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 Full Title From ‘Cure to Care’ Among the Elderly.  Old-Age Vulnerability in 
Tanzania.
 Short Title Cure to Care
 Project Leader Honorati Masanja
 Description Old-age research in relation to culture, health and illness in developing countries is gradually gaining in importance in the social sciences.  However, social anthropology studies on older care, care support schemes and burden of elder care are only in its initial stage.  This proposed research builds on a selected review of current literature and on findings of a previous study of the applicant on old-age vulnerability in Southeast Asia, where care needs related to chronic illnesses were identified by the elderly persons as principal spheres of concern.  As a matter of fact, in non-Western societies the degree of old-age vulnerability is influenced to a great extent by providing – or just failing – care support.

This medical anthropology research study is based upon the conceptual framework of ‘health transition’ – that includes rapid demographic and epidemiological transformation, socio-cultural change, fast urbanization and migration as well as broad change of lifestyle in most developing countries – and correlates it with the assumption of growing social, economic and health uncertainties (i.e. uncertain family, kinship and community support; minimal state provision; increased risk of suffering concurrently from infectious and chronic disease) for elderly people nowadays in most developing countries.  Harsh living conditions for many elderly people in Sub-Saharan Africa, shaped, for instance, by economic poverty, poor access to professional health services and last but not least the HIV/AIDS pandemic, put already a heavy burden and strain on the older persons whose most important asset is still a health body and mind. 

Along with the global processes of ‘health transition’ and above triple uncertainties, appropriate and adequate care for frail elderly may become a major challenge for most societies in Sub-Saharan Africa.  The above-stated transformations postulate a distinct shift ‘from cure to care’.  Care in this sense is understood as both practice and attitude and encompasses more than mere medical activities. Households ‘produce’ not only health, but also care which belongs to the biggest part into the realm of laypeople and of women as principal caregivers.  The ‘vulnerability’ concept refines these approaches by regarding elderly individuals as being social actors who share particular risks and exposures, but who can mobilize coping resources and potentials to prevent, mitigate or overcome bad outcomes.

The six specific research objectives are;

1. to investigate elderly persons’ perception of ‘old age’ (emic view)

2. to identify relationship of main carer(s) to chronically ill elderly

3. to look into resources and capacities of elderly people which strengthen their resilience regarding care and support

4. to explore the significance of rural-urban relations for chronically ill 
elderly persons

5. to find out the role and burden of elder caregivers

6. to assess nature and priority of care improvements of chronically ill 
elderly people (emic view). 

Qualitative and, on a smaller scale, quantitative research methods are applied to achieve these objectives.  The study approach comprises different societal levels, namely community, household and 
individuals, and diverse stakeholders.

The research period will last three years (January 2008 – December 2010).  In order to study urban-rural dynamics in relation to care schemes and old-age vulnerabilities as well as mobility of elderly people and their caregivers, we have designed a research approach that includes a rural and an urban area.  Main research area and also ‘point of departure’ is the Rufiji District (in Pwani or Coast Region), and metropolitan Dar es Salaam will be the selected urban environment.  In Tanzania, we have an interdisciplinary and international research team including one country and one field coordinator plus two PhD students (of social anthropology); the main applicant acts as principal project coordinator.

The project makes a major contribution to old-age research in developing countries, particularly to care schemes.  The effects of ‘health transition’ and concomitant HIV/AIDS and poverty on elder care schemes in non-Western societies are not yet widely studied and understood, thus this research fills this gap of knowledge. Moreover, this study strengthens the international dimension of North-South research and exchange.  And finally, it will provide empirically grounded recommendations for Tanzanian researchers, politicians and 
policy-makers.
 Collaborators Peter van Eeuwijk            University of Basel

Brigit Obrist                    University of Basel

Joyce Nyoni                    University of Dar es Salaam
 Source of funding Swiss National Science Foundation
 Start Date July 2009                          End Date        June 2011     
     

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