One interview was conducted at each of the eleven HCIIIs, two interviews (with the in-charge and OPD in-charge) at each of the seven HCIVs and hospitals (Table 1). The response rate was 83%, with 20 of 24 anticipated key informants consenting for the interviews. Four interviews could not be conducted because in-charges were not at their health facilities during the data collection period. The majority of the key informants were health facility in-charges (n=16, 80%), Medical Clinical Officers by cadre (n=9, 45%), and resided in rural settings (n=10, 50%). There was equal sex distribution among interviewees, although more female health workers (n=7) worked at lower-level health facilities located in rural settings. The average respondents’ age was 33 years (SD± 7.866). The average time spent at the health facility was 3.8 years, enabling us to interview people with a well-informed community perspective.
Table 1: Characteristics of Key informants (n = 20)
Variables
|
Health Facility Level
|
Total
|
HCIII (n=11)
|
HCIV (n=7)
|
Hospital (n=2)
|
n (%)
|
Cadre of Key informant
|
Medical Doctor
|
0
|
4
|
1
|
5(25)
|
Medical Clinical officer*
|
9
|
0
|
0
|
9(45)
|
Nursing Officer
|
1
|
2
|
1
|
4(20)
|
Enrolled Nurse
|
1
|
1
|
0
|
2(10)
|
|
Responsibility
|
Health facility In-charge
|
11
|
4
|
1
|
16(80)
|
OPD In-charge
|
0
|
3
|
1
|
4(20)
|
|
Sex
|
Male
|
4
|
6
|
0
|
10(50)
|
Female
|
7
|
1
|
2
|
10(50)
|
|
Health facility location
|
Urban
|
1
|
2
|
2
|
5(25)
|
Semi urban
|
2
|
3
|
0
|
5(25)
|
Rural
|
8
|
2
|
0
|
10 (50)
|
*A rank comparable to Physician Assistants or Assistant Doctors [24]
The four themes that emerged were; Structures to leverage for CBGS; promotion of community-based geriatrics support; who should be involved in community-based geriatric support; and activities to be leveraged to advance the community-based geriatric support agenda (See Table 2). In our narrative, we include the most representative verbalizations.
Structures for community-based geriatric support
Under this theme, four sub-themes featured prominently, these included; The Village health team (VHT) structure, Local leadership structures, Community-based organizations, and family support structures.
The majority of key informants noted that CBGS would best be implemented through the existing Village Health Teams (VHTs) support structure, a system they reported to have helped them in identifying other groups of interest from the communities for health care and support.
Many respondents also advanced views of training VHTs and local leaders to work together in the provision of community-based geriatric support. Some of the participants had this to say:
"Currently, we work in partnerships with VHTs. So, I think just like the way they pick out cases of maybe fistula or things like mothers who have [gotten] issues during pregnancy, sexually transmitted diseases (STDs), and all that stuff. I think they can look out for those old people who need a lot of..." (Key Informant, 017)
"…Ideally, we have VHTs. The VHTs can work with the local leaders" (Key informant, 003)
Table 2: Analytical Summary of Emerging Themes and Subthemes
Theme
|
Sub theme
|
Respondent category
|
Meaning Unit
|
Condensed meaning Unit
|
HCIII
|
HCIV
|
Hospital
|
MCO
|
NO
|
MO
|
NO
|
MO
|
NO
|
Structures to leverage for CBGS
|
VHTs
|
7
|
1*
|
|
1
|
1
|
|
"Currently we work in partnerships with VHTs. so I think just like the way they pick out cases of maybe fistula or things like mothers who have [gotten] issues during pregnancy, STDs and all that stuff, I think they can look out for those old people who need a lot of..." (KI, 017), "…Ideally we have VHTs, the VHTs can work with them and the local leaders" (KI, 003).
|
VHT structures will make institution of CBGS easier
|
Community based organisations
|
1
|
|
|
|
|
|
"The most reliable method now is through the VHT’s and a few community-based organisations" (KI, 005).
