Research presentation to the University

CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Like other developing countries in the world, the population of older persons in Uganda is
increasing. According to the 1991 Uganda Population and Housing Census, the population of
older persons was 686,260 (4.1%) of the total population of 16,671,705. This population
increased to 1,101,039 (4.6%) as per Uganda Population and Housing Census results of
2002. The Uganda National Household Survey (UNHS) Report 2005/06 estimated the
population of older persons at 1,200,000 of which 53% were female while 47% were male.
This population increase has profound consequences at individual, community and national
level.
According to Rowland and Lyon, 1996, globally, poor access to health services among the
elderly has been well documented. The primary reason for this poor access is lack of health
insurance, either employer-sponsored or public. Approximately 16% of Americans aged 65
years were uninsured in 2000. A large percentage of working-age Americans without
coverage have histories of chronic conditions, including diabetes, heart disease, and
depression. The vast majority of these people delayed or did not receive needed care because
of cost. Although the most important factor affecting the ability to use health services is lack
of insurance, other factors have also emerged. Factors highly correlated with lack of
insurance, including race, income, and other socio-demographic characteristics, have been
associated with lower health services access in elderly populations
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In Africa, according to the study conducted by Help Age International, 2000 report, there are
series of factors contributing to poor access to health services among the elderly, some of the
key factors are mainly due to being unable to pay for transport to get to the health Centre, or
for the medication, lacking the right identity especially not knowing how old they are to
qualify them as elderly people - documentation to prove their eligibility for free or subsidized
services, being unaware of what they are entitled to, being physically unable to queue for a
long time while waiting to be seen, or to take an arduous journey to the health centre by
public transport being geographically isolated from services, with a lack of public transport.
These factors are compounded by the fact that health care staff may not be trained in geriatric
care, and may discriminate against older people. In Mozambique, over 47 per cent of elderly
persons regardless of all the limiting factors, reported degenerative effects of ageing such as
hypertension, anaemia, diabetes, among others.
According to L. M. Waweru, E. W. Kabiru, J. N. Mbithi and E. S, the East African Medical
Journal (February 2003), in East Africa the situation of poor access to health services by the
elderly is compounded with a lot of factors influencing even a poor health seeking behavior
among the elderly, functionally, most elderly persons in Kenya, Tanzania and Uganda are
similarly independent in activities of daily living whereby they feel satisfied with their
current way of life therefore perceiving themselves as healthy even when they are having a
lot of ailments. It is observed that much of the failures in access to health services among the
elderly in Uganda are tagged more on the nature of their economic dependency, loneliness
and resented in the society due to their old age perceived as unproductive by the society, lack
of health facilities for the elderly in the community hence giving a lee way for a poor seeking
behavior and access to health services.
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1.2 Statement of the problem
Despite an improvement in government efforts to scale up health services in Kasese district
with medical supplies, improved number of health personnel, the problem of access to health
services among the elderly still exists. There is perceived lack of quality of care and
availability of drugs, perceived lack of skilled staff in existing health facilities especially
handling illnesses associated with ageing, late referrals of critical health problems, health
workers’ attitudes, costs of care and lack of knowledge (Kiwanuka SN etal, 2008) However,
the causes of such factors still remain uncertain. This therefore necessitated an immediate
research to establish the reality of the matter in Katiri Ward, Bulembia Division Kasese
Municipality.
1.3 Objectives of the study
1.3.1 General objective
The overall objective of the study was to examine the factors contributing to poor access of
health services among the elderly in Katiri Ward, Bulembia division Kasese Municipality.
1.3.2 Specific objectives
1. To examine the levels of availability of health outreach programs to the elderly in Katiri
Ward, Bulembia division.
2. To assess the prevailing operational and existing conditions of health facilities in Katiri
Ward, Bulembia division.
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3. To assess the contribution of implementing government developmental and health related
programs targeting the elderly in improving their income levels to meet health related
costs in Katiri Ward, Bulembia Division.
1.4 Hypotheses
1. Availability of health outreach programs in an area significantly affects access by the
elderly in Katiri Ward, Bulembia division Kasese Municipality
2. Operational and existing conditions of health facilities significantly affect access to
health services by the elderly in Katiri Ward, Bulembia division Kasese Municipality.
3. Implementing Government development programs targeting the elderly have a significant
effect in meeting their health related costs in Katiri Ward, Bulembia division Kasese
Municipality.
1.5 Significance of the study
1. This study would provide the community stakeholders, planners, policy makers and other
development partners with information on levels of availability of health services to the
elderly in Bulembia division, which will contribute in guiding the process of effective
planning for better services delivery to the elderly.
2. It would also point out the need to formulate policies that will target on the health needs
of the elderly in Bulembia division and Kasese Municipality in general.
3. The study findings would also provide a basis for service providers to understand their
areas of weaknesses and strengths during service delivery to the elderly and be able to
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take into account new approaches and procedures in ensuring access and utilization of
health services by the elderly.
4. The study findings would contribute to the board of knowledge in the field of access to
health services as a cross cutting issue to all people in the community.
5. The study was conducted by the researcher as a requirement for the fulfillment for the
award of a Bachelor’s Degree in Development Studies of Bugema University.
1.6 Scope of the study
This study was conducted in Katiri Ward, Bulembia division Kasese municipality in Uganda.
The content of the study was confined to establishing the levels of availability of health
services, the operational and conditions of health facilities and contributions of implementing
government development programs with participation of the elderly in raising their income
levels to meet health related costs. The target population for this study were the elderly
persons aged 60 years and above in accordance with the National Policy for Older Persons
(Republic of Uganda – Ministry of Gender, Labour and Social Development April 2009)
health workers, local leaders and other members of the community in Katiri Ward, Bulembia
division Kasese municipality. The study was carried out in the period of January to August
2013
1.7 Limitations of the study
1. The study was limited due to insufficient financial resources to support the researcher in
areas of transport costs, timely communication to coordinate with the target groups;
however, this was addressed by cutting on other expenses like lunch during field travels.
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2. The other limitation was the issue of time, given that a lot of things were going on during
the study which required more time to be able to handle, however this was overcame by
having a clear work plan which the researcher followed effectively and did what was
expected as planned, where and when.
1.8 Theoretical framework
The study was guided by the Sick role theory of Parsons (1951), which was viewed
appropriate for this study because it examined the aspects associated with health care access
and utilization which was also in line with the objectives of this study. In this theory, Parsons
postulated that when any individual is sick, they adopt a role of being ill. He continued to say
that this sick role theory comprises of six main components:
1. The individual is not responsible for his/her state of illness and is not expected to be able
to heal without assistance from a health worker.
2. The individual is excused from performing normal roles and tasks;
3. There is general recognition that being sick is an undesirable state therefore it requires
seeking for health services from a qualified health worker.
4. And to facilitate recovery, the individual is expected to seek medical assistance and to
comply with medical treatment.
5. That it is possible for the sick individual and the professional health care provider to have
differing opinions of the illness depending on the diagnosis outcomes.
6. The belief that following a particular health recommendation would be beneficial in
reducing the perceived threat, and at a subjectively-acceptable cost. He explained cost as
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perceived barriers that must be overcome in order to follow the health recommendation;
it includes, but is not restricted to, financial costs.
Parsons, in his Sick role theory therefore went ahead and explained that culture,
economics, access, perceptions, knowledge, and belief in efficacy, age, gender roles, and
social roles are all among the extensive list of factors influencing both the choice to seek
health care and the assessment of which health care option to utilize for prevention and
treatment of illness.
1.9 Conceptual Framework
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Figure 1: Conceptual framework below shows the levels of availability of health outreaches,
health centers existing conditions, and development programs targeting elderly in accessing
health services.
Independent Variables (IV) Dependent Variables
(DV)
Source: Developed by the researcher
Source: Developed by the researcher
The above conceptual framework shows that the levels of availability of Outreach health
programs like the presence of relevant elderly health medicine (Geriatrics) in our local health
facilities and the distance covered to access such medical care contributed to an increase in
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1. Levels of availability of outreach
health programs
• Geriatric medicine
• Short distance to services
• Early diagnosis & prevention
2. Health facilities’ operational and
existing conditions
• Attitudes of health workers
• Competence in diagnosis
• Motivated health workers
3. Government programs targeting
the elderly
• Elderly active participation
• Programs ownership
• Increase in produce to the markets
for incomes
Elderly’s access to health services
• Increased utilization of health
services
• Reduced time taken to get the
services
• Better customer care
• Effectiveness
• Quality Services
• Commitment
• Elderly’s improved livelihoods
• Ability to meeting health costs
• Sustainable development

