Universal Pension Pilot in Muleba District Results from the baseline survey 1/2017

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1 Universal Pension Pilot in Muleba District Results from the baseline survey 1/2017 Table of contents INTRODUCTION 2 SURVEY RESULTS * 4-10 Personal data Accessibility Household 4 Living conditions / Livelihood 6 Community network / Support 7 Empowerment and Wellbeing 8 Impacts of pensions in overview 9 Health 10 ANNEXES Kwa Wazee; July 2017 * This is a preliminary presentation of results with only few comments and explanations. A more detailed report on the first year of the Universal Pension Pilot will appear in November

2 Kwa Wazee Baseline Survey 'Universal Pension Pilot' 2017 INTRODUCTION Towards the end of 2003 the Tanzanian NGO Kwa Wazee started to support older people by means of social pensions in a number of wards of the Muleba District. This was the first time in Eastern Africa that the concept of non contributary social pensions for older people was applied. Kwa Wazee understands itself as a small laboratory in developing and testing various approaches to protect and empower older people and their dependents. Over the years cash transfers were gradually complemented by a health programme and by the promotion of various forms of self organisation of older people around 1,300 older people headed households were supported with pensions and supplements for vulnerable children in their care. Lessons learned from field experience and evidence from various studies: Social pensions prove to be the corner pillar for the social protection and the strengthening of the older population. Regular cash transfers immediately improve the food security of older people and their access to basic goods. The regular income by a pension has also a positive effect on the psychological wellbeing of older people, it strenghtens their status and inclusion in their community and it ultimately capacitates older people to better self-help. The positive impact of social pensions on older people is extended to the family and the community Most obvious beneficiaries are children in care of their grandparents and family members. The regular extra influx of cash considerably stimulates the local economy. Local shopkeepers, traders or craftsmen are among those directly benefitting from social pensions. Longterm objective: Universal and unconditional In a context of widespread vulnerabilty of older people as experienced in rural Tanzania, means testing (to select the poorest from marginally less poor) proves inadaquate and discriminating even if it is done with utmost care. Based on experience, Kwa Wazee strongly advocates a universal approach. Social protection of older people by means of social pensions in the Region Until 2004 there were hardly any national programmes of social pensions in Sub Saharan Africa. Since then a number of countries have successfully introduced social pension schemes. In Tanzania, a feasibility study initiated by HelpAge Tanzania and published by the Ministry of Labour, Employment and Youth Development in 2010 concluded that universal social pensions were an effective and an affordable means of poverty reduction. In the same year the Prime Minister's speech to the Parliament confirmed the Government's commitment to introducing a social pension for the elderly. The commitment has been confirmed at various occasions since then and is also part of the Manifesto of the present Government. HelpAge Tanzania has the leading role in promoting universal pension schemes on a political level within the Civil Society of Tanzania. In April 2016 Zanzibar introduced universal social pensions. Neighbouring Uganda has started a programme of progressive introduction of universal social pensions. Most recently Kenya has announced the introduction of universal pensions from

3 New pilot programme: Kwa Wazee introduces universal pensions in two villages of the Muleba District As a consequence of our own evidence and experience and of the current debate on social pensions, Kwa Wazee started a small scale pilot with universal pensions in the Muleba District. Since November 2016 every older person who is 70 years old or older and who has lived for at least five years in one of the two villages, Ikondo and Nsisha, receives a pension of 15,000 TZS every month. The scheme is implemented by local Village Pension Committees, which have been elected by older people's assemblies in both villages. Kwa Wazee provides the funds and is responsible for training and for monitoring. While the various positive impacts of social pensions for older people have been well documented in national and international studies indeed in several Kwa Wazee studies 1 the pilot scheme is ambitious to extend the knowledge in areas which have been less examined. One key objective of the pilot is to learn and to inform stakeholders about numerous practical aspects of the implementation of a universal pension scheme in rural settings in Mainland Tanzania. Of special interest are: How reliable are local data and various forms of ID for the registration process? What are the gaps and how can they be bridged? How can older people who are especially vulnerable through disabilities or remote locations be reached and by which forms of cash transfer? How can older people themselves be included in the various processes of the pension scheme? Baseline Survey Part of the pilot is a baseline survey which allows for periodic monitoring of developments and changes. The survey also sought new insights on impacts of pensions where little evidence exists so far. It also explores issues like the health condition of people over 70 years, their sense of safety and of agency within their community. Methodology The relatively low total number of older people in the two villages who are in the pilot programme offered the opportunity, not to use as in previous studies a randomized sample for the survey, but to include all participants without exceptions. There is no control group. Interviews were conducted with all of the 183 older people aged 70 years or older in the two pilot villages Ikondo and Nsisha. They were carried out in February/March 2017, three or four months after the start of the pilot. The average duration of interviews was 45 minutes of the interviews were carried out at meeting points interviews (29%) were conducted in the homes of the pensioners. - In 16 households two pensioners received a pension. In one case three pensioners lived in the same home. - 8 of the interviews were made or partly made with a family member when the older person was not fit to answer. 1,SALT, SOAP AND SHOES FOR SCHOOL The impact of pensions on the lives of older people and grandchildren in the Kwa Wazee programme in Tanzania's Kagera Region.' HelpAge International, REPSSI, World Vision, Swiss Agency for Development and Cooperation TOWARDS UNIVERSAL PENSIONS IN TANZANIA - Evidence on opportunities and challenges from a remote area, Ngenge Ward, Kagera HelpAge International, Help Age Germany, Kwa Wazee Switzerland

