Morogoro Eldrely People`s Organization (MOREPEO) added a News update.

MOROGORO ELDERLY PEOPLE`S ORGANIZATION.

(MOREPEO)

ACCOUNTABILITY PROGRAMME IN TANZANIA

(TAN 239 - ACT)

MOROGORO ELDERLY PEOPLE`S ORGANIZATION.(MOREPEO) ACCOUNTABILITY PROGRAMME IN TANZANIA(TAN 239 - ACT)Morogoro Best Practices

Consultant:-

Mr. AMANI, PAUL JOSEPH

LECTURER – MZUMBE UNIVERSITY

THE FACULT OF HEALTH MANAGEMENT

Abbreviations

CHF                            Community Health Fund

CCHP                          Comprehensive Council Health Plans

CSO                           Civil Society Organization

CHFB                          Council Health Fund Board

CHMT                         Council Health Management Team

DOPF                          District Older People Forum

HBC                            Home Based Care

HFC                             Health Facility Committee

HSSP                           Health Sector Strategic Plan

IGA                             Income Generating Activities

NGO                            Non Governmental Organization

MDG                           Millennium Development Goals

MKUKUTA                 Mpango wa Kukuza Kchumi na Kupunguza Umaskini

MOREPEO                  Morogoro Elderly People’s Organization

OPF                             Older People Forum

OPMG                         Older People Monitoring Groups

PPP                              Public Private Partnerships

PEEs                            Peer Educators

RCC                             Regional Consultative Meeting

TASAF                         Tanzania Social Action Fund

TBC                             Tanzania Broadcasting Corporation

TIKA                            Tiba kwa Kadi

List of Tables

List of text boxes

Text Box 1       Guidance to identify Target Population

Text Box 2       Guidelines for the introduction of Older People’s Focal Persons

Text Box 3       Guidelines for the formation of Older People Monitoring Groups

Text Box 4       Guideline in the Use of Media

Text Box 5       Guideline for use the Community Health Fund

Text Box 6       Guideline to establish and operationalisation of Income Generating Activities

Text Box 7       A Guide for Partnership and Networking

Executive Summary

Best practice is a strategic management tool aimed at delivering high quality services and promises the best outcome. The best practices identified in this report were as documented   project namely; “Accountability Programme in Tanzania (ACT TAN 239) . The PROJECT is implemented by MOREPEO in Kilosa district councils in Morogoro region The programme   is also implemented   by sisters age care organizations of MAPERECE in Magu, PADI in Songea, MOPSEA in Moshi Kilimanjaro, SAWATA Kasulu , SAWAKA Karagwe, SHIDEPHA Bukombe, NABROHO Shimiyu, KIWWAUMBA Mbarali and TWAULAE in Shinyanga. The project aims at enabled strengthening evidence based advocacy through the OPFs and OPMGs; working with local and central government authorities to mainstream and reinforce accountability on older people’s rights and entitlements; promoting intervention which accelerate campaign against the murder of older people on witchcraft allegations; and working with the media to influence their role as change agents to build positive image and promote equity to services and entitlements among all citizens. Key activities implemented includes:-Engagement meetings with the council Health management Teams (CHMT) ; Engagement meeting with the District Serious Crime Task Force addressing the issue of elderly abuse and brutal killings of older people due to witchcrafts allegations; Mobilization meeting with older people to participate in constitutional referendum; Ageing Mainstreaming Workshops with District Council; Older people and partner representative’s engagement follow-up meetings with Councilors’ and their MPs on the rights and needs of older people; and Dissemination of National Ageing Policy.

The main aim of this assignment was to find out and document the best practice experienced during the implementation of the project. In order to reach this end, the study adopted a comparative approach whereby different processes and procedures used to implement project objectives in Kilosa district council were examined. In view of this, qualitative methods were largely used. The main methods used to collect data included making desk review, Focus Group Discussion, Observations and Interviews. The main target group of respondents included, older people, Key district heads of departments (i,e District Executive Director, District Medical Officer ,District Planning Officer ,District Community Development Officer, District TASAF Coordinator, District Social Welfare and District Vicoba Coordinator ), implementing Age Care Organization (MOREPEO), health care providers, RMO, DMO, Older People Focal Persons, members of Older Peoples Monitoring Groups, Local village leaders and media people. The data collected from different sources were classified and analyzed to determine the best practice in pilot project area.

