Raising Older People’s Voices in Health Systems

By Dr. Prakash Tyagi

World Health Day this year centers around Universal Health Coverage (UHC). But one key group that often gets left out of UHC discussions are the very people who rely on health systems the most, older people. People 60 and over are the fastest-growing segment of the population globally and have specific needs that require different approaches to care. Cumulative inequalities experienced over the life course can also lead to poorer health status and lower levels of functioning in older age, but the lifetime effects of broader socioeconomic inequity often go unfactored into health systems planning.

Human needs in later stages of life are critical for UHC frameworks to address. However, little data is collected on health in older age, especially in low- and middle-income countries, and even less is known about what development approaches best support healthy aging. HelpAge developed the Health Outcomes Tool to bridge these gaps in data on older people’s health and functioning. It was also designed with local network partners like GRAVIS in mind to help us better understand how our community-level projects impact the older people we work with and serve.

About the Tool

The Health Outcomes Tool is a survey that collects information on 5 key domains related to older people’s health: basic demographics, general health status, functional ability, access to health services, care support, and self-care. Responses are self-reported, based on older people’s perceptions, and are accompanied by an objective measure of functionality, the sitting-to-standing test, which assesses a respondent’s ability to stand from a sitting position.

For the first time, we’re able to report on the key components that contribute to health in older age and gain an understanding of how our interventions can affect these areas over time. In practice, the findings from the tool have helped guide the future direction of local health services and informed measures to improve service quality.  

The tool was first launched in Colombia in 2014 and later replicated in various countries across Africa and Asia. In 2016, GRAVIS piloted the Health Outcomes Tool in India. GRAVIS reaches about 200,000 people across the Thar desert, one of the poorest parts of the country, providing primary and secondary level medical services to older people. We also work to improve public health programs to meet the needs of India’s most marginalized groups through research and advocacy.

As an organization that is active in both service delivery and public health support, we’ve felt a strong need for a resource like the Health Outcomes Tool for a long time. Two of the most crucial needs identified in GRAVIS’s long-term plans were the ability to 1. take a person-centered approach to strengthen the inclusion of older people and 2. evaluate the quality of existing services. With the Health Outcomes Tool, we’re now able to do both.

Insights from Older People in India

Over two rounds of surveys between 2016 and 2017, we interviewed 523 older people living in 10 remote villages.  

The tool provided important insights into where health and care services were falling short. The findings confirmed that older people experienced various levels of difficulties in accessing health services. Specific barriers include the shortages of essential medicines for chronic diseases available in villages. Older people reported having to travel long distances to get medicines to manage conditions such as diabetes and hypertension. Assistive devices such as glasses, mobility aids, and hearing aids were similarly very difficult to access for those who needed them.

Another barrier to health services reflected in older people’s responses was the lack of separate lines or waiting areas for older people who are frail or have mobility issues, which could make it too inconvenient or even physically unbearable for certain people to seek treatment.

In terms of older people’s access to care, most reported having to depend on informal support, such as care from family, friends, and the community in general. Those who had lower incomes and education levels indicated greater difficulties accessing care support. These insights are useful for informing the design of long-term care systems that are inclusive of everyone, including those with the greatest barriers to access.

It also became apparent that self-care education needed to be prioritized. Our findings indicated a low level of self-care being practiced among older people in Thar, but many surveyed felt it was important to learn about self-care activities and to engage in decision-making about their health.

Impacts of the Health Outcomes Tool

These valuable insights helped inform changes to our medical services and programs. What we learned from older people also prompted us to start the Collaborating for Health (CFH) project, a co-designing process that engages local communities in identifying key priorities related to older people’s health. We took evidence collected from the tool on older people’s barriers to health care access and presented it to local government representatives. Specifically, we reached out to government-run Primary Health Centers, starting dialogue on ways to make service delivery more accessible to older people. And because of the needs we saw related to greater self-care education, we have improved GRAVIS’s self-care training curriculum to reach more older people.

Going forward, we hope to continue employing the health outcomes tool and gain a longitudinal data set on older people’s health and access to health services in India. We’ll also continue leveraging this data to advocate for health and care services that are affordable, accessible, and meet human needs in later stages of life.

What I’ve appreciated most about the Health Outcomes Tool is its ability to bring older people’s voices and concerns to the table. Equipping all people in a community, especially those who are often marginalized such as older people and people with disabilities, with the resources they need to manage their health is one of the most effective ways to achieve the Universal Health Coverage commitments under Sustainable Development Goal 3. The Collaborating for Health project that grew out of using the Health Outcomes Tool has empowered individuals to make healthier choices and sparked community action to ensure quality, affordable services are available. We need more programs like it.

As governments begin to explore pathways toward achieving UHC, it’s critical that healthy aging and the needs of older people are a part of the roadmap. For us, fostering increased coordination between local communities, governments and health service providers through data has been an effective approach to start including older people in the conversation.

To learn more about the Health Outcomes Tool and older people’s health, download the report.

Download the Report

Analyze the Data

The online dashboard that accompanies this report allows users to interact with the data collected and draw out further analyses – for example, to filter responses by certain age groups, gender, etc, and to look at particular indicators in relation to others.

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