication assistance including taking medicines, and escorting to doctor appointments • • Emotional companionship and spiritual support • Clients are also encouraged to engage in active ageing clubs where they socialize, prepare and eat meals together, discuss their health needs and are sensitized by health workers on exercise, nutrition etc. Housework and personal care such as grooming particularly for solo-living older people. #olderpeoplecount

Scope (Cont’d) • Each HBC Provider is allocated 15 households and visits each 2 -3 times per week • HBCs receive HBC kit containing BP and weighing machines, oils, spirit, mouth wash and cotton wools • They use patient cards to document all care activities undertaken in a client’s home and submit their monthly reports through HBCs monitoring forms to HBC coordinator located at a health facility who in turn reports to the Mo. H. • Clients for HBCs are identified by pre-established structures utilized for HIV/AIDS HBC (where local leaders nominated people within their community to be trained as caregivers) routines as well as through incoming HBC providers. #olderpeoplecount

Financing • The HBC model works primarily on volunteerism. However, the training, supporting supervision and the day to day support to the HBCs is co-financed between the BHOPA and the Local Government through the Health Facilities. • The local council finances the salaries of staff who train and supervise, providing drugs and other medical requirements while the project supports the primary HBC kits, the training costs and mobilization of older people through their Older People Forums to provide psychosocial and some physical supports. #olderpeoplecount

Provision of quality care • The BHOP has developed tools for assessing health facilities and services on their age friendliness. • As a result many health facilities have had their health workers trained on provision of services to older persons, • They have subsequently established a no-queue policy for older people, and recognize the need to provide special attention to Better Health clients. • The age friendliness in delivery of services as well as client satisfaction are assessed every 3 months by registered older people monitoring groups (OPMG) who building on monitoring information provided monthly by the trained HBC clients #olderpeoplecount

Providing integrated care • The Better Health Program is working to change the attitudes of older people towards the healthcare system but also of governments and healthcare staff, towards older people. This work encourages the government to invest in the healthcare of older people and create long-lasting change. #olderpeoplecount

Ensuring equity in access to the care service • Programme targets poor and bed-ridden older people who in many cases have no dependents, the BHOPA HBC component also has on board clients with functional impairments #olderpeoplecount

Ensuring decent, fair working conditions for care workers Evidence from the programme is shared at the national level (through annual national health stakeholders meetings). The Mo. H has begun designing the Community Health Care package. This is expected to assimilate the HBC model into the Health system and by so doing the conditions of HBCs will be improved including providing them with some allowances and other incentives #olderpeoplecount

Views of clients and family members on LTC service vis-à-vis customary norms of family care obligations • The BHOPA HBC work draws on the strengths of families and communities. • Its goal is to provide hope through goodquality and appropriate care that helps clients and families maintain their livelihoods and the best possible quality of life. • HBC clients receive care and treatment in a familiar, supportive environment that promotes self-care and prevention. • Clients can continue to participate in family matters, and they maintain a sense of belonging within their communities. #olderpeoplecount

Views of clients and families • HBC strengthens family ties and family attachments, • Enables family members accept the client’s condition. • The family members gain skills and knowledge from on chronic illnesses, care and support. This helps them to keep the cost of medical and other care-related expenses. • Many OP live alone due to migration, HIV and AIDS and are left in the care of neighbours who are unable to provide LTC due to lack of necessary skills and time. #olderpeoplecount

Views…. (Cont’d) • This model is perceived so positively in almost all the communities. Equally the client appreciates the scheme commenting it to be complementing the family which used to provide for these services. #olderpeoplecount

Opportunities and Challenges for future sustainability Programme Successes • Securing better access to health services for older clients. • Helping more than 12, 000 older people gain access to quality HBC. • Working towards significant policy changes that enable older people to access free or subsidized services. • Initiating the development of tools for assessing quality and age-friendliness of health service provision #olderpeoplecount

Success (Cont’d) • Influencing the practice of government and local councils • Improving health training for HBC providers and health staff. • Building strategic partnerships with leading agencies such as the Diabetic Association of Tanzania, the NCD Alliances of Tanzania and WHO to advance work on NCD among older populations. #olderpeoplecount

Prospects for programme continuity post BHOP • There are prospects of current efforts influencing policies/strategies at national and local levels. • There are positive indications that the government will incorporate a HBC component in the Nurses Training Curriculum. • This likely will enable HBC providers to be officially recognized as health workers thereby qualifying for remuneration. #olderpeoplecount

Prospects for programme continuity post BHOP • Second, there has been a high uptake of the HBC component by local councils, clear signs that the model will be adopted, implemented and sustained in future. • Last, HBC older beneficiaries hold the program in high regard and openly appreciate the benefit it has added to their lives by providing long term care #olderpeoplecount