|
CBOs can play a role
|
Family
|
|
|
2
|
1
|
|
|
Issues can be dealt with from home…" (KI, 005,), " I advise the elderly to come with their with their grand..., relatives when coming to hospital"
|
Families are a key player in CBGS
|
Local leaders
|
2
|
|
1
|
1
|
|
1
|
"…Ideally we have VHTs, the VHTs can work with them and the local leaders" (KI, 003), "...We could train the local leaders..." (KI,009),
|
Local leaders can support their communities to institute CBGS
|
Promotion of CBGS
|
Creating awareness
|
6
|
|
|
1
|
1
|
|
"...to create awareness and increase vigilance…" (KI, 005), "We can sensitize them, we can get them on board" (KI, 007), "...we advertise over TV, Radio and use posters..." (KI, 004,), "...We can sensitize the community and tell them the needs of the elderly and how they can support them" (KI, 017)
|
Creating awareness ensures that communities know the needs of the elderly
|
Community education
|
3
|
1
|
1
|
1
|
|
1
|
"teaching them the advantages of giving these old people care" (KI, 008), "I think this is something to do with giving community education, educating them about the elderly [old people]...the complications that along with age, what we can do, [and] how the community can support them"(KI, 007)
|
Education empowers communities to support the elderly
|
Training VHTs on geriatric care
|
|
|
|
1
|
|
|
"…Giving them (VHTs) knowledge about geriatric nursing, I think it can help…" (KI,014)
|
When trained, VHTTs can support the elderly in the community
|
Key actors in providing CBGS
|
Neighbours
|
1
|
|
|
|
|
|
"...if you are my neighbour, I think we can give the attention to you, old people are very important to our society…" (KI, 005)
|
Neighbours are an important factor in provision of CBGS
|
Family
|
|
|
1
|
|
|
|
"…I think old people are more comfortable at home than at the health facility, for this engaging their family members and relatives is pertinent" (KI, 006).
|
Family members are critical tool for CBGS
|
Activities to leverage for CBGS
|
Health outreaches
|
4
|
1
|
1
|
|
|
1
|
"... during (our) usual health outreach activities, we can continue highlighting the same [importance of community geriatric support] …" (KI, 005), "Like some never come to the facility, they stay in the community but if we have an outreach program, we could look them up and give them the care they need"(KI, 15)
|
Existing outreaches can be leveraged to provide CBGS
|
Home support/visits
|
|
|
|
|
1
|
|
"...Yes to help those people from where they are so that they don’t go through this bother of going to the health unit every time they get a small problem" (KI,008)
|
Home visits are the best way to support the elderly
|
MO=Medical Officer, MCO=Medical Clinical Officer, NO=Nursing Officer, RN= Registered Nurse, *Response by RN
Relatedly, a demonstrable number of respondents noted the family structures as another entry point for providing support to old persons, with relatives escorting old persons to health facilities as an example of demonstrating that support.
"I advise the elderly to come with their relatives when coming to the hospital" (Key informant, 14).
On the other hand, one respondent fronted the idea of engaging existing community-based organisations, which have already played an instrumental role in supporting existing health structures to improve the quality and content of rural health care.
"The most reliable method now is through the VHT’s and a few community-based organisations" (Key informant, 005)
Promoting community-based geriatrics support
Under this theme, two subthemes emerged; creating community awareness and community education.
Participants generally observed that the practice of community-based geriatric support is not well understood and practiced in communities. Even with the existing informal support to older persons at community level, there are gaps in knowledge on likely complications faced by older adults and standards of care to be followed as voiced by one of the participants below:
"I think this is something to do with giving community education, educating them about the elderly [old people] ...the complications that [come] along with ageing, what we can do, [and] how the community can support them" (Key informant, 007).
The respondents further noted that creating community awareness and education requires active involvement of health workers and geriatric support organizations to inform and educate locals about this new aspect of care for the elderly within their catchment areas.
"... the most important thing is that we need to create awareness about geriatric care and how communities can support their old adult from the community…" (Key informant, 005)
In order to popularize community based geriatric support, leveraging locally available channels for public health promotion and education such as use of local radios, televisions and posters were suggested by the participants.
"...we need to advertise over Television, Radio and use posters to inform communities about the importance of taking care of the elderly, more so in the communities ..." (Key informant, 004).
Activities to leverage for the community-based geriatric support
Integrating CBGS activities within existing health outreaches was a popular avenue observed by the participants as key for promoting community-based geriatric support agenda. Through the health outreach activities, the older adults could be reached with tailored health services as well as provide health education to them and their caregivers. Below are some of the participants’ voice excerpts;
"[Like] some never come to the health facility, they stay in the community [,] but if we have an outreach program, we could look them up and give them the care they need" (Key informant, 015)
"... during (our) usual health outreach activities, we can continue highlighting the same [importance of community geriatric support] …" (Key informant, 005),
Some participants suggested that health workers provide standalone home visits for old adults. This was argued to reduce the inconvenience of older adults trekking long distances to health facilities for health problems that may not require facility based care and treatment.
"... [Yes] to help those people [the elderly] from where they are [,] so that they don’t go through this bother of going to the health unit every time they get a small problem" (Key informant, 008).
Key actors for community-based geriatric support
Much as health workers were noted as the primary players in the provision of community-based geriatric support, family members, and in cases where this is not possible, neighbours were another resource that participants pointed to as key in the provision of geriatric support to old adults. This is illustrated by the following quotations:
"…I think old people are more comfortable at home than at the health facility, for this engaging their family members and relatives is pertinent..." (Key informant, 006)
"...if you are my neighbour, I think we can give attention to you, old people are very important to our society…" (Key informant, 005).