The best practices which were identified in the two projects were seven, namely i) Targeting; ii) establishment of Older People Focal Person at the council level; iii) establishment of grass root structures at village/mtaa level; iv) Use of media; v) use of Community Health Funds; vi) engagement of older people into income generating activities; and vii) Networking and partnership. These practices were selected after carefully observing and making comparison of processes and procedures used by Kilosa and Morogoro Municipal Council councils to achievement project objectives. The uniqueness of each practice is explained below.

a) Targeting Key People: Targeting as an approach is generally used to capture information from purposefully selected population. In this project targeting was not only concerned with targeting key decision makers at high level such as District Mayor, District Executive Directors, Planning Officers and the like, but also implementers of decision at lower levels i.e. local leaders such as (WEO,VEO,MEO), health providers, the community members, older people and the media people who became active drivers of change. The strategy worked well as all those who were targeted become front runners in addressing the rights and entitlements of older people including free medical services to older people and their dependants.

b) Appointment of Older People Focal Persons: The establishment of older people focal person is a good initiative which helped to link issues of older people between the council and age care organizations. The focal person helped to raise issues of older people within the council structure so that different actors in the district council could take immediate actions. This action helped the council to increase its capacity in understanding older people’s issues and mainstream them in their plans and budgets. In addition, focal persons did not only work as facilitators between civil society organizations, local community leaders, but he/she reflected the fact that, what was done were not just for MOREPEO but they had a blessing of the councils. Hence the implementation of the project was part of the agenda of the council.

c) Establishment of Older People Monitoring Groups (OPMGs): In Kilosa council i were MOREPEO is implementing the project, Older People Monitoring Groups ,Home Based Care groups and Peer Educators were established by the community members. This approach was unique in the sense that, it was community based and it had an in built sense of sustainability from community members themselves. Among other things, these groups were concerned with data collection concerning the status of older people, and also acted as monitors and providers of information to relevant authorities at different levels to facilitate decision making process. Hence regular monitoring meetings which took place throughout the project period provided learning opportunities for the participants and involving key stakeholders, and feedback to the duty bearers at the grass root level. It was also noted that, while such findings from monitoring were used immediately by the OPMGs, HBCs PEEs at village and ward level by engaging village, wards and district council on aspects of health services which needed improvements, these findings were also presented on quarterly basis to the implementing partners who later presented them the council for further action. Last but not least, the introduction of home based care services to older people brought new hope to many older people who were previously living in isolation and had virtually no one to turn to for both social and material support.

d) Use of media: The media were taken as one of the important stakeholders in advocating older people’s rights and their entitlements. This helped them to appreciate that they too had a role to play and can make meaningful contribution to the project. This motivated the media to play an active role in raising public awareness and to increase visibility of older people’s accountability issues to policies and strategies, taking this as part of the obligation they have to the society and not as an opportunity for earning revenue where they could charge commercial rates for airing the program. Secondly, there was a strong willingness of media personnel to participate in various meetings, workshops and seminars not as journalistsbut as participants. Their full participation in such forum helped not only to increase their capacity of understanding ageing issues, the national policy frameworks and strategies concerning the protection of older people’s rights, but to disseminate the right information to the public. In Morogoro Municipal for example the media people were invited to participate in all meeting organized by different stakeholders which discussed issues of older people. Such meetings included for example, District Consultative Committee (DCC), and MOREPEO meeting. Thirdly, As a result of the above point, there were increased passion among media people through their personal involvement and commitment in advocating older people’s rights. This was evidenced in Both Kilosa and Morogoro district councils were I noted the presence of special media journalists Chance Katembo of Radio Tumaini and John Nditi of Tanzania Standard News Paper Ltd  who specialized in writing issues and articles concerning older people; and willingness to participate in issues concerning older people without expecting any payment.

e) Use of Community Health Funds: The use of Community Health Fund facilitated the increasing access of health services to the dependants of older people. Statistics provided in two council’s health providers indicating an increased number of older people testify this. Both two Councils have established the community health fund have finalized the legal formalities and have started allocating funds to cater for health services for older people and their dependants. last but not least, the mainstreaming meetings conducted by MOREPEO to key district heads of departments acted as a challenge for the council to start allocating funds for older people and their dependants through Community Health Fund.