the uptake of health services by the elderly and this will also impact on the time spend in the
process of receiving medication.
It also shows us how operational and existing conditions like health workers’ attitudes
towards clients/patients and their competences in diagnosing the elderly’s sicknesses would
positively determine their effectiveness and better customer care approaches, later this would
effectively motivate the elderly in accessing health services. Further, as health workers in
health centers are well motivated with better pay and relevant refresher courses would
strengthen the commitment and quality of work which subsequently improves better health
standards of the elderly as they increasingly access and utilize the health services.
On the other hand, it was believed that when health workers are not motivated and subjected
to working long hours, their quality of work, and attitude towards clients would be
compromised which later affects their effectiveness and commitment at work; hence the
elderly would be demotivated in the process of accessing and utilizing the services.
However, the framework also shows a direct impact of the development programs targeting
the elderly to their access to health services. As elderly are involved in implementing
development programs, the more they will own them, their access to markets will increase,
which has a direct benefit to their livelihoods in terms of improved income levels and at the
end, the elderly will have the ability to meet health related costs.
1.10 Operational definition of terms
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1. Socio-demographic characteristics: These are variables which includes age, ethnicity,
sex, socioeconomic status, marital status, and family size among others.
2. Geriatric medicine: This is a type of medicine that aims to promote health by preventing
and treating diseases and disabilities in older persons.
3. Diagnosis: This is the identification of the nature and cause of anything. Diagnosis is
typically used to determine the causes of symptoms, mitigations for problems and
solutions to issues.
4. Elderly: According to this research, an elderly was that person considered to be aged 60
and above
5. Access: According to this research, this meant a person aged 60 and above getting health
services from the competent health facility personnel from either a private or public
health facility.
6. Efficacy: According to this research, it was the ability of a drug to reproduce a desired
effect in expert hands and under ideal circumstances.
7. Spur: This is a word used to encourage someone to attempt something
CHAPTER TWO
LITERATURE REVIEW
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2.1 Introduction
This chapter presents the review of other related literature on the contributing factors to poor
access of health services among the elderly. The researcher reviewed a number of books in
order to obtain relevant literature on levels of availability of health outreach services to the
elderly, existing and operational health facilities’ conditions and their effects of access by the
elderly and participation of elderly in implementation of developmental and health related
programs and their impact in meeting their health related costs.
2.2 Levels of availability of health outreach services to the elderly.
According to Ellen Unruh et al, (2001), Community-based outreach is to increase health
insurance coverage, it was important to clarify what was meant by “outreach services”. In
this study, the term was used to describe any type of health service that mobilizes health
workers to provide services to the population especially the elderly, away from the location
where they usually live. Outreach services can be organized on a permanent basis with health
workers hired to serve in remote places according to a set schedule. Outreach services can
result from a voluntary or a mandatory approach. When mandatory, the activities would be
part of the health worker’s job description and fully acknowledged in his/her activity report.
Outreach services could also be included in the health system’s service delivery options and
should therefore be fully supported to ensure success. Outreach activities may also need to be
supported by a large number of stakeholders, but when experimented on a limited scale, they
can be decided locally with the resources available.
In reference to the article in the New Vision Volume 27, page 4 by Patrick Jaramoji, (30th
Nov 2010), elderly persons in Wakiso district complained of difficulty in accessing
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HIV/AIDS health services. They said they look after grandchildren who lost their parents to
the disease, some of them being HIV positive. There are no outreach services in their
community which brings services closer to them this is because there are no development
partners bringing such services and if outreaches are done, they only focus on the youth
friendly services. Therefore older persons’ entire time and resources are all utilized in
ensuring that the orphans are supported, as this in the process compromises with their little
capacity to access and utilize health services regardless of them being sick or not. This is
backed by Lack of regular sources of income – older persons comprise those who were
formally working in public service but are currently retired or those that had meager or no
retirement benefits. Others in the urban areas are engaged in petty trading while those in rural
areas depend on low agricultural productivity. Coupled with this is the limited physical
energy that elderly persons have, limiting them from actively undertaking productive work
which would otherwise guarantee them a regular source of income to facilitate them meet
their health care needs.
The distance covered by an older person to seek for medical services is a significant factor
affecting them from accessing services, though the government of Uganda has increased the
number of health facilities in the rural communities which mostly conduct static health
services within the health facilities necessitating the clients to move long distance closer to
the services for which reason still does not favor the elderly. The circumstance of where
older persons live therefore has a significant overall effect on the number of primary-care
doctors, nurses and health centers or hospitals and other health resources available. In rural
communities, lack of transportation and long distance to an emergency room or a hospital is
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an important barrier to receiving prompt treatment (American Journal of Public Health, May
2004)
According to the World Health Organization report (2006), working together for health;
Outreach strategies are often implemented on a small scale in health facilities. They are not
well documented because they are considered either as charity or as part of the delivery
system. The existing reports generally describe the projects and give some data about
activities, but analytical information is scarce. Because of limited attention paid to delivery
of services and to human resource productivity, there are no studies that fully assess outreach
services in terms of health outcomes and impact and human resource mobilization. Knowing
the real impact of these activities is essential to develop efficient strategies. Comprehensive
assessment would also allow decision-makers to have a realistic overview of health issues in
remote and rural areas.
The levels of health outreach programs are very limited with an effect to the elderly’s access
in existing health facilities and in the health sector because many developers of outreach
programs are not aware of their audiences’ literacy level as well as the major cultural norms
and boundaries that support or impede community members’ behaviors relating to screening,
early detection and prevention and yet outreach programs are important tools for bringing
health education and screening services directly to community members and serve to
contribute to reducing health disparities. They assist communities and hospitals to reach
mutually beneficial goals that would otherwise not be achievable for promoting accessible
and equitable care. Thus, meeting the challenge of a strong health disparities agenda in
community outreach requires integration of culture and literacy in all phases of intervention,
communication and programmatic development. To effectively help the elderly respond to
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such extension or outreach services, strengthening propagation of Health awareness by the
government health sector and private sectors by undertaking extensive awareness programs
aimed to provide the community with knowledge on prevention, early diagnosis, and
treatment of health issues. This will lay emphasis on sharing information with the common
man in the local areas about the latest developments in the field of healthcare and providing
expertise to the local population on treatment and prevention of diseases. (Trinity Care
Foundation by Tony Thomas, July 2012)
2.3 Existing and operational health facilities’ conditions and their effects to the elderly.
According to the Journal by Aged Family Uganda (2008), older persons in Uganda
experience similar diseases as older persons in Western countries – stroke, heart disease,
pneumonia, diabetes and high blood pressure - as well as HIV/AIDS and malaria. Many older
persons do not visit health centers due to long distances, poor mobility and negative attitudes
by health workers towards older persons. There is limited availability of drugs and limited
Geriatric expertise. Traditional healers are often the alternative.
The findings of the retention study carried out by the Ministry of Health with Capacity
Project support (MoH 2009) revealed that working conditions of health workers are often
difficult and characterized by poor infrastructure, lack of adequate staff accommodation,
inadequate equipment and supplies, work overload and inadequate remuneration which to a
large extend have caused poor attitude towards clients, and mostly the elderly are affected
directly by this situation since much of their medication is rare at health centers and no time
is therefore allocated to handle their cases amidst health workers’ dissatisfaction. They are
told to go back home and use herbal medicine with a belief that older persons are suffering
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from “old age”. For example, during the Survey by (MoH 2009) an older person reported that
she was rebuked by a nursing assistant at a Health Centre who said, “Why are you wasting
your grandchildren’s drugs? Better I give you Paracetum and let you go back home.” the
poor working conditions at health centers are aggravated by weak Human Resource
management; with Human Resource managers ill equipped to effectively and efficiently
manage the health workforce. Performance management, regulatory and disciplinary
mechanisms are ineffective and the number of trained health workers is insufficient to meet
the needs of the populations they are intended to serve especially in areas of Geriatric
services.
Previous studies done in Uganda show that there were no significant improvements in the
quality of health care overall (Asiimwe et al. 1996; Ocom, 1997; Jitta, 1998), staff most of
the time are absent and supplies out of stock (Mwesigye, 2002) and exemption and waivers
were largely ineffective (Kivumbi, 2000). These findings were also highlighted by the first
Participatory Poverty Assessment report which indicated that drugs availability, staff attitude
and performance, equipment, range and effectiveness of services have not only not improved
but also worsened in many cases (GoU, 199a). Coupled with these circumstances, older
persons find it so hard to reach a health facility and he/she finds no health worker, no drugs
and even no good reception all these existing and operational conditions drives them away
from seeking health services in health facilities.
According to the Health Sector Strategic Plan - HSSP I (2000–2005) and HSSP II (2006–
2010) endorsed by the Uganda Government and Development Partners prioritizes key actions
wherein interdependent factors that determine access and utilization of health services are
aptly described in a Health Access Livelihood Framework. They are related to the health
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seeking process, the nature and organization of health services and access of livelihood
assets. In the process of seeking health care, people will use services if they find them to be
close and acceptable. How acceptable services are is related to the nature and organization of
services which includes their availability, accessibility, affordability and adequacy; this
encompasses the health services approach
2.4 Participation of elderly in implementation of developmental and health related
programs and their impact in meeting their health related costs.
The majority of older persons live in rural areas where poverty is rife, economic
opportunities are limited, ill-health is common and health services are inadequate. They work
in the agricultural sector, which is characterized by fluctuations in produce prices, irregular
income and low returns to labor. About 85% of the active older persons are engaged in crop
farming with no social security, rendering them totally vulnerable. Their economic situation
is worsened by the burden of looking after orphans and other vulnerable children left by the
