NATIONAL POLICIES ON AGEING AND OLDER PEOPLE IN TANZANIA.

Although the Tanzanian Government has recognized older people in its various policies and strategies, still there is no coherent system for these government policies, registrations, strategies, directives of executive government leaders at national, regional or district levels (e.g. Prime Minister, Regional or District Commissioners, etc), and programmes to effectively deliver consistent and good quality of services for all older people in the country.

Significant government documents, policies, directives and support mechanisms under discussion include the following:-

• The Constitution of URT 2005 English edition.
• National Ageing Policy (NAP) - 2003.
• Millennium Development Goals (MDGs).
• MKUKUTA phase 1(2005 -2010) and phase II (2010 – 2015).
• Public Service Reform Programme (PSRP).
• Local Government Reform Programme (LGRP).
• Prime Minister`s Speech of 1^st Oct. 2010.
• National Health Policy – 2007.
• Cost Sharing and Community Health Fund (CHF) – 2001.
• Primary Health Service Development Programme (PHSDP) 2007-2017.
• Health Sector Strategic Plan (HSSP)-2009-2015.
• National Strategy for Non - Communicable Diseases (NCDs) 2009 – 2015.
• National Eye Care Strategic Plan (NECSP)-2010 -2015.
• TACAIDS Policy _ 2001 and 2010.

            Brief notes for each of the above mentioned documents are given here    bellow:-

a)   . The Constitution of URT ( 2005 English edition)

Under section 11 (1) of the URT Constitution consideration for the older age says:-

‘’The state authority shall make appropriate provisions for the realization of a person's right  to work, self education and social welfare at times of old age, sickness or disability and in other cases of incapacity. Without prejudice to those rights, the state authority shall make provisions to ensure that every person earns his livelihood.’’

b) The National Ageing Policy (NAP) published in 2003: This is a comprehensive document on Age and Ageing Policy in Tanzania. As for health sector, the policy addresses negative attitudes of health care providers as a key concern and sets out healthcare rights for older people, including free healthcare at all government health facilities for people aged 60 years and above. However, the policy is not yet regulated and still lacks legislation which would specify the minimum standards and framework for implementation across the national by the central and local government authorities and other stakeholders.

c) Tanzania Vision 2025 is a document providing direction and philosophy for the long –term development of the country. Among other things, Tanzania wants to achieve by 2025 a high quality of livelihood for all Tanzanians (which means, the elderly included).Health is identified as one of the priority sectors contributing to a higher quality livelihood for all Tanzanians.

d) Millennium Development Goals (MGGs) 2000 – 2015. This is a UN document with eight goals that all 191 UN member states (Tanzania included) have agreed to try to achieve by the year 2015. The United Nations Millennium Declaration, signed in September 2000 commits world leaders to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. The MDGs are derived from this Declaration, and all have specific targets and indicators.

The MDGs also provide a framework for the entire international community to work together towards a common end – making sure that human development reaches everyone, everywhere. If these goals are achieved, world poverty will be cut by half, tens of millions of lives will be saved, and billion more people will have the opportunity to benefit from the global economy.

The eight MDGs goals being:-

• Goal 1: Eradicate extreme poverty and hunger.
• Goal 2: Achieve universal primary education.
• Goal 3: Promote gender equality and empower women
• Goal 4: Reduce child mortality.
• Goal 5: Improve maternal health.
• Goal 6: Combat HIV/AIDS, malaria and other diseases.
• Goal 7: Ensure environmental sustainability.
• Goal 8: Develop a Global Partnership for Development.

e) National Strategy for Growth and Reduction of Poverty (NSGRP) or community called MKUKUTA-Mkakati WA Kukuza Uchumi Na Kupunguza Umasikini Tanzania (MKUKUTA) is a national strategy emphasizing on improving quality of life and social wellbeing with particular focus on the poorest and national most vulnerable groups.

MKUKUTA phase I (2005-2010) sets:

v  40% of eligible older people reached with effective social protection measures by the year 2010(pg. 38).

v  Access health services by 100% of eligible older people provided by specialized (trained) medical personnel by 2010 (pg.39).

Unfortunately, the dissemination, resourcing and implementation of this strategy remain patchy across the country.

As an example, under health service regulations, people aged 60 years and above are entitled to free medical treatment in government health services. In the Views of the People 2007, the Survey reveals that only 10% of elderly people respondents had received free treatment; 48% were

unaware of their rights to exemptions from medical fees; 18% had been refused treatment in government facility because they could not afford to pay for services, and 13% indicated that they had been refused free treatment due to lack of proof of their age (pg. 44).

Unavailability of drugs at all government health facilities proves to be an outstanding cry and challenge countrywide.

MKUKUTA phase II (2010-2015) sets to implement the gaps and focuses to provide adequate social protection and rights to vulnerable and needy groups including older people.

f)    Public Service Reform Programme (PSRP).

g) Local Government Reform Programme (LGRP).

h) National Health Policy –(2007): In this Policy of the Ministry of Health and Social Welfare ,it considers the need for the provision of health services to older people although implementation faces a number of constraints such as poor administrative structures and procedures ,unnecessary bureaucratic obstacles, unavailability of proper medical services and medication , as well as reluctance of health care staff and local government officials to adequately deliver to older people their entitled services.

i)    Coast Sharing and Community Health Fund.

     Cost Sharing.

Description.

Cost sharing in government health facilities was introduced in 1993. This revised

the previous health financing policy that aimed to provide health services free to all from all government health facilities. The previous policy was deemed unrealistic as GOT financing was insufficient to truly provide all services for all of the population, and the policy resulted in poor quality and inequitable health services delivery. Attempting to cover everyone with free essential health services resulted in poor quality care and poor coverage. The poor suffered the most, as they had fewer alternatives, whereas the wealthier members of the population could opt out of the government system and pay private providers. The objectives of cost sharing are to (i) generate additional revenues to bridge the gap in government allocation, (ii) improve availability and quality of health

services, (iii) strengthen the referral system, (iv) rationalize utilization of health care services, (v) improve equity and access to health services by pooling financial risk and cross-subsidizing costs and (vi) strengthen community voice (users/payers) towards improving service quality and provider’s accountability.

Exemptions:

The scheme charges fee for service (1) for different health services in

government health facilities. However, the government has mandated that the following are exempted from paying fees at any government facility; all children under the age of five, pregnant mothers including deliveries , vulnerable groups that can not afford to pay because of income, particular diseases that drain substantial income from the patients, such as chronic diseases (e.g., tuberculosis and AIDS),and any disease if it is an epidemic.