f) Engaging older people in income generating activities: Older people are largely poor. Poverty makes them fall out of community and family safety net. The most challenging task was how to select the few among many poor older people to get loans This activity was facilitated by TAN 605 and 611 Sida funded project . In accomplishing this task there were various procedures established which qualifies it to become one of the best practices. These procedures included the following: i) regular monitoring of projects through OPMGs and village government leaders, ii) involvement of group members who benefited from the loan to make follow up of their fellow group members who seemed to default. This involved motivating their fellow group members and counseling from selected team members to follow up the implementation of income generating activities, iii) There were elements of savings among the beneficiaries of the loans as expressed in their pass book which clearly identified sections for loans, savings and payment, and iv) Giving the loan to older people helped to learn that older people who were in a group using it as collateral worked better than if given to an individual. Where it had happened, those who defaulted, the whole group was held responsible to reimburse the money and the group or individual was forced out of the group later.

g) Cross visits, Partnership and networking: Accomplishing project objectives needed a concerted effort from different actors. Effective networking and partnership skills were necessary in order to engage different partners and stakeholders to support the initiatives of the implementing partner. It is for this reason networking helped to strengthen relations and collaborations with other organizations which were dealing with other programs in different parts of the districts and across the region . This was made possible through good rapport existing between the implementing partners with other nongovernmental organizations by inviting them to participate in issues concerning older people. Apart from this networking further helped in sharing resources and promoting teamwork. In so doing, cross visits , partnership and networking helped to increase access and entitlement of health services to older people and their dependants.

The study concludes that the project had a good number of best practices which need to replicate in other areas in Tanzania and outside the country. However not all best practices can be universally applied because their applicability depends on various other circumstance such as different levels of development, perception of the implementers, cultural or differing circumstances which may not be favorable. However, a key strategic talent required when applying best practice to organization is the ability to balance the unique qualities of an organization with the practice that it has in common with others. In addition, a best practice are not static they change as new development and new approaches emerge at different points in time.

Table of Contents

Abbreviations

List of Boxes

Executive Summary

1.0  Introduction

2.0  Background of information

3.0  Methodology

4.0  Best Practices

4.1  Targeting Key People

4.2  Establishment of Older People Focal Persons

4.3  Establishment of Older People Monitoring Groups

4.4  Use of media

4.5  Use of Community Health Fund

4.6  Engagement of Older People in Income Generating Activities

4.7  Cross Visit Partnership and Networking

5.0  Conclusion

MOREPEO copyright

ACCOUNTABILIT Y PROGRAMME IN TANZANIA ( ACT)Kilosa District in Morogoro Region

1.0    Introduction

Best practice is a strategic management tool aimed at delivering high quality service and best outcome. It is a technique that has consistently shown results superior to those achieved with other means that is used as a benchmark. Within this context, this report draws best practices from this project namely “Accountability Programme in Tanzania -ACT” (TAN 239) which was implemented in Kilosa district council in Morogoro region. Whereas in Morogoro the project was implemented by Morogoro Elderly People’s Organization (MOREPEO). The overall purpose of the project aims at enabled strengthening evidence based advocacy through the OPFs and OPMGs; working with local and central government authorities to mainstream and reinforce accountability on older people’s rights and entitlements; promoting intervention which accelerate campaign against the murder of older people on witchcraft allegations; and working with the media to influence their role as change agents to build positive image and promote equity to services and entitlements among all citizens.

In the course of implementing the project (i.e. TAN 239) best practices have been drawn with a view of documenting and replicating them in Tanzania and outside Tanzania. These practices are normally used to describe the process of developing a standard way of doing things that other organizations can use. These practices are used to maintain quality as an alternative to mandatory legislated standards and can be based on self assessment. The best practice are not static they keep on changing and becoming better as new methods, approaches and procedures are discovered. Establishing procedures and practices was not easy much as it involved studying different methods and procedures which were used to attain high quality output. However, not all best practices can be applicable in all situations; some may apply while others cannot apply depending on prevailing circumstances. The implementation of these projects had several good practices but for the sake of this assignment we have selected the best few practices which were unique and which could be replicated within and outside Morogoro Region.

