Summary
Health Nest Uganda (HENU) is an indigenous non-profit organisation based in Entebbe, Uganda. It seeks to promote the dignity, equality and independence of older people. HENU supports older people through three approaches: rights awareness and advocacy, developing skills and promoting healthy lifestyles, and carrying out research. In 2010, HENU identified that older people were facing many challenges in relation to income, health, social isolation and loneliness. In response, HENU employed a Community Life Competence Process (CLCP) to support the design, delivery and monitoring of community driven solutions to the issues faced by older people. The CLCP approach promotes community self-reliance by stimulating and supporting people to appreciate their strengths and how they can address the issues they face. The aim of older people’s engagement in the CLCP and the activities it led to is to improve older people’s health and increase the focus on healthy ageing within communities and the health system. Community action plans, developed by older people through group discussions, highlighting and agreeing their priorities, aimed to inform activities at the community level and the health system. The plans include interventions focused on preventing and managing Non Communicable Diseases (NCDs), increasing self-care, and strengthening informal and formal health system collaboration. Solution to health, nutrition, sanitation issues were found within the older people groups and with the communities.
Planning and Implementation
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What was the challenge you were trying to address?
In 2010, HENU identified that older people were facing many challenges in relation to income, health, social isolation and loneliness. Yet community level institutions and systems were not including them in their services.
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Who were you trying to impact?
Older people in general
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What sectors were you targeting?
Health, Information and Communication
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Who else was involved?
Government, Civil Society Organization, Older People's Association, Social Care
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How did older people participate?
Older people helped to implement the project
Lessons learned
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Please describe how collaboration worked in your initiative.
The OPAs identified a need for health services to be accessible at the community level. In order to achieve this HENU facilitated a meeting between older people, health providers and community leaders. During the meeting the group discussed how to strengthen collaboration between the informal community health care services and the formal health system. The older people (representing the OPA members and their communities) and the health workers agreed a strategy of identifying retired health workers and members of Village Health Teams (VHTs) to be trained to provide services for older people at the community level. Retired health workers were identified by the OPAs and others in the communities. The majority are older people themselves. Members of VHTs were also identified in this way. VHTs are part of the formal health system in Uganda but are primarily focused on providing maternal and child health services. OPAs suggested approaching VHTs and asking them to expand their services to also focus on screening and health information for older people. VHTs are organised by government but are volunteers and the majority are older people. Working with them provided an additional opportunity to increase older people’s engagement.
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What was the impact of your initiative on older people, their families, and/or their communities?
Older people’s engagement has led to changes in how they view health and wellness. There is a greater sense of individual responsibility and ownership for health among older people, and they understand health is a right. Older people also have an increased awareness of the collective role they can play to support healthy ageing. Self-esteem has increased among older people in OPAs as a result of their engagement and their sense of being able to generate solutions to the challenges they face. The interactions between older people and health workers have involved local and regional leaders who are more aware of the issues and challenges faced by older people. OPAs have invited local leaders to meetings so OPA members can share their experiences with them. This has amplified older people’s voice, shifted attitudes towards them, and made them feel more heard. Engaging formal and informal health workers with older people has led to a shift in attitude amongst the health workers and an increased awareness of the issues faced by older people. They have recognised that older people were not being reached with services and support. There are now strengthened links between community health services and Entebbe Hospital, supporting referral and improved access to care. As a result, more older people are now seeking health services and care. There is also an increased level of awareness of NCDs and healthy behaviours among older people. Finally more older people attend OPAs’ meetings.
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What issues did you face, and how did you address them?
The majority of members (around 90%) are women. HENU, through the OPAs, encourages engagement of all older people within the communities, but older women have been most interested and willing to engage. This could be due to a greater interest in health issues among older women and observed poor health seeking behaviour among older men. HENU staff have discussed the lack of engagement of older men with the chairs of the OPAs and the groups have tried to reach out and encourage older men to join. So far this has proved difficult and would require a more sustained and purposeful effort. In some areas in which HENU works some gender dynamics have been observed alongside the lack of engagement from older men. In Namutumba District when both older women and men attended OPA meetings they sat separately. Older men sat on chairs and older women on mats on the ground. This type of dynamic is not commonly seen but needs to be addressed and considered. Older people of different ethnic origin are sometimes more isolated, as they moved to the central region without their families and as they have got older and have started to experience increased health and care issues, they have lacked a family network to support them. HENU tries to address this challenge by re-connecting older migrants with their family members in other parts of the country.
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What lessons did you learn from implementing this initiative?
HENU learnt the importance of being clear about their role. Having established OPAs, HENU supported the older members to co-construct understandings of health and wellness in older age. Group discussions focused on how older people define health and wellness, and how they can engage, using their strengths and resources, to develop interventions to address the challenges identified. In this process HENU made sure it approached the group discussions as facilitators, not as experts. This approach was critical. Older people are the experts on their health. They need to be seen in this way, and to see themselves in this way.
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Do you have any other reflections you would like to share?
Exchange of basic information about sanitation is mostly done through peers. It touches very critical and intimate areas of their personal hygiene and can help preventing further health issues. Through discussions, practical challenges can be overcome such as the difficulty for older people to use squat toilets, and the pain they were experiencing as a result. Some said they did not want to eat because they were scared to use the latrine. During this discussion, an older person shared that she had bought a ceramic seat for her latrine to convert it from a squat toilet and make it more comfortable to use. Some older people purchased seats for their latrines, but for others for whom this was unaffordable, designed a brickbuilt seat instead. Nutrition is another critical area that can affect health. Through information sessions on hypertension and diabetes older people have increased awareness of the importance of a balanced and healthy diet. They recognise that their diets have changed, moving away from more traditional eating practices, focused on bananas and greens to more fried foods. As a result, the OPAs agreed that each homestead should have a small garden of vegetable and fruits to support a more balanced diet. In one community, an older person offered to train their peers in growing plants. Most older people now have a small garden of fruit and vegetables and older community members share seedlings and plants. OPA members also come together to do physical exercise to promote healthy ageing and delay disability.