Highlights
- Facilitators of access to healthcare include the availability of public health facilities, social support, financial resources, and having a healthcare provider who is a relative.
- Challenges to accessing healthcare for older people include a lack of essential medicines for non-communicable diseases, ageism in the health sector, absence of geriatricians, and treatment adherence issues among older persons.
- Accessing healthcare is difficult for older people in Uganda due to limitations in the healthcare system and individual challenges.
- To address these barriers, the health system must be strengthened and a national health insurance scheme that covers all vulnerable groups must be established.
Introduction
As life expectancy rises around the world, the proportion of adults aged 50 and over is increasing. In 1950, there were 205 million older persons (60 years and older); by 2010, that number had grown to 810 million. By 2022, it is projected to reach one billion; by 2050, it will reach two billion, outnumbering children aged 0–14.
In sub-Saharan Africa (SSA), the number of older persons has grown from 43 million in 2010 (5% of the population) to an estimated 163 million in 2050 (8.3% of the population). In Uganda specifically, there were 1.1 million older persons in 2002 (4.5% of the population); by 2010, this had increased to 1.3 million and projections show it will reach 5.5 million by 2050 (5.7% of the population).
The World Health Organization (WHO) and United Nations (UN) use age 50 as a definition for 'older person' in SSA countries due to lower life expectancy. The definition of age 60 years and older has been adopted by the Ministry of Gender, Labour, and Social Development in Uganda. This resonates with the retirement age in Uganda – 60 years.
As they age, older persons face a range of health challenges related to non-communicable diseases (NCDs). These have been observed across various contexts— in Uganda and rural South Africa. Yet access to healthcare for such individuals can be limited due to increasing vulnerability in old age and deprivation associated with aging populations. In Uganda, specifically, there is no national health insurance for all citizens. Coupled with persistent ageism within health care systems that ignores or minimizes problems faced by older people, particularly at lower-level facilities, “older persons are just wasting medicines”. This leaves those who are most vulnerable without safety nets or appropriate care for managing NCDs.
Data and Methods
This article is based on qualitative interviews conducted as part of a doctoral study in Uganda in 2014. The study focused on access to healthcare for older individuals in Busia, Kiboga, and Hoima districts. Interviews were conducted with 18 individuals, and seven group discussions were held, involving a total of 52 participants.
The study was approved by the Uganda National Council of Science and Technology. All interviews were transcribed and translated from local languages to English. The transcriptions were analysed using QSR International Nvivo software, using both deductive and inductive thematic analysis.
The analysis was based on the Health Access Livelihood Framework (HALF model), which looks at five dimensions of access to healthcare: availability, affordability, accessibility, adequacy, and acceptability, as well as five dimensions of livelihood assets.
In summary, the study examined how older individuals in Uganda access healthcare and identified factors that affect their access. The findings contribute to a better understanding of the challenges faced by older individuals in accessing healthcare and can inform efforts to improve healthcare services for this population.
Results
Facilitators of access to healthcare
Facilitators of access to healthcare include the availability of public health facilities, social support, support from civil society, access to financial resources such as Social Assistance Grants for Empowerment (SAGE), transportation opportunities, access to village health teams, and having a healthcare provider who is a relative.
Challenges of access to healthcare
Challenges of access to healthcare for older people include lack of essential medicines for non-communicable diseases (NCDs), ageism, absence of geriatricians, treatment adherence issues, accessibility and affordability challenges, acceptability issues, referrals and prescription challenges, and shortage of specialized equipment for NCD screening and testing in lower-level health centres (Mulumba et al., 2014; Wandera, Kwagala, et al., 2015).
Conclusions
Accessing healthcare in Uganda poses significant barriers for older persons due to limitations in the health system and individual challenges. Older persons, who require more healthcare due to non-communicable diseases and functional limitations, face obstacles such as inadequate supply of essential medications, lack of geriatricians, long waiting times, unaffordable services, and discrimination.
There are also social inequalities among older persons in accessing healthcare, including financial constraints, transportation difficulties, physical disabilities, and multiple health conditions. To address these barriers, the health system in Uganda must be strengthened. This includes improving the supply of essential medications, training more geriatricians, reducing waiting times, ensuring affordability, and eliminating discrimination.
Academic and research institutions can play a role in addressing this issue by providing knowledge and expertise. Additionally, the establishment of a national health insurance scheme that covers all vulnerable groups, including older persons, is urgently needed.
Author and affiliation
Stephen Ojiambo Wandera, Makerere University, Kampala, Uganda & Consortium for Advanced Research Training in Africa (CARTA) Graduate.
References
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