2.0    Background information

The majority of older people in Tanzania still live in abject poverty. Poverty rates in households with older people are higher than in households without. Households headed by older people with their dependants especially grandchildren who are particularly at more risk. For example, despite older people’s right to be free from hunger, lack of basic needs such as food is a serious cause of poor healthy problem caused by malnutrition. Apart from poor health status, the majority of older people are marginalized in numerous ways including having poor access to health care facilities and receiving low priority in government programs.

In view of the above circumstances, Tanzania has taken various initiatives towards the provision of social protection to the most vulnerable categories of people in Tanzania. Among these initiatives include a broader strategy with the National Strategies and Policy Frameworks such as the National Development Vision 2025, National Ageing Policy (NAP) of 2003, the National Health Policy and the National Strategy for Growth and Reduction of Poverty (NSGRP) I and II. The Health Sector Strategic Plan (HSSP) III launched in March 2010, the completion of Public Private Partnership (PPP) strategy and creation of position for PPP within the Ministry of Health and Social Welfare are some of initiatives the government has adopted towards improving health care services delivery. Furthermore, through the decentralization process, government encourages collaboration between Civil Society Organizations and the local government for the realization of health sector objectives. However, whereas free access to health care services was granted to older people on a loosely defined means tested basis, its implementation was patchy as a result of lack of awareness of policy amongst local health care professionals, lack of clarity on procedures for verifying age at local level (MoLEYD, 2003). As a result of challenges within means testing mechanism, and increasingly recognition that older people need to enjoy their right to free medical services, the Ministry of Health and Social Welfare has recently universalized the user fee exemption to cover all older people. However, it likely that implementation will remain challenging for some time to come. Moreover, full impact of the exemption policy are unlikely to be felt while older people are unable to meet the private costs associated with accessing medical care for chronic illness.

In all these initiatives, the commitment to improve the quality of life and social well being of older people is well reflected. However, despite the existence of these initiatives, there has been no substantive development to implement these policies at district and community levels due to inadequate awareness of the policies and limited capacity of the local authorities to implement them. Instead the right of older people including health care rights and recognition from health care providers has remained an area of key concern. Hence the implementation of this project was an attempt to fill the above gaps through awareness raising campaigns and increase access to health services to the older people and their dependants in collaboration with other stakeholders.   In so doing the project was aimed at achieving the following objectives:

1. To enabled strengthening evidence based advocacy through the OPFs and OPMGs;
2. Working with local and central government authorities to mainstream and reinforce accountability on older people’s rights and entitlements;
3. Promoting intervention which accelerate campaign against the murder of older people on witchcraft allegations; and
4. Working with the media to influence their role as change agents to build positive image and promote equity to services and entitlements among all citizens.

3.0 Methodology

The process of documenting the best practices in accessing health rights and entitlements for older people and their dependants involved various methods. These methods involved examining and comparing procedures in order to determine the best practice. The main aim was to measure the key outputs of the project against the best procedures which made a difference in the realization of project outputs. This entailed qualitative and quantitative measurements which allowed the internal and external assessment. In an attempt to determine the most effective and efficient means of realizing the main objectives of the project, the study adopted a participatory approach by involving a number of key stakeholders. These included project beneficiaries (older people), the implementers of the project, district council officials, health service providers, older people monitoring groups, the media, the members of the network, community members, local leaders – village and ward leaders from Kilosa district and Morogoro municipal councils.

A wide range of data collection methods and techniques were employed during the study. Some of key methods included review of important project documents such as, project proposal, Mid Term Review and Annual Project Reports. The desk review was important because it provided a fairly good knowledge about the projects, objectives and the achievement made. Other methods included individual and group interviews, focus group discussion and observation. The stakeholders which were engaged in this process included, MOREPEO staff members, Executive committee members of the organization, older people, government officials (i.e. Municipal and District Executive Directors, Health Service Providers, District/Municipal Medical Officers, Social welfare Officers, Community Development Officers, District Planning Officer, TASAF Coordinator, District Vicoba Coordinator Ward and Village Executive Officers) and media personnel who were engaged in this project.

