Access to health care and its determinants: the case of older persons in Chivi South district, Zimbabwe.

Abstract

This study investigates the accessibility of health care services by older persons living in rural areas of Chivi South district. Access to health care has remained invisible in the scholarship in third-world countries like Zimbabwe. In this respect, the study explores the lived experiences of rural older persons residing in Chivi South, a research site embedded in political uncertainty and economic quagmire bedeviling Zimbabwe. This qualitative study was anchored on the interpretivist approach. A sample of 10 key informants and 20 older persons participated in key informant and in-depth interviews. This study established four key findings that will contribute immensely to the sociology of ageing in poor-resourced settings such as Zimbabwe. The cultural meaning of illness among older persons is essential in creating acceptable healthcare services. The consequences of not making a more enabling and inclusive environment for older persons will have a dire impact on healthcare delivery. Changes in policies that support more preventative health and social care globally instead of a reactive approach, which is wholly unsustainable for today’s ever-growing population. In Zimbabwe, older persons are often treated as a homogenous group with similar needs, leading to blanket interventions that overlook individual differences. This has resulted in poorly conceptualized and targeted assistance programs, failing to address local needs. Socially constructed narratives of successful ageing could inform the design of appropriate geriatric policies and programs to transform the healthcare needs of older persons in Zimbabwe. The key findings of the study show that the older persons living in the rural areas of Chivi South district experience challenges such as limited access to economic resources, traveling long distances to access healthcare services, inequalities in the healthcare service delivery system, reduced health status, limited availability, acceptability, and accessibility of healthcare services and inter alia. These challenges limit older persons from accessing much-needed healthcare services. The preeminent aim of this study is informed by the theoretical accounts of Penchansky and Thomas (1981) and Giddens (1984). The structures that frame rural healthcare provision ultimately function as key determinants of the nature and scope of healthcare service utilization, which propounded the structuration theory. Based on the subjective narratives of the research participants, the uniqueness of this study is anchored on its ability to offer a sociological foundation for developing innovative interventions and workable public policy options that support the aging population in African rural spaces. The study showed evidence of how social determinants of health may help reduce disparities in healthcare access for older persons in rural settings. Older persons, especially those residing in poor communities, have unique needs when addressing social health needs. The ageing population in Zimbabwe faces socio-economic predicaments and various challenges in the healthcare sector. It is particularly challenging to manage social connectedness in rural areas because of the issues around accessibility of health care, i.e., physical, financial, and societal barriers, making these multifaceted but crucially critical social determinants of health. Any efforts to improve the health and well-being of older rural persons address rural-urban disparities in healthcare needs and include a focus on the social determinants of health.