youth who have succumbed to the HIV/AIDS pandemic (The Uganda National Household
Survey, 2005/06 report)
The Second World Assembly on Ageing adopted the Madrid International Plan of Action of
Ageing (MIPAA). This plan focuses on older persons in terms of poverty eradication, health
promotion, access to food and adequate nutrition, income security, access to knowledge,
education and training, HIV and AIDs, housing, support to carers and service providers
among others. Participation of older persons in economic spheres of life has to be
emphasized if the needs of older persons are to be adequately addressed which has a direct
impact on them to meet health related costs when seeking the services. A bottom-up
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approach is used in planning and implementation of such programs for older persons and
participation of older persons in the process enhances ownership and sustainability of the
different development programs.
Under the National Objectives and Directive Principles of State Policy of the Constitution of
Uganda, it is stated; “The state shall make reasonable provision for the welfare and
maintenance of the aged.” The programs of older persons are therefore decentralized and for
effective participation of older persons in decision making processes on matters that affect
their lives in areas of development programs and health issues, older persons should actively
be represented at various levels of local government from village to district level, the aim for
this is to have older persons on board during planning and implementation of community
development programs without leaving their issues aside which are more equally important,
that, will contribute to their livelihoods. In addition, the Social Development Sector Strategic
Investment Plan articulates interventions for promoting the elderly’s participation and ability
to access basic services. In order to achieve this, the Social Development Sector ensures that
vulnerable groups especially those of the elderly persons are protected from risks and
repercussions of livelihood shocks by overcoming constraints that impede the development
of their productive capacities.
According to the National Policy for the Elderly in Uganda (April 2009), the partnership
principle therein, emphasizes service delivery and care for the older persons in areas of
considering them to benefit from development programs in raising their income levels which
has a direct impact on them especially meeting health and other related costs. It emphasizes
that stakeholders work together to ensure older persons access services and help them to
maintain the optimum level of physical, mental and emotional well-being to prevent or delay
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the onset of illness which would negatively affect their active participation in implementing
development programs to raise their income levels.
In the same way, the Intergenerational linkages principle in the Older Persons Policy of
Uganda emphasizes engagement of older persons in community activities together with
different age groups towards creating a society for all and the priority areas of focus includes
Economic Empowerment of older persons; Strengthening the formal and informal
community support institutions; enhancing access to Social Services such as health, water
and sanitation, food and nutrition, shelter, recreation, leisure and sports, education and
training and Psycho-Social Support Care for older persons
According to the article published in the New Vision page 23, Vol.27 (June 13, 2012) by
Donald Kiirya which reports on the demand of the Elderly in Jinja district who have
requested government to consider giving them money under the Social Assistance Grants for
Empowerment (SAGE) Program. They said the program is implemented in other districts
unlike Jinja where they have not benefited and they feel marginalized by government,
expressing a concern of low income levels among the many households of the elderly. “We
hear government distributes money to the elderly and vulnerable families but I have never
received any money from it. I request this program to be considered and implemented in
other districts of Uganda like Masaka, Kabarole, Kasese, Mpigi and Jinja inclusive because
most of us the elderly hardly get even a coin to help us pay for medicine when we are sick,
forcing us to stay back at home and die,” said Muzeeyi Sabasi.
In reference to the Uganda’s Poverty Eradication Action Plan (PEAP 2001-2003) which
builds on the first PEAP (1997), and in accordance to its strategy of implementation, it
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emphasizes an increase in the ability of the poor to raise their incomes, and in relation to the
poverty policy which reflects on the prevention of an increase in inequality and its reduction
through increasing the participation of the poor inclusive of the elderly in economic growth.
The thrust for rapid growth of the economy especially in the agricultural sector therefore is
intended to speed up the process of transforming the economy more rapidly by enabling the
vulnerable and poor farmers including the older persons to raise their ability to raise incomes
and spend their extra income in the market on non-agricultural goods and services like health
hence boosting the domestic demand. However, as clearly defined in the strategies
aforementioned, older Persons have not benefited much from the initiatives. The only
poverty eradication initiatives targeting older persons in Uganda remain the pension scheme
and the National Social Security Scheme. The pension scheme moreover targets retired civil
servants who constitute a marginal percentage of older persons in Uganda who need social
protection and income security to meet their needs more especially health related costs, food,
clothing and descent shelter.
CHAPTER THREE
METHODOLOGY
3.1 Introduction
This chapter presents research design, population size, locale of the study, sampling
strategies, data collection methods and instruments, validity and reliability of instruments,
data collection procedure and analysis techniques of the study.
3.2 Research Design
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The researcher employed a case study as a research design.
The study was descriptive and explanatory in nature to enable the researcher in collecting
detailed information or representative data to avoid duplication. The study was explanatory
because it explains the factors contributing to poor access of health services among the
elderly in Katiri Ward, Bulembia division Kasese municipality. The approach for the study
applied both qualitative and quantitative methods in collecting and analyzing data because
the researcher moved in the communities to get in contact with the target population and able
to find out exactly the factors contributing to poor access of health services among the
elderly. The quantitative method enabled the researcher to use a set of questions and also
helped the researcher to get a large sample in his research with the aim of generalizing data at
the end of the findings to come up with clear views. Further, this quantitative method helped
in analyzing data quantitatively using frequencies, percentages and mean of older persons
who are being affected by factors of not accessing health services
The approach was qualitative because the researcher used checklists to get information and
also the researcher reviewed secondary data from the existing reports and documents about
the factors contributing to poor access of health services among the elderly in Katiri Ward,
Bulembia division offices.
3.3 Locale of the Study
The study was carried out in Katiri Ward, Bulembia Division. Katiri is located 10
Kilometers north of Kasese Municipal main town, it also covers approximately 390
Kilometers from Kampala Capital City, it is neighboring Namuhuga Ward from East,
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Kyanjuki Ward from the South and Nyakabingo Ward from the west and Rwenzori National
Park from the North.
3.4 Population of the study
The research population covered illiterate and the literate groups of people. The key target
population was the older persons. Leader of older persons groups i.e. Community Aged
Foundation, local council leaders, Community Development Officer, the Nurses of the
existing health facilities and the town clerk of Bulembia division constituted the key
informants during the study.
3.5 Sample size
Elderly persons in Katiri Ward, Bulembia Division formed the target population for this
study. The study also generated information from Key Informants like the Community
Development Officers, Councilors, leader of older persons groups and health facilities’
Nurses. According to the Uganda population and Housing Census of 2002, the total
population of older persons was 1,101,039 (4.6%); Bulembia division had a total population
of 9,391 people. Basing on this data, older persons’ population in Bulembia Division was
quantified as 9,391x0.046 = 431. The population for older persons in Katiri Ward was
therefore determined as 431/4 = 108 (4 stands for the number of Wards in the Division)
Table 3.1 Sample size table
Category of respondents Target population Sample size Sampling technique
Males 45 40 Random
Females 80 66 Random
Total 125 108
Krejcie R.V and Morgan D.W (1970)
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The total sample size was 108 which were enough to obtain results that were generalized to
represent the views of the target population of the area under study. However, there were 2
extra responses from the respondents.
3.6 Sampling Procedure
The procedure included random sampling for the older persons as the main respondents. In
this random sampling, each person had equal chances of being selected, here; every
household name of older persons in the area was put on a piece of paper and chosen blindly,
because by doing this, it helped the researcher to carryout research without bias but rather
having a variety of information. A purposive kind of non-random sampling for the case of the
Key informants, that is to say, Community Development officers, the Nurses, religious,
leader of older persons groups and the town clerk was used in this study. This implied that,
only the population that was assumed knowledgeable was selected, (Amin, 2005)
3.7 Research Instruments
A closed ended questionnaire was used to collect data from the older persons as the main
respondents which based on a likert scale that utilized item analysis approach where a
particular item was evaluated on the basis of how well it discriminated both those
respondents whose total score was high and those whose total score was low whereas an
open ended questionnaire was administered to the Key Informants giving room for
generating a wide range of information focusing on the topic under study. This was due to
the fact that questionnaires offer a number of options for respondents to choose from (Amin,
2005). Questionnaires were used because they are very effective for assessing services
satisfaction and are easily administered, (Bouffard and Little, 2004).
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An illustration of the likert scale (here, the respondent chose only one answer)
5. Strongly Agree 4.Agree 3. Don’t know 2. Disagree 1. Strongly disagree
The likert scale technique assigned a scale value for each score that measured the
respondent’s view about a given issue. The scale was easy and each respondent accordingly
answered given questions therein.
3.8 Validity of instruments
Validity is the extent to which an instrument measures what it is supposed to measure and
performs as it is designed to perform. The validity of the instruments was scientifically
determined by using Content Validity Index formula.
The consideration of the instruments being valid had its Content Validity Index (CVI) 0.860.
Therefore, CVI was calculated using the formula below.
CVI = 35/43+38/43 = 73/2 = 37/43 = 0.860x100 =
86%
Note: 43 = total No of items in the instrument, 35=relevant items during the first check, 38 =
relevant items during the second check of the instrument by the research experts.
3.9 Reliability
Reliability refers to the consistency of a measure. Establishing the reliability of the
instruments was done using Cronbach’s Alpha. A coefficient of reliability Statistical Package
for the Social Scientist (SPSS) was obtained to determine the consistency of the instruments.
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The coefficient of reliability was .778, basing on this coefficient, the instruments were
considered reliable (Chronbanch, 1978).
The findings from reliability are shown in the table below as generated by the SPSS. The
Alpha Value generated was .778 which was considered to be reliable
Table 3.2: Illustration of the reliability Statistics
Reliability Statistics
Cronbach's
Alpha N of Items
.778 22
3.10 Data collection Methods
3.10.1 Questionnaires
The researcher used self-administered questionnaires while collecting data because
questionnaires offer a number of options for respondents to choose from (Amin, 2005) and
they are easily administered (Bouffard and Little, 2004). Questions elicit data regarding the
variables; levels of availability of outreaches, operational conditions of health facilities and
participation of elderly in health related development programs. The questionnaire included
both open and closed ended questions which focused on the variables under study. A likert
24