4.0 Best Practices

In the course of implementing project activities in Kilosa district council, there were several good practices which contributed the achievement of the project objectives. Out of these, few best practices which demonstrated uniqueness and high level contribution in accomplishing project objectives were documented. These include the following: i) Targeting key actors/people; ii) Appointment of Older People Focal Person at the council level; iii) Establishment of Older People Monitoring Groups at village/mtaa level; iv) Use of media; v) use of Community Health Funds; vi) Engagement of older people into income generating activities; and vii) Cross visits/Networking and partnership. Each of these practices is explained in details below.

4.1 Targeting Key Actors/People

Targeting was used to capture members from the local government and community members who were strategically placed to influence decision making process and also to change their mind set towards the rights and entitlements of older people. One of the major criteria of targeting was looking for key actors within the district/municipal council who were capable of changing the prevailing old practices and behavior to positive thinking and response to older people’s issues. The targeted population within the district and municipal council level included council leadership such as Mayor(in Morogoro Municipal Council), Chairperson of the Council (in Kilosa district Council), the councilors, head of departments at the council level who included District Executive Directors, District Medical Officers, District Planning Officers, Community Development Officers ,district TASAF coordinator, district VICOBA coordinator, district Medical Officer and Social Welfare Officers. These were both political and technical experts who were strategically placed to influence decisions in favor of older people. At the lower level (i.e. ward and village/mtaa) older people, community members, health care providers and ward and village executive officers were also targeted.

At the council level, targeting as a strategy helped to involve the council leadership in planning, implementing and evaluating the project activities, hence making it easier for council to mainstream issues of older people in the council’s plans and budgets. In addition, this brought in the sense of ownership and long term sustainability strategy much as the targeted leaders helped to support follow-ups and addressing challenges facing older people which came to their attention. At community level, older people and community members were targeted to change their attitudes towards care and support to older people, while village and ward leaders were targeted to support the implementation of the project through the provision of logistical and administrative support. At village level for example, local government leaders provided administrative and logistical support to older people who were involved in undertaking income generating activities. It should be noted that TAN 239 did not have funds to implement Income generating activities but the funds was disbursed by TAN 611 Sida funded   project and the Kilosa district council through TASAF II programme. This was done through guaranteeing the older people who secured loans, monitoring the project activities undertaken by older people, enforcing the process of recovering the loans and linking the older people who were undertaking piggery/goats to veterinary services. On the other hand, there were high level of involvement of the community leadership in monitoring and evaluating the project. This was done through receiving reports from OPMGs, HBCs,PEEs and participating in reinforcing the decision made from district levels. It was further observed through the discussion that, local government leaders were part of Health Facility Committee (HFC) at the village level.

At operational level of Council Health Management Teams (CHMT), Council Health Fund Board (CHFB), heads of health facilities and health providers were also targeted as policy implementers at council level. This was a strategic approach whereby each of these actors had a different role to play in attempting to realize the objective of the project. The targeted population was empowered/trained to build their capacity on ageing issues, national policies and strategies concerning older people and the role of different actors at different levels. This was meant to build their capacity in understanding the older people issues and solicit their willingness to support the project by working with local and central government authorities to mainstream and reinforce accountability on older people’s rights and entitlements; promoting intervention which accelerate campaign against the murder of older people on witchcraft allegations; and working with the media to influence their role as change agents to build positive image and promote equity to services and entitlements among all citizens.

Hence, though targeting as an approach have been used elsewhere in implementing other projects, this project targeting was not only concerned with targeting decision makers at district/municipal level, but targeting was extended to the lower levels i.e. the implementers, local leaders, health providers, the community members, older people and the media people who became active drivers of change. The strategy worked well as all those who were targeted became in the fore front in addressing the rights of older people including free medical services to older people and their dependants and the inclusion of elderly people in councils` plans and budgets.

