Health care prioritization process for the elderly in rural Tanzania under decentralized system: prospects and challenges

Introduction: In the early 1990s, many countries in the world adopted health sector reforms that focused on strengthening the primary health care system through strong community participation. However, most of the primary health care systems in many countries including Tanzania have remained weak. Most of the vulnerable groups like the elderly have been neglected in the priority setting process. The study aimed to analyse the prospects and challenges of the implementation of the prioritization process for elderly health care services under a decentralised health system.Methods: The study adopted an exploratory case study design that used Key Informant Interviews (KIIs) and focus group discussions (FGDs). The study was conducted in Nzega and Igunga districts in Tabora Region of western Tanzania. The study employed 24 key informants from the two districts. Data were analyzed using the content analysis approach. Results: The study found prospers of the Local Government Authorities (LGAs) that LGAs can conduct a priority-setting process that involves different stakeholders. Different procedures are used for prioritizing the elderly at LGAs including the issue of dealing with their complaints, identifying the elderly and providing identities (IDs) for exemption purposes. In addition, the priority setting process is done on a teamwork basis and uses different guidelines which are prepared by the central government to help the process of priority setting at LGAs. However, there were some challenges facing LGAs, these included; difficulties during elderly identification, there being no specific law that protects elderly matters, exemption/waivers being not clear and insufficient resources to implement the planned activities at the LGAs. Conclusion: The LGAs are important and have the chance to improve the health care services of the elderly. However, due to the encountered challenges, the government should enact a law that will protect the elderly’s interests and that will give the direction of the exemption policy. Also, having a specific per cent of the LGAs revenue for the elderly matters and improving the identification process by having a database at the LGAs level.