scale was used to simplify responses from respondents by choosing from alternatives as
below
Table 3.3: Likert Scale showing values for each response
Strongly Agree Agree Don’t know Disagree Strongly
disagree
5 4 3 2 1
1 up to 5 represents a score of each response
The above scale was using a value to each of the responses considered with the statement in
the instrument. This helped in giving a score of the respondent which then measured his/her
view towards a given point.
3.10.2 Observation
Observation method was used because it is recommended since it provides first-hand
information and it supplements on other methods, (Amin, 2005). Observation was made on
the levels of availability and accessibility of physical infrastructures like health facilities and
road networks.
3.10.3 Key informant Interviews
Semi-structured interviews guides were used to gather information from key informants like
health centers nurses, community development officer, religious and cultural leader and the
town clerk. The interview was intended to investigate key factors that contribute to poor
access of health services among the elderly. Interview findings were used because they
helped in improving the understanding and credibility of the study (Key, 1997) and they led
to a more understanding of the topic under study.
25

3.10.4 Documents review method
The researcher reviewed some of the reports, books that had information relevant to the topic
under study, reports and other circulars were asked by the researcher from the Ward offices.
Key information needed here ranged from how often older persons seek for services in health
facilities and records on older persons inclusion in health related and development programs
in the division.
3.11 Data Analysis Method
Qualitative data from interviews was analyzed as the study was progressing, while
quantitative data was first coded in the excel data sheet and the following were the key
coding features; Age was coded as 1 for those aged 60 -70, 2 for 71-80 and 3 for 81 and
above; Sex for Males was coded as 1, females as 2. For marital status; Single was coded as 1,
married as 2, separated as 3, divorced as 4 and widowed as 5.The education levels, for the
Non educated was coded as 0, primary level as 1, secondary as 2, tertiary as 3 and university
as 4. For the responses were coded as 1 for strongly disagree, 2 for disagree, 3 for those who
did not know, 4 for agree and 5 for strongly agree. After this coding, data was later
transferred into the Statistical Package for Social Sciences (SPSS) for analysis, under this
process it was ran into the SPSS frequency tables under Descriptive Statistics, it was after
this that frequencies and percentages for objectives 1 to 3 were generated in accordance to
finding the factors contributing to poor access of health services in consideration of the
variables; levels of availability of outreaches, operational conditions of health facilities and
participation of elderly in health related development programs.
26

