They "don't cure old age": Older Ugandans' delays to health care access
About the Presentation:
Purpose of study: Uganda’s population is aging, which comes with increasing and varied burdens of disease and health care needs. At the same time, gerontological care remains neglected. This paper examines the factors that cause older Ugandans to delay health care access.
Design and methods: We conduct a thematic analysis of data drawn from nine focus groups held with rural Ugandans aged 60-plus. Our analysis highlights the factors that delay older persons’ access to health care, and how these align with the Three-Delay Model, which was developed to assess and improve obstetric care in low-resource settings.
Results: Our participants report delays in (I) deciding to seek care related to mobility and financial limitations, disease etiology, severity, and stigma; (II) reaching care because of poor roads and limited transportation options; and (III) receiving appropriate care because of ageism among health care workers, as well as poorly staffed and undersupplied facilities.
Implications: Delays to care are complex and impacted by factors at the individual, community and health system levels. We argue the need for multipronged interventions that will address these delays, improve access to care, and ultimately enhance older Ugandans’ health and wellbeing.
About the Speaker:
My research brings a gendered lens to examining the social and structural impacts of HIV on older persons’ physical health and social well being in South Africa and Uganda. South Africa has high HIV prevalence (about 19%), but also a strong set of social welfare programs, which older persons can access. Uganda has a lower overall HIV prevalence rate (about 7%), but also fewer social welfare programs. Thus, it is important to understand the ways that casework for others, the loss of careers, and household dynamics in the context of poverty, migration, and the HIV epidemic affect older persons health and well being. Much of my work focused on the impact of HIV on older persons, their roles and responsibilities in households affected by HIV, and the ways that social welfare mediated their health and other needs. More recently, my work has begun to focus on the fact that the aging of African populations and roll out of antiretroviral treatment (ART) for HIV has meant an increasing number of people aging with HIV, as well as larger numbers of those being infected at older ages. The health needs of these populations are significant; the UNAIDS 2014 Gap Report singled out older adults as a population that has been “left behind”, and who will require more attention if HIV response goals are to be met. My projects in Uganda and South Africa are among the first to focus explicitly on the barriers for older persons to ART access and adherence. As a result of this work, my colleagues and I plan to develop interventions to improve older persons ART access and adherence, as well as their overall health and well being. I will spend June-December 2017 at the University of Western Cape’s School of Public Health (Cape Town, South Africa) on a Fulbright Fellowship investigating these issues.