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Mediha gets her blood pressure taken by a doctor, in Ethiopia

Report title: Cash transfers and older people’s access to healthcare: A multi-country study in Ethiopia, Mozambique, Tanzania and Zimbabwe
Publication date: 25 May 2017
Authors: Flavia Galvani (HelpAge), Ken Bluestone (Age International), and Silvia Stefanoni and Camilla Williamson (Development Action) 
Pages: 28 


This study identifies key barriers faced by older people in accessing healthcare across Ethiopia, Mozambique, Tanzania and Zimbabwe, and documents how older people use cash transfers to access health services in situations where healthcare is limited and resources are scarce.

‘Ill health and poverty are inter-related. You cannot get to a hospital if you cannot afford to travel.’ – Peter, Project Co-ordinator, Tanzania

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Cash transfers and older people’s access to healthcare: A multi-country study

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  • Desk-based review of data and literature
  • Qualitative research in all four countries
  • Small-scale quantitative survey in Mozambique

Key findings

Good health should be available to people of all ages. Achieving this requires a mixture of approaches that includes:

  • Improving the supply of health services
  • Removing barriers to accessing healthcare
  • Paying for the cost of treatment
  • Providing adequate cash transfers

Improving the supply of health services

The study shows how access to health services is greatly influenced by their supply, such as:

  • Availability
  • Accessibility
  • Affordability
  • Adequacy

‘[The health clinic] is too far for me to walk to. It takes a day to get there on foot and I don’t have enough money to go by bus.’ – Chaussauca, 89, Mozambique

Removing barriers to accessing healthcare

The study identified key barriers faced by older people in accessing healthcare, including:

  • Reaching health facilities
  • Availability and cost of transport
  • Paying for the cost of treatment
  • Discrimination

Providing adequate cash transfers

The study found evidence of cash transfers supporting older people’s access to healthcare, particularly by enabling older people to pay for transport to reach health services, and for the treatment itself:

‘We use cash transfers as transportation money to help us go to the hospital when sick. We also use it to buy drugs when we are sick.’ – Female focus group participant, Mbarali, Tanzania

However, older people reported that the monetary value of the cash transfers was not enough to remove their concerns about seeking healthcare. They also talked about the significant challenges presented by low staffing levels, and the lack of health facilities and equipment:

‘We need training on geriatrics. All doctors should be learning about the needs of older people.’ – Dr Omuchamba, Health Clinic, Tanzania

Policy recommendations

  1. Improve coverage and adequacy of cash transfers
  2. Ensure health entitlements and service delivery include older people
  3. Promote links between cash transfer programmes and other social protection and health promotion initiatives
  4. Ensure age-disaggregated data and evidence on older age, social protection and health at all ages is available

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