CHAPTER FOUR
PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA
4.1 Introduction
This chapter presents findings from the study about factors contributing to poor access of
health services among the elderly in Katiri Ward, Bulembia division. The variables
investigated included: Levels of availability of outreach health programs, health facilities’
operational and existing conditions and government programs targeting the elderly. A
number of self-administered questionnaires and interviews guides were used to gather data
from the target population.
27

This chapter has subsections on the socio-demographic characteristics of respondents and the
study objectives. The data attained was presented in the frequencies and percentages from
which conclusions were drawn in accordance with the objectives of the study
4.2 Respondents’ socio-demographic characteristics
The study considered the respondents’ demographic characteristics of age, sex, marital status
and education levels. The main objective was to find out whether there were variations in the
respondents’ background and whether these had impact on the respondents’ views. The
findings were presented in subsections below of the report.
Table 4.1: Showing age of respondents
Age distribution Frequency Percent
60 - 70 79 73.1
71 - 80 26 24.1
81 and above 3 2.8
Total 108 100.0
Source: Primary data
Table 4.1 revealed that a great number of older persons ranging from 60-70 years were the
major respondents during the study at 79 (73.1%) followed by those at 71-80 years at 26
(24.1%) and lastly 3 respondents at (2.8%) was a representative of older persons from 81
years and above.
Table 4.2: Showing gender response distribution
28

Gender Frequency Percent
Male 42 38.9
Female 66 61.1
Total 108 100.0
Table 4.2 shows sex of the respondents. It was revealed that 66 (61.1%) of the respondents
were females and 42 (38.9%) were males. Majority of the respondents were females and
males were significantly represented.
Table 4.3: Showing marital status of respondents
Marital status Frequency Percent
Single 3 2.8
Married 70 64.8
separated 14 13.0
Divorced 1 .9
Widowed 20 18.5
Total 108 100.0
Table 4.3 above shows that majority 70 (64.8%) were married and 20 (18.5%) of the
respondents were widowed while 14 (13.0%) were separated and 3 (2.8%) were single while
1 (0.9%) were divorced.
Table 4.4: Showing Education levels of respondents
29

Education level Frequency Percent
Non Educated 62 57.4
primary 38 35.2
secondary 7 6.5
University 1 .9
Total 108 100.0
Table 4.4 shows the education levels of respondents investigated during the study, 62
(57.4%) had never gone to school, 38 (35.2%) only attended primary school, 7 (6.5%) had
also attended secondary education and only 1 (0.9%) of the respondents had reached
university level.
4.3 Study findings on levels of availability of health outreach services to the elderly
This was meant to answer objective one: To examine the levels of availability of health
outreach programs to the elderly in Katiri Ward, Bulembia division and in order to meet the
objective responses, a number of variables were determined among which was the level of
older persons’ awareness of the existing health facilities in their areas. Findings are indicated
in the following table below.
Table 4.5: Showing whether older persons are aware of health facilities in their division
Responses Frequency Percent
Strongly Disagree 12 11.1
Disagree 2 1.9
Don’t Know 2 1.9
Agree 91 84.3
Strongly Agree 1 .9
30

Table 4.5 shows that 91 (84.3%) agreed that they are aware of the existing health facilities in
their area, 12 (11.1%) strongly disagreed, 2 (1.9%) disagreed, those respondents who did not
know anything were at 2 (1.9%) and only those who strongly agreed were at 1 (0.9%).
However, all the Key Informants agreed that two health facilities of Kilembe Hospital and
Kilembe Health Center II existed in the community of Katiri Ward
Table 4.6: Showing the responses of respondents on the distance coverage of the existing
health facilities from older persons’ households, at least less than 2KMs
Disagree 22 20.4
Don’t Know 38 35.2
Agree 29 26.9
Strongly Agree 10 9.3
Total 108 100.0
Table 4.6 shows that 38 (35.2%) of the total respondents did not know the distance being
covered when accessing services at a given health facility, 29 (26.9%) agreed that their
distance to the facilities is less than 2KMs, 22 (20.4%) disagreed that the distance is longer
than 2KMs, 10 (9.3%) strongly agreed and only 9 (8.3%) of the respondents strongly
disagreed. It was also revealed by Key informants that most of the older persons who access
31

health services come from the far hills of the Rwenzori Mountain covering more than 2
kilometers.
Table 4.7: Showing responses of respondents on whether they have ever accessed
medical services in their community under an outreach program.
Disagree 59 54.6
Dont Know 8 7.4
Agree 12 11.1
Total 108 100.0
Table 4.7 shows that 59 (54.6%) respondents disagreed as having accessed services under
outreach program, 27 (25%) strongly disagreed while 12 (11.1%) agreed to have accessed
outreach programs, 8 (7.4%) did not know and only 2 (1.9%) strongly agreed of having
accessed services through an outreach program. In regard to the Key Informant responses, it
was revealed that outreaches have not been conducted from the time the area flooded with
water because there are no means to the community due to poor roads destroyed.
32

Table 4.8: Showing views of respondents on whether they have always received
medication related to their sickness in a health facility.
Disagree 34 31.5
Dont Know 23 21.3
Agree 35 32.4
Total 108 100.0
Table 4.8 above shows whether older persons have always accessed medication related to
their sicknesses, 35 (32.4%) of the respondents agreed to have accessed geriatric related
services from the exiting health facilities, 34 (31.5%) disagreed, 23 (21.3%) did not know
whether they received medication related to their sickness 9 (8.3%) respondents’ views
strongly disagreed, 7 (6.5%) of the respondents strongly agreed for having accessed
medication related to their sickness.
Table 4.9: Showing responses of respondents about their early diagnosis and treatment
of their sickness
Disagree 48 44.4
Dont Know 2 1.9
Agree 41 38.0
Total 108 100.0
33

Table 4.9 shows respondents’ responses about their seeking for an early diagnosis and with
access to treatment, 48 (44.4%) disagreed of having gone for an early diagnosis and treated
of their sicknesses while 41 (38%) agreed to have gone for an early diagnosis and 12 (11.1%)
strongly agreed, 5 (4.6%) of the respondents strongly agreed while 2 (1.9%) did not know
whether they were diagnosed early and treated of the illnesses.
4.4 Study findings about health facilities’ operational and existing conditions
The findings are addressing objective two: To assess the prevailing operational and existing
conditions of health facilities in Katiri Ward, Bulembia division, and a number of study items
were designed in order to have quality information about this objective, below are the
statistical findings.
Table 4.10: showing respondents’ views about how often they are welcomed well by
health workers and the gate keepers when seeking for health services
Disagree 53 49.1
Dont Know 5 4.6
Agree 29 26.9
Total 108 100.0
34