4.2 Appointment of Older People Focal Persons

The appointment of older people focal persons in each of the two councils of Morogoro Municipal   and Kilosa was a fantastic initiative which was brought about after sensitization campaign and realization of taking on board issues of older people in the plans and budget of the councils. The decision to appoint older people focal persons was made to increase the capacity of the council to understand concerns of older people as well as increasing the level of accountability and collaboration between the council and the Civil Society Organization, nongovernmental organization and community based organizations. The main functions of the focal person included the following:

a)            To collect information from CSOs and analyze them with other stakeholders the provision of health services and their dependants

b)            Inform the council on regular basis the progress of the implementation of the project

c)             Receive complaints and problems regarding the implementation of the project and channel them to the relevant authorities for further action

d)            Disseminate information from the council to civil society organizations and other non government organizations on decisions made towards resolving identified problems

e)             To liaise with other stakeholder in providing health services to older people and their dependants

f)             Organize meetings, sensitize stakeholders on older people’s rights and entitlements and keep records of older people issues in the council.

In view of the above functions, the focal persons helped to link the issues of older people between the council and civil society organizations. The focal person helped to raise issues of older people within the council structure so that different actors in the council could take immediate actions. The Morogoro experience reveals that, issues which were brought by Older People Monitoring Groups in their councils were already raised by the focal persons. What looks peculiar in this practice was that, the move to introduce focal person helped the council to increase its capacity in understanding older people’s issues and mainstream them in their plans and budgets. Secondly, focal persons worked as facilitators between civil society organizations, local community leaders and they took a leading role in undertaking older people’s concerns. Last but not least, it became increasingly clear that, what was implemented by the project were not just for MOREPEO, but they had a blessing of the councils. Hence the establishment of older people focal persons implied that, project activities were part of the agenda of the council.

MOREPEO -ACT Consultant`s best practices

4.3Establishment of Older People Monitoring Groups.

Establishment of Older People Monitoring groups such as Older People Monitoring Group and Home Based Care group was another best practice which facilitated an increased access increased access of health care services to the older people and their dependants. The existence of these groups has proved to be a key channel for older people to give their feelings and views regarding their health status and other basic needs. The roles and responsibilities of these groups are described below.

a) The Older Peoples Monitoring Groups

The Older Peoples Monitoring Groups (OPMG) was composed of ten members, two of which were nominated representative (one older man and one older woman) from the ward level. The roles of OPMGs include the following: i) to collect at ward level priority issues raised by older people; ii) to present and discuss these priorities in meetings with the village government committees, Ward Development Councils and district council, and lobby for their inclusion in the ward and district development plans; iii) collect information to monitor the progress against annual priority and targets in ward and council plans; and iv) to pass information on policies and entitlements to older people and the wider community in their villages.

After receiving information concerning the older people the village office, ward and municipal councils in collaboration with the implementing partners met at different levels to discuss older people’s issues with a view of resolving the matter. The composition of the caucus meeting depended on the concerned parties. There was a very close collaboration between the OPMGs, the Mtaa/ward leaders and municipal councils. The collaboration was made easier as a result of the impact of awareness rising campaigns through training, workshops, seminars and public meetings. The role of OPMGs in collaboration with the implementing partners and district councils in gathering data on health services delivery was to ensure that all stakeholders had a responsibility to keep local government duty bears accountable in their responsibility to support entitlement of the rights of older people.

In view of the above, the creation of Older People Monitoring groups helped to break the isolation of older people and provided a space in a non threatening environment to meet, share their grievances, exchange ideas, offer mutual support and draw strength in a collective forum to engage with local leadership and advocate for better health service provision. In addition, the involvement of OPMGs ensured that the project took into consideration the social and cultural aspects of the communities during project implementation. These were some of the qualities which made this practice best.

B

b) Home Based Care

Home based care model was one of a community based approach to support older people by providing them with moral and material support. The community home based care providers were selected on the basis on their willingness to serve the older people. The members were supposed to seek for the information concerning needs and problems affecting older people in their homes and provide support by helping them in domestic work, giving them advice, information and assisted them to go to the hospital when they felt sick. They also initiated support groups for trained home based carers, for self advocacy and linking older carers to support services. The reports received from the HBCs were first reported to the Mtaa/village chairperson who took action. In complicated cases, the matter was reported to village chairperson who then involved other stakeholders to address the matter.[1]

