Determinants of access to healthcare among the elderly.the case of Kibera informal settlement, Nairobi County, Kenya
Wairiuko, Judy Wanjiru
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Access to Health care by the elderly can be defined as the ability of the aged to get the required medical care from the health service providers when they need it. It’s a comprehensive measurement of access to health care that requires a systematic assessment of physical, financial and socio-psychological access to services. These are further defined into three basic indicators: availability, affordability and acceptability. The proportion of the elderly is increasing rapidly in Kenya. This comes up with health problems like hypertension, diabetes, cancers among others. Which can be delayed if good health care is accessed; whether the healthcare is prepared to take care of the elderly has not been extensively investigated in Kibera urban informal settlement, Nairobi County, Kenya. This was a descriptive cross-sectional study targeting both elderly men and women aged 60 years and over, in Kibera informal settlement of Kenya, to identify factors influencing access to healthcare by the elderly. Data collection tools employing both qualitative and quantitative parameters were used in the study. A multistage sampling approach was used. Kibera urban informal settlement was purposively selected while the sub-locations Gatweekera, Kianda and laini-saba were randomly selected. Probability proportionate to size sampling of the elderly was done and systematic sampling was done to identify the respondents. Data was obtained from a total of 399 elderly using interviewer administered questionnaire. Key informant interviews on health facility managers were used to provide additional information. Data was analysed by SPSS and presented using tables, graphs and cross tabulations, while association between variables was assessed using Chi-square statistics and Odds Ratio. Thematic analysis was done on qualitative data. Findings showed that access to healthcare was at 40.4 %. Marital status (χ2=8.321, df=2, p=0.016), type of house (χ2=7.069, df=2 p=0.029), education (χ2=12.521, df=3 p=0.006) was statistical significant in relation to access to health care services by elderly. The odds of access increased with those who lived in permanent houses (OR: 30.699, 95% CI 1.827-515.927 P<0.017) when compared against those who lived in temporary houses. Services of CHWs was significant (χ2=9.092,df=2,p=0.011) in relation to access. Satisfaction of health care services (χ2=257.326,df=4,p<0.001) was significantly associated with access. Availability of equipment (χ2=48.871, df=2 p<0.001) and availability of drugs (χ2=39.031, df=2 p<0.001) were significantly associated with access to healthcare. The study showed need to address access to health care factors that contribute to elderly not accessing health care. Findings in this study will be used by policy makers to develop a policy on elderly person’s welfare, ensure that there are elderly friendly services in all primary health care facilities, with trained health personnel on geriatric health, and basic drugs and medical equipments for non communicable diseases.