The findings from the table above on welcoming patients revealed that 53 (49.1%) of
respondents disagreed to the question item while 29 (26.9%) respondents confirmed that they
have ever been welcomed by the health service providers and 13 (12%) disagreed, while 8
(7.4%) strongly agreed that in one way or the other, health workers had welcomed them
during the time of their visit to seek health services and 5 (4.6%) did not know whether they
were welcomed or not.
Table 4.11: Showing respondents’ responses of whether they are always attended to
early and well by a health worker whenever they explained their health problems
Disagree 56 51.9
Dont Know 7 6.5
Agree 22 20.4
Total 108 100.0
Table 4.11 shows that majority respondents 56 (51.9%) confirmed not having been attended
to early and well by a health worker whenever they seek for health services while 22 (20.4%)
of respondents on the other hand agreed and 16 (14.8%) strongly disagreed while 7 (6.5%) of
the respondents did not know and those who strongly agreed were 7 (6.5%). It was also
revealed by the Key Informants that health facilities receive many clients which contribute to
long waiting hours.
35

Table 4.12: Showing responses of respondents on whether they have always been
attended to by a qualified health worker and comfortable with the care received
Disagree 13 12.0
Dont Know 65 60.2
Agree 15 13.9
Total 108 100.0
Findings from table 4.12 revealed that 65 (60.2%) of respondents did not know whether they
have been attended to by a qualified health worker and had no knowledge of whether the care
received was the recommended one and 15 (13.9%) respondents agreed to the statement
while 13 (12%) disagreed to the statement and 13 (12%) strongly agreed and while 2 (1.9%)
strongly disagreed.
Table 4.13: Showing responses about the availability of a road network to a health
facility from older persons’ areas of residence
Disagree 43 39.8
Dont Know 2 1.9
Agree 38 35.2
Total 108 100.0
36

Proper access to health facilities for services is well enhanced by road network, in reference
to the above statistics, the majority of older persons 43 (39.8%) confirmed having no access
to roads which influences their poor access to health services and only 38 (35.2%) agreed
that they had access to road network leading them to the health facilities, while 13 (12%)
respondents strongly disagreed to the statement and 12 (11.1%) strongly agreed and only 2
(1.9%) did not know of any road network leading them to a health facility. It was also
revealed by the Key Informants that in Katiri Ward, there were poor road network due to the
nature of its landscape which causes it hard for older persons to access health services.
4.5 Study findings about Availability of government livelihood programs targeting
active participation of the elderly.
This finding answers objective three: To assess the contribution of implementing government
development and health related programs targeting the elderly in improving their income
levels to meet health related costs in Katiri Ward, Bulembia Division, and in order to have
better information about this objective, a series is questions were set to target the elderly in
the area under study, below are summaries of the findings.
Table 4.14: Availability of government livelihood programs targeting active
participation of the elderly
Disagree 35 32.4
Dont Know 15 13.9
Agree 42 38.9
Total 108 100.0
37

Responses in table 4.14 indicates that there are government programs targeting older
persons’ participation in Katiri ward which reflected 42 (38.9%) who agreed to the statement,
however a substantial number of older persons disagreed reflecting 35 (32.4%) while 15
(13.9%) did not know whether there are government programs targeting them in their area
and 12 (11.1%) strongly disagreed while 4 (3.7%) of the respondents strongly agreed to the
statement. Key Informants also agreed that in Katiri ward there are government programs
which targets old persons’ participation which confirms with the views of major respondents
above.
Table 4.15: showing respondents’ responses about their direct participation in
development programs from their areas
Disagree 49 45.4
Dont Know 13 12.0
Agree 31 28.7
Total 108 100.0
It is believed that direct participation of the elderly in development programs enhances their
capacity to sustain their livelihoods at household levels, in table 4.15 above clearly indicates
that most older persons from Katiri ward 49 (45.4%) have never participated in government
development programs which directly target them while 31 (28.7%) respondents agreed
having participated in development programs which is quite a small figure, on the other hand,
38

13 (12%) of the respondents didn’t know that they have participated in government programs
while 10 (9.3%) strongly disagreed to the statement and 5 (4.6%) strongly agreed. Key
informants revealed that older persons are not in groups and a few groups have not registered
at the Ward offices which becomes hard for the older people to access and participated in
government programs.
Table 4.16: showing respondents’ responses about them being members of particular
older persons’ groups that have received funds or any inputs from CDD and NAADS
programs respectively
Disagree 42 38.9
Dont Know 1 .9
Agree 43 39.8
Total 108 100.0
It is reflected in statistical table 4.16 above that at least majority of older persons are
members of a given group which had accessed or received funds and inputs from CDD and
NAADS programs and this was ranked at 43 (39.8%) while 42 (38.9%) of older persons as
groups’ members have never accessed any funding or inputs from government programs, on
the other hand, 17 (15.7%) strongly disagreed to the statement while 5 (4.6%) strongly
agreed and 1 (0.9%) did not know.
39

Table 4.17: showing responses on the number of respondents with income generating
activities in their home(s)
Disagree 55 50.9
Don’t know 7 6.5
Agree 18 16
Total 108 100.0
Table 4.17 revealed that 55 (50.9%) respondents disagreed having any income generating
activities at their home(s), 26 (24.1%) responses also strongly disagreed with the statement,
18 (16%) responses agreed, 7 (6.5%) did not know whether what they have at home are
income generating project and only 2 (1.9%) of the respondents strongly agreed having
income project at their home(s)
It was revealed by some Key Informants that older persons have no incomes due the fact that
they are weak to sustain any projects even if it was given to them by NAADS or CDD this is
why few of them had benefited.
40

Table 4.18: Showing respondents’ responses about their access to market by selling
some of their products from the Income generating activities in the last six (6) months
Disagree 48 44.4
Don’t know 9 8.3
Agree 8 7.4
Total 108 100.0
Table 4.18 revealed that 48 (44.4%) of respondents have never gone to the market to sell
products from their income generating activities, 39 (36.1%) responses strongly disagreed, 9
(8.3%) of the respondents did not know whether they have gone to market for the last six (6)
months, while 8(7.4%) agreed and 4 (3.7%) strongly agreed.
Table 4.19: showing responses of respondents about their ability to pay for a medical
bill the last time they visited a health facility
41

Disagree 59 54.6
Dont Know 1 .9
Agree 19 17.6
Total 108 100.0
In table 4.19 above, the study found out that 59 (54.6%) of respondents disagreed with the
statement under study while 19 (17.6%) of the responses reflected an agreement with the
statement and 18 (16.7%) strongly disagreed while 11 (10.2%) strongly agreed and only 1
(0.9%) respondents did not know.
Table 4.20: showing responses from respondents whether every time they visit a health
facility, they take less than an hour due health workers’ commitments
Disagree 56 51.9
Dont Know 4 3.7
Agree 21 19.4
Total 108 100.0
In reference to table 4.20 above, indicates that a great number of older persons in Katiri Ward
take long hours of waiting when they are accessing health services as clearly evidenced in the
frequency column whereby 56 (51.9%) of respondents disagreed with the statement and 23
42