What made this approach best practice was its community based nature and its inherent sense of sustainability from community members. Furthermore, since these groups were concerned with data collection concerning the status of older people, they also acted as monitors and providers of information to relevant authorities to facilitate decision making process. Hence regular monitoring meetings which involved members of these groups which took place throughout the project period provided learning opportunities for the participants and involving key stakeholders, including older people themselves. The monthly and quarterly meetings between OPMGs, HBCs, implementing partners and council officials received problems and discussed how to solve the problem which emerged from different villages/sites.[2] In other words, the presence of these monitoring groups helped to provide feedback to duty bearers at the grass root level. Additionally, while such findings from monitoring were used immediately by the OPMGs at village and ward level by engaging village, wards and district council on aspects of health services which needed improvements, these findings were also presented on quarterly basis to the implementing partners who later presented them the council for further action. Last but not least, the establishment of home based care services to older people brought new hope to many older people who were previously living in isolation and had virtually no one to turn to for both social and material support.

4.4 Use of media

The media was used to transmit information to different categories of the population. The main media houses which were used included, Tanzania Broadcasting Corporation (TBC TV/Radio), IPP Media (ITV and Radio One) , Abood Media (TV/Radio), and Radio Okoa , TOP FM, and Planet Radio . The radio program included News Bulletin, special program like“tuzumgumze asubuhi” from the above radio programs in songea. Radio programs like, “Wazee ni hazina” from Radio Tumaini “Asubuhi njema” from Radio Ukweli, and through “Vipindi maalum” by Radio Abood covering activities and events concerning older people. These were programs which were aired from 20 to 150 minutes depending on the radio programs. The main messages delivered in most of these programs revolved around the following areas, namely: i) Accessibility of older people’s Rights and entitlement; ii) The right to free medical services for older people; iii) The national policies and strategies with a bearing to issues of older people; iv) Needs and problems of older people; v) Universal social pension; and vi) Live interviews from different older people concerning their experiences and activities.

National television programs run by TBC1, ITV, Channel Ten, Star Television and regional television program by Abood Television in Morogoro region were invited and participated in Media tracking and awareness forums at local and national level to increase visibility of OP accountability issues related to policies and strategies. The major methods used in the television programs were through the news bulletin, production of documentaries and use of individual profile of older person and live interviews. The media was more effective in delivering the message to larger population compared to other methods. Whereas the media have been used in various advocacy and awareness raising campaign, the participation of media in this project was unique because of the following reasons.

a)            The media were taken as one of the important stakeholders in advocating older people’s rights and their entitlements. This helped them to appreciate that they too had a role to play and can make meaningful contribution to the project. This motivated the media to play an active role in raising public awareness on older people’s issues taking this as part of the obligation they have to the society and not as an opportunity for earning revenue where they could charge commercial rates for airing the program.

b)            There was a strong willingness of media personnel to participate in various meetings, workshops and seminars not as journalists (who would come and listen briefly and go) but as participants. Their full participation in such forum helped not only to increase their capacity of understanding ageing issues, the national policy frameworks and strategies concerning the protection of older people’s rights, but to disseminate the right information to the public.

c)             As a result of (b) there were increased passion among media people through their commitment and personal involvement in advocating older people’s rights. This can be evidenced by the following features: i) an inclusion of a media person in the MOREPEO Executive committee (Mr. Wilson Karuwesa); ii) existence of special group of journalists who specialized in writing articles concerning older people; iii) willingness to participate in issues concerning older people without expecting any payment, and iv) special programs organized by ITV, TBC1,Abood TV and Iman TV such as documentaries on the older people`s challenges and tracking individual profiles of older people were a result of such commitment.

4.5The use of Community Health Funds

Tanzania launched the Community Health Fund (CHF) in 2001; however the coverage of the poor has remained negligible. The older people in particular appear either unable to make the required financial contributions or have become disenchanted with the scheme given the poor quality of old age health care services at local level. Unfortunately, the entitlement of benefits of CHF has not been demanded for lack of knowledge about how it works by potential beneficiaries.[3] The Poor segment of the population including older people and their dependants did not enjoy this facility partly because they were unable to contribute to the CHF unless the local government allocates funds for them.

