Gendered challenges of older adults in accessing health care services in Uganda : a case of urban refugees
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This study sought to understand the challenges of older refugee men and women –aged 60 years and above in accessing health care services (HCS) in Uganda. Specifically, the study set out to establish which health care services were available to older adult refugees living in the low resourced communities, such as slums in Kampala; assess the extent to which health care services were accessible to older adult refugee men and women; and establish the challenges older adult men and women refugees faced as they sought to access HCS. The study was anchored on two theories: the first was Capability Theory, drawn from the Neoclassical Economic Theory proposed by Sen Amartya in the year 1973 and the second was the Feminist Standpoint Theory by Sandra Harding. In the capability theory, human beings are conceptualized as autonomous rational decision makers and free from social power imbalances. The feminist theory on the other hand positions knowledge and the knower within a social context. This study presupposed that the health care services are inclusive and so anybody, regardless of his or her age and status can gain access. However, sometimes, due to several factors within one’s context, this access could be affected. Thus, the study examined how inclusive HCS were, focusing on how the older adults, in their varied social positioning as well as their autonomous and rational decision-making positions were able or not to access the health care services. The study adopted a mixed methods research approach and used an exploratory sequential research design. The sample size for the quantitative part of the study was 60 (30 males & 30 Females) respondents, selected using a systematic sampling method. The qualitative data was collected from 41 in-depth interviews and 3 focus group discussions. Observations were also done to collect primary data during camp and health center visits. The study findings revealed that, there are no customized services (geriatrics) available to OAs. However, to a lesser extent, OAs were able to access general HCS. Disparities in access were noted as more old women than men reported challenges in access to HCSs. Challenges included poverty, language barrier, mobility related issues and marginalization during health visits. The study recommends that specialized services for OAs, as it is for other categories such as children (pediatrics wards), antenatal or postnatal for mothers be introduced in all HC facilities across the country. Further, health care providers need to be trained in the area of geriatrics. At a policy level, government should include refugees in the available social protection institutions. Where possible there should be guidance on “naturalization” to shade off the refugee status. This is because a good number of them have been in Uganda for a long time - over ten years with no hope or interest of returning to their home countries.