(21.3%) of the respondents strongly disagreed while 21 (19.4%) respondents agreed with the
statement and 4 (3.7%) strongly agreed.
Table 4.21: showing respondents’ responses about their current ability to meeting
medical cost due to their income activities
Disagree 35 32.4
Dont Know 2 1.9
Agree 17 15.7
Total 108 100.0
Table 4.21 shows that 51 (47.2%) respondents strongly disagreed with the statement while 35
(32.4%) disagreed with the statement and 17 (15.7%) agreed and 3 (2.8%) strongly agreed. It
was revealed by the Key Informants that older persons depend on their sons’ handouts which
if they are not there; older persons will not meet any medical bill as they will not access
services because they can’t afford to pay.
Table 4.22: showing current responses of older persons behavior of seeking for medical
services early than before
43

Disagree 39 36.1
Dont Know 5 4.6
Agree 21 19.4
Total 108 100.0
A great number of older persons who disagreed and strongly disagreed that they currently
seek for medical services early than before, the response to this was ranked at 39 (36.1%) and
37 (34.3%) respectively while the other older persons who agreed and strongly agreed to the
statement above were only 21 (19.4%) and 6 (5.6%) respectively.
44

CHAPTER FIVE
SUMMARY, DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS
5.1 Introduction
This chapter presents the discussion of results, draws conclusions according to the findings
on each of the study objective and gives recommendations as per research objective.
5.2 Summary
The overall objective of the study was to examine the factors contributing to poor access of
health services among the elderly in Katiri Ward, Bulembia division Kasese Municipality.
The processes used in collecting quantitative and qualitative data were guided by use of self-
administered questionnaire and key informant interview guides respectively. The approach of
analyzing quantitative data was carefully done using the SPSS (Scientific Package for Social
Scientists). The study findings revealed that older persons who have taken time to seek for
medical services 31.5% of those interviewed disagreed having received medication related to
their sickness, 54.6% of the respondents disagreed as having accessed services under
outreach programs, 51.9% of older person revealed that the minimum time they take at a
45

health facility is three hours, 45.4% had never participated in these government development
programs which directly target older persons
5.3 Discussion
5.3.1 Levels of availability of outreach health programs
In accordance to the study findings, the relevancy of this objective in understanding the
situation of older persons accessing health services is very substantial, the argument of older
persons rate to access health services is leveraged on the quality provisions of outreaches
close to the people more especially the older persons of Katiri Ward. Though 84.3% of the
respondents were awareness of health facilities in their division it did not directly contribute
to their access to the services offered due to the long distance travelled to the facilities
whereby 35.2% of the respondents did not know the distance being covered when accessing
services at a given health facility. This has study findings concurred with findings by Aged
Family Uganda’s Journal published in 2008 that long distances affect older persons’ access
to health services. Meaning that the distance from their households is longer hence
influencing them not to go for medical services. Proper access to health facilities for services
is well enhanced by road network, in reference to the statistics generated, the majority of
older persons 39.8% confirmed having no access to roads which influences their poor access
to health services and this was confirmed by most of the responses by the Key Informants.
46

On the other hand, 54.6% of the respondents disagreed as having accessed services under
outreach programs meaning that the less the outreaches the more the number of older persons
not accessing health services. It was also revealed that the few older persons who have taken
time to seek for medical services 31.5% of those respondents disagreed having received
medication related to their sickness, an indicator that more is still needed to make heath
facilities’ services friendly to the needs of the older persons, this has resulted in a higher
percentage of older persons 44.4% not going for an early diagnosis and treatment of their
sicknesses as per findings of this study. This is related to the findings made by Ministry of
Health (2009) which stated that an older person is given paracetamol when he/she seeks
medication because he/she is wasting his grand children’s drugs.
5.3.2 Health facilities’ operational and existing conditions
It was important to note that communication and welcoming patients at a health facility is
very vital, however the existing health facilities’ human resource in Katiri ward have not
significantly enhanced welcoming her patients especially the older persons because this was
presented by 49.1% of respondents saying they have never heard any welcoming and
greeting message from their service providers whenever they seek for medical services which
demoralizes clients being served by such facilities in addition to their long hours of waiting
to be attended to whereby 51.9% of older person revealed that the shortest time they take at a
health facility is three hours and above, most Key Informants also confirmed that it was true,
older persons take long seated on their benches waiting for someone to attend to them.
During a sharing with older persons, their responses showed a great doubt of whether they
are attended to by qualified health workers and 60.2% respondents had no knowledge of
whether the care they receive was the recommended one, the reason for this assertion was
47

that older persons are always told to go back home because their medicine is not available
saying that it is just old age and this finding was also confirmed by the MoH report on survey
finding (2009)
5.3.3 Government development programs targeting the participation of elderly
It is believed that direct participation of the elderly in development programs enhances their
capacity to sustain their livelihoods at household levels; however it is different to know that
development programs exist and also taking active participation in the same programs is also
different too. According to the study findings, it was indicated that 38.9% of older persons
were aware of the existing programs targeting their participation and by the time of this study
45.4% had never participated in these government development programs which directly
target older persons while only 28.7% respondents agreed having participated in
development programs which is quite a small number. It is therefore important to note that
for older persons to participate in development programs there should be special
considerations and easy mechanisms through which they can use to access these programs.
The only approaches that were used by older persons in accessing government development
programs like Community Demand Driven fund and National Agricultural Advisory
Development Services was through formation of groups which was confirmed by the study
findings that 39.8% older persons had joined older persons’ groups with 38.9% having not
benefited from the programs, this means that the majority of older persons 50.9% from Katiri
Ward had no income generating activities though they were members of older persons’
48

groups that had benefited from development programs of the government since benefits from
these programs only boost the groups and takes long to benefit an individual at household
level. This has a direct effect to the older persons because 54.6% of respondents agreed they
cannot manage to pay for their medical bills if they fell sick hence causing delayed seeking
for medical diagnosis as 36.1% and 34.3% of respondents disagreed and strongly disagreed
respectively that they can’t go for an early diagnosis if they are not sure of their financial
status.
5.4 Conclusions
In relation to the levels of availability of outreach health programs in Katiri ward, Bulembia
division, it was concluded that, outreaches with various packages of health services leveraged
on issues of older persons was the most important approach for them to effectively access
and utilize health services because older persons have a number of illnesses, therefore if
outreaches are extended close to the community, health needs assessments should be
conducted so that there is relevancy in the kind of health packages to be extended to the older
people during outreaches.
It was also important to note and conclude that refresher courses for some health workers in
client management was the most important as it enhances their skills of how to handle people
who seek for health services and this could be tailored on how best older persons should be
handled in the event that they tend to shy away from accessing health services as a result of
the way they are handled and treated of their illnesses.
Investigations about the health facilities’ operational and existing conditions in Katiri ward, it
was important to conclude that Kilembe Hospital and Kilembe dispensary respectively could
49

design operational policies that gives special considerations for the aged people in the
process of getting medication rather than looked at in the same category of young men and
women who can hold their strength to wait for long hours to be treated. Associating certain
illnesses with old age among the elderly is quite stigmatizing especially when a health
worker tells a client that the pain in the back or waist is due to old age in not scientifically
proven, therefore health workers of Kilembe hospital and dispensary could mainstream
geriatric skills in their health career development so that even older persons can be well
examined and treated like any other person.
For the government development programs targeting the participation of elderly in Katiri
ward, it was concluded that older persons not only be aware of the programs but the
mechanisms and approaches for accessing these programs would be friendly and easy for
older persons to directly participate in.
5.5 Recommendations
5.5.1 Kilembe Mines Hospital and Dispensary:
The two health facilities above should strengthen their outreach programs and tailor them not
only to the children and mothers but also have special packages for the elderly like checking
for their blood pressure, general pains among others so that their referral mechanisms can be
strengthened to benefit the community of Katiri ward and the general population.
Designing and implementation of refresher courses for the health workers in areas of client
management, leadership development program should both be considered in order to create
health workers as managers who lead and are age friendly in all circumstances.
50

