Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
PLoS One. 2024 Jun 10;19(6):e0304243. doi: 10.1371/journal.pone.0304243. eCollection 2024.
Beginning the early 1990s, many countries globally adopted the third-generation health sector reforms with a focus of strengthening the primary health care system through community participation. On the contrary, three decades later, primary health care systems in many Low- and Middle-Income countries (LMICs) including Tanzania have remained weak. Specifically, priority setting for the vulnerable groups including the elderly have been weak. We aimed to analyse the prospects and challenges of the priority setting process for the elderly health care services following the 1990s health sector reforms in Tanzania.
We conducted an exploratory case study on priority setting process for the elderly healthcare services in Igunga and Nzega Tanzania. We carried out 24 Key Informant Interviews (KIIs) with the positions of District medical officers, social welfare, Medical Officers in-charge (MOI), planning officers and health system information focal person. Additionally, we carried out two focus group discussions (FGDs), one from each district with six participants from each group. Participants for the FGDs were MOI, health secretary, representative members of Health Facility Governing Committee (HFGC) and Council Health Management Team (CHMT). Data were analyzed using the qualitative content analysis.
Two categories emerged from the analysis of the transcripts. These were the prospects and challenges in priority setting for the elderly population under the decentralized health sector in rural Tanzania. The prospects included; the capacity of the LGAs on priority setting; existence of strategies used by LGAs; availability of teamwork spirit and the existence of guidelines for priority setting at LGAs. The challenges included difficulties of elderly identification, insufficient resources to implement the planned activities at the LGAs, unintegrated digitalized government health information tools or programs at the LGAs, interference of LGAs by the Central Government and low interest of stakeholders on elderly health care.
This study highlights the prospects and challenges facing priority setting for elderly care at the centralized health system in rural Tanzania. From the results the process is well organized but faces some challenges which if not addressed jeopardized and has potential to continue affecting the priority setting. Addressing the challenges highlighted requires joint efforts from both the elderly population in the community, healthcare providers and decision makers across all levels of the health system. This study serves as an eye-opener and calls for a bigger study to get a comprehensive picture of priority setting of the elderly health care in Tanzania.
从 20 世纪 90 年代初开始，许多国家开始实施第三代卫生部门改革，重点是通过社区参与来加强初级卫生保健系统。然而，三十年后，包括坦桑尼亚在内的许多低收入和中等收入国家（LMICs）的初级卫生保健系统仍然薄弱。具体来说，弱势群体（包括老年人）的优先事项制定一直很薄弱。我们旨在分析 20 世纪 90 年代坦桑尼亚卫生部门改革后，老年人医疗服务优先事项制定过程的前景和挑战。
我们对坦桑尼亚伊古恩加和恩扎地区老年人医疗服务的优先事项制定过程进行了探索性案例研究。我们对 24 名关键知情人（KII）进行了访谈，这些人担任地区医疗官员、社会福利、医疗主任（MOI）、规划官员和卫生系统信息协调人。此外，我们还在每个地区进行了两次焦点小组讨论（FGD），每组有 6 名参与者。FGD 的参与者是 MOI、卫生局长、卫生设施管理委员会（HFGC）和理事会卫生管理团队（CHMT）的代表成员。数据采用定性内容分析进行分析。
从对农村坦桑尼亚分散卫生部门老年人人口优先事项制定的分析中得出了两个类别。这些是在农村坦桑尼亚分散的卫生部门下，为老年人确定优先事项的前景和挑战。前景包括：地方政府机构在确定优先事项方面的能力；地方政府机构使用的战略的存在；团队合作精神的存在和地方政府机构优先事项制定的指导方针的存在。挑战包括难以确定老年人的身份、地方政府机构实施计划活动的资源不足、地方政府机构缺乏整合的数字化政府卫生信息工具或方案、中央政府对地方政府机构的干预以及利益相关者对老年人保健的兴趣较低。
本研究强调了在农村坦桑尼亚集中卫生系统中为老年人保健确定优先事项所面临的前景和挑战。从结果来看，该过程组织良好，但面临一些挑战，如果不加以解决，将危及并有可能继续影响优先事项的确定。解决突出的挑战需要社区老年人、医疗保健提供者和各级卫生系统决策者共同努力。这项研究引起了人们的关注，并呼吁进行更大的研究，以全面了解坦桑尼亚老年人保健的优先事项制定情况。