In both cases the Morogoro and Kilosa experiences provides best practice for the use of community health fund. In Kilosa for example, through the project, the knowledge about Community Health Fund and how the fund operated in favor of older people and their dependants was provided. As a result, the district council managed to fund older people and their dependants by through the use of Community Health Fund in government health facilities and Faith Based Organization health facility. As a result, through CHF program older people and their dependants were registered and paid 10,000/- for each family. Through this program a total number of 8,000 ( F 4,500,M 3,500) older people and 32,000 dependants have benefited. Hence most of the dependants living with the vulnerable older people have benefited from the program. Kilosa district council provided identity cards to older people while their dependant’s names were listed in a registration form. In the case of Morogoro municipal council the project initiated the law for the establishment of CHF in the municipal council. As a result, in its annual budget 2015/2016 the municipal has set aside 32 million to cater for older people and their dependants (through the program known as TIKA – Tiba kwa Kadi). In view of the above, the use of Community Health Fund had the following merits:

a)            The use of community health fund facilitated the increasing access of health services to the dependants of older people. Statistics of the attendance of older people from different health providing centers observed in four councils testify this.

b)            The council which had not established the community health fund such as Morogoro municipality finalized the legal formalities and it has started to set funds to cater for health services for older people and their dependants

c)             The fund provided by project to pay for older people and their dependants through community health fund acted as a challenge for the council to start allocating funds for older people and their dependants through CHF

4.4    Engaging older people in income generating activities by TAN 611

Engaging older people in income generating activities was a challenging one but worthy it. In all four districts the process of administering the loan to selected older people was more or less similar. The following procedures were used.

a) Identification of the Beneficiaries

Before the older person became a micro credit scheme beneficiary, he/she was identified by his or her fellow older people through the village assembly public meeting in the presence of village government leaders and OPMG. In order for one to qualify for a credit scheme, an older person was required to fulfil the following criteria namely: i) he or she must be at the age of 60 or more ii) he or she must be a resident of the selected village, iii) he or she must possess the ability to repay the loan, iv) he or she must be accepted by the fellow older persons and his or her fellow income generating group members as trustworthy person; v) it was preferably that over 55% of the beneficiaries must be women, with a defined number of dependants she cared.

b) Entrepreneurial Training

For those who qualified for a credit scheme, they had to undergo training on how to select and run viable IGA projects, record keeping, budgeting, diversifying projects and marketing. The kind of projects was decided upon by the beneficiaries themselves. The district council workers including Health workers, Community Development Officers participated in training as facilitators.

4.7 Networking and Partnerships

Through the decentralization process, government has openly encouraged collaboration between CSO and the local government for the realization of health sector objectives. The health sector strategic plan launched in March 2010, the completion of Public Private Partnership within the Ministry of Health and Social Welfare are some of the initiatives the government has adopted towards improving health care services delivery. Within this context, through the reports from the OPMGs and Home Based Care committee, it was realized that there was a need of engaging the services of private health providers to serve the older people.[4]

Networking also played a vital role in raising awareness on the rights and entitlements of older people. MOREPEO managed to engage other nongovernmental organizations in the district to advocate the agenda for older people. This was made possible through strong network between MOREPEO and those organizations. These organizations were HUDESA; Morogoro Paralegal; UNGO Morogoro region; and FARAJA Trust.

Apart from networking helping to strengthen relations and collaborations with other organizations, sharing resources and promoting teamwork, partnership and networking helped to increase access and entitlement of health services to older people and their dependants.

5.0 Conclusion

We have noted the best practice drawn from four councils in Morogoro regions. We acknowledge the dire need to replicate the successes of the project to wider areas within and outside the country; however it should be noted that, best practice may not be applicable in all circumstances depending on the different levels of development, perception of the implementers, cultural or differing circumstances which may not be favorable. However a key strategic talent required when applying best practice to organization is the ability to balance the unique qualities of an organization with the practice that it has in common with others. In addition, a best practice are not static they change as new development and new approaches emerge at different points in time. Nonetheless despite the level of achievements and best practices identified in the implementation of the project, poses new challenges which call upon the local and national government and other stakeholders to focus more on the main problems affecting the older people. It was interesting to note that, despite these best practices there was still lack of disaggregated data about older people a fact which would support planning of older people issues at local government levels. Last but not least, whereas the councils aspire to serve many older people and their dependants, the capacity to do so is limited in terms of resources (financial, human and material resources). The situation is much more critical because after rising the awareness of the older people’s rights there is an increasing demand from the older people while the capacity to fulfill their demands remains limited.