5.5.2 The Government of Uganda
In order for development programs to directly benefit vulnerable persons like the elderly,
steps taken for them to access these programs should be easier, non-strenuous and friendly
and there should be special considerations for the elderly to access and directly participate in
these programs at an individual level to enhance their incomes.
The Ministry of Health should strengthen its monitoring processes to the health sub districts
and facilities to envisage any gaps that do exist in as far as medicine is concerned, more
emphasis should be put on medication that treat illnesses of the elderly (geriatric medicine)
5.5.3 The older persons
Problem owners are always initiators of solutions; in this case, older persons should actively
have their groups registered at Bulembia division headquarters so that they can be legally
recognized and considered to benefit from existing programs.
Older persons groups should create a linkage with other community development partners
who offer capacity building in group dynamics, financial management and project
development so that the little activities they have in their groups should be well managed to
benefit all members of the groups which will have a direct bearing on individual
development.
51

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The world health report (2006) - Working together for health. Geneva, World Health
Organization
Uganda National Minimum health Care package (2002) -Study report on Social
Protection
Uganda Population and Housing Census report, 1991
Uganda Report on the Review and Appraisal of the Implementation of The Madrid
International Plan of Action on Ageing (Website: http://www.mglsd.go.ug)
Uganda’s Poverty Eradication Action Plan-PEAP (2001-2003)
Uganda Ministry of Health: Health Sector Strategic Plan I (2000/01–2004/05).
54

Uganda Ministry of Health: Health Sector Strategic Plan II (2005/06–2006/07).
Appendix A
A questionnaire for the elderly persons
Thank you for your acceptance in the participation of this study. I am Mwesigye Selvano of Bugema
University undertaking this study to understand some of the factors contributing to poor access of
health services among the elderly in Katiri Ward, Bulembia Division. Please take your time to read
through the questions in the table below. Your views are very important in this study because they
will contribute to the board of knowledge in the field of access to health services as a cross cutting
issue to all people in the community.
The questionnaire is designed on a likert scale where all responses are assigned a mark, 1 being the
lowest and 5 the highest. Circle only one response per question.
Respondent’s socio-demographic characteristics:
Age………….Sex ……….Marital status………………Education level……………........
55

56
Variables Strongly
disagree
Disagree Don’t
know
Agree Strongly
agree
A. Levels of availability of outreach
health programs
I am aware of a health facility(s) in my
Division
1 2 3 4 5
The distance to my health facility is
less than 2KMs
1 2 3 4 5
I have ever accessed medical services
in my community under an outreach
program
1 2 3 4 5
I have always received medication
related to my sickness in a health
facility (Geriatric services)
1 2 3 4 5
I always seek for an early diagnosis
and treated whenever I feel sick
1 2 3 4 5
B. Health facilities’ operational
and existing conditions
Whenever I go to the health facility I
am always welcomed well by health
workers and the gate keeper
1 2 3 4 5
I am always attended to early and well
by a health worker whenever I explain
my health problem
1 2 3 4 5
I am always attended to by a qualified
and competent health worker and I am
always comfortable with the care I get
1 2 3 4 5
There is a road network leading to my
health facility
1 2 3 4 5
C. Government programs targeting
the elderly
There is a government livelihood
program targeting active participation
of the elderly in my area.
1 2 3 4 5
I have participated in one or more
development programs in my area.
1 2 3 4 5
I am a member of a group for the
elderly who received development
funds or inputs from the CDD or
NAADS programs respectively.
1 2 3 4 5
I have an income generating activity in
my home.
1 2 3 4 5
I have visited the market or sold some
of my produce at home in the last 6
months.
1 2 3 4 5
The last time I visited a health facility
I was able to pay for my medical bills.
1 2 3 4 5
D. Elderly’s access to health
services
Every time I visit a health facility I
take less than an hour due to the
committed health workers
1 2 3 4 5
Because of my income activities, I am
currently not worried about meeting
medical costs if I get sick
1 2 3 4 5
Currently I seek for medical services
very fast than ever before
1 2 3 4 5

1. If you have been accessing health services under outreach programs, what kind of services have
you been
receiving? .................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
....................................
2. Could share what kind of care you always receive at health facility that makes you feel
comfortable?
...................................................................................................................................................................
...................................................................................................................................................................
..........................................................................................................................................................
3. (a) If you have participated in government development programs in your area, explain these
kinds of programs?
.................................................................................................................................................................
.............................................................................................................................................................
(b) What kind of income generating activities do you have at home?
...........................................................................................................................................................
...........................................................................................................................................................
.....................................................................................................................................................
57

Appendix B
Key informants interview Guide
Thank you for your acceptance in the participation of this study. I am Mwesigye Selvano a
student from Bugema University undertaking this study to understand some of the factors
contributing to poor access of health services among the elderly in Katiri Ward, Bulembia
Division. Please take your time to read through the questions in the table below. Your views
are very important in this study because they will contribute to evidence based information
which will be used for future planning in the struggle in improving health services for elderly
persons in Bulembia division and Uganda as a nation.
a. Levels of availability of outreach health programs
Qn1 How many facilities exist in Bulembia Division? List their names and exact locations
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
……………………………….
Qn2 (i) Do these facilities offer outreach programs in the community? Yes/No
2(ii) If Yes to 2(i) above, how often?
.....................................................................................................................................................
.................................................................................................................................
…………………………………………………………………………………………………
…………… (iii) If No to 2(i) above what do you think could be the major reason(s)?
58

.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
..................................................................................
3(i) Expanded program outreaches are targeting which people?
.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
........................................................................
3(ii) What outreach services do they offer?
.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
.........................................................................
3(iii) If elderly persons are not targeted during the expanded outreaches in (ii) above, what do
you think should best be done to scale – up elderly related services?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
………………………………………
b. Health facilities’ operational and existing conditions
4(i) Do the mentioned health facilities experience stock out? Yes/No
4(ii) If Yes to (i) above, how often
…………………………………………………………………………………………………
………
4(iii) What do you think should be done to minimize stock-outs?
59

.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
........................................................
5 (i) Do older persons usually seek for health services in the existing health facilities
mentioned above? Yes/No
5 (ii) If Yes to 2(i) above, how often?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………
6 (i) Have there been any failures of handling elderly health related cases among the health
facilities mentioned above? Yes/No
6 (ii) If Yes, what could be the major reason(s)?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
………………………………
6 (iii) For the above reasons in 3(ii), what do you recommend to effectively handle elderly
health related cases?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
………………………………………
c. Government programs targeting the elderly
7 (i) Do you have government programs? Yes/No
7 (ii) If Yes to 1(i) above, what kind of programs are
they…………………………………………..
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
………………………………
60

7 (iii) Who are the target people for the programs mentioned in (ii) above?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
………………………………………
8 (i) Are there any groups or individual older persons who have benefited from existing
government programs? Yes/No
8 (ii) If Yes, what kind of programs did they benefit from?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
……………………………………….
8 (iii) If No, what could be the major reason(s)?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
………………………………………………
9 In your own opinion, what should be done for older persons to benefit from government
programs as a way of contributing to raising their income levels?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
……………………………………………………….
Thank you for your time.
61

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