The effect of elderly exemption policy on access to and utilization of health care services in Tanzania

Abstract

Exemption from and waiver of social service cost for elderly people have been implemented in Tanzania for the past three decades. In order to facilitate the exemption of the elderly from paying for health services, the then Ministry of Health directed all districts in Tanzania to issue identify cards (IDs) to the elderly in order to address the challenges already observed in the implementation of the exemption and waiver policy. Despite an increase in demand and popularity of the IDs among elderly people, it was not clear whether this new mechanism offered the elderly access to health services. This paper examines the implementation of this policy in Mbarali and Ubungo districts in Tanzania. The study adopted a mixed method approach using surveys (n=879) and semi-structured interviews (n=23). Quantitative data were analysed descriptively and qualitative data were analysed thematically. It was found that elderly identity cards have only improved physical access to health facilities through simplification of identification. Shortage of health care services, particularly medicines and medical supplies, long waiting time due to shortage of staff and the use of unfriendly language by the health care workers, have caused negative perceptions of the elderly towards the exemption policy. The use of elderly IDs has not solved the earlier observed challenges facing the exemption policy for the elderly population. It is recommended that the government needs to work more to improve the quality of health care services for the elderly in public health facilities. Key Words: Elderly Identity Cards, health care services, Tanzania