4 SURVEY RESULTS PERSONAL DATA ACCESSIBILITY gender 3 age distribution female male 36% 6 6% 2 10% 5% no answer widowed divorced married not marital status 1 28% 8% 50% A total of 183 older people (117 women and 66 men) participated in the Pilot when the survey was done. All of them were interviewed. 132 of all older people were widowed, divorced or not married during the survey (7). Just over 50% of all men (35) were married, while less than 1 of all women (16) were married. Despite the high percentage of married people (28%) only in eight houses husband and wife were both over 70 years old. It's quite common that men are married to younger wives. capability to read from a poster ability to collect the pension I can read it 11% always collected myself 4 I can read it with difficulties I never read 39% 38% most of the time I get informed by family 10% rarely or never 36% The high number of older people who express difficulties with reading is also reflected later in the survey where 51% of all pensioners reported having problems with their eyes. Difficulties with walking (6) and chronic illness (26%) were the most important reasons for older people not to collect the pension themselves. access to mobile phone mobile money transfer have own phone 3 I have used it 25% access with trusted person no access to phone 1 49% the family uses it I have no experience 33% 4 Comment: When asked about assets, 63% of respondents also stated that a mobile phone is available in their household. While just a small minority of 1 of the pensioners is left with no access to a mobile phone at all, a much larger number (4) have no experience so far with mobile money transfer. HOUSEHOLD 8 one older person number of pensions in the household 9% husband and wife 3% parent and child 6% siblings Of a total of 183 participants of the Universal Pension Pilot, 150 (8) are the only older person in the household to receive a pension. in eight houses (9%) married couples get a pension; in eight houses (9%) a m and a child or two siblings both receive a pension. In just one case three pensioners were living in the same house. 4

5 household situation number of persons living in household living alone living with older persons only 3% 10% 10% 16% 15% 10% 16% 13% living with the family number of grandchildren living in same household number of grandchildren in household who go to school % 1 8% 5% 5% 39% 18% 15% 18% 6% and more and more 41% of all households contained three or less people. The average household with an older person included 3.7 people (1.8 adults and 1.9 under 18 years). In 61% of the households there were two or more children under 18. In four households there were between 7 and 9 children. Also in 61% of the households there was at least one child who goes to school. In two families there were 8 children going to school. grandchildren contributing to household income In 33% of households a member needs special care: who needs constant care? no grandchild can 7 children 6 1 grandchild contributes 1 adults 18% 2 grandchildren contribute 3 or more contribute adults and children no answer 3% 1 * In every third household there are very young children who need constant care or adults with disabilities or chronic diseases who need constant care. In by far the majority of cases this relates to small children. In 22 households (1) there are both adults and children with special care needs. 89% how older people contribute to their households 71% 41% 45% % 1 get food cook food school expenses collect water, firewood buy medicine personal care care for very young child contribution to support group Older people above the age of 70 years see their main contributions in areas where they can buy things: 89% of all older people buy food, 71% buy medicine. They also contribute to school expenses or fees for mutual support groups. On the hand they do less hard work (collect water or firewood) or personal care for. 5

6 LIVING CONDITIONS / LIVELIHOOD house construction toilet system 1% hut house (grass only) mud wall, grass roof 36% mud wall, iron sheets brick wall, grass roof 49% brick wall iron sheets water borne toilet no toilet pit latrine form of toilet 18% 76% The quality of the houses has improved in the last decade. Yet to improve their house remains one of the biggest needs of older people once nutrition and basic needs are secured (see page 9). Only one out of 25 older persons can use a toilet which can be flushed. 86% 63% 88% 85% 9 assets owned by older people 86% 45% 3 31% 15% 3% 2 21% 9% 3 of the older people stated that they do not own a mattress for sleeping. The vast majority of older people do not own animals. To buy a mattress is one of the most often mentioned basic goods older people hope to purchase in the future; To buy poultry or a goat are among the preferred ways of improving the farm and the self subsistence (see page 9) how do you get your food? several answers possible 91% 91% 9% 25% 8% 9% 3% harvest from my land buy from local shops buy regional salesmen gifts from my family gifts from neighbours gifts from groups (church) reward for daylabour The response to this question is typical for subsistence farming and is also a strong indication about the importance of local shops. A minority of older people mention food gifts or food as reward for fieldwork. which are your sources of income? several answers possible 70% 38% 1 15% 5% 3% 1% 9% selling crops small business daylabour gifts loans sale of assets Nation pension Private pension scheme Less than 5% of Tanzanian people receive a state pension or a private company pension. In the two pilot villages just under receive a state or a private pension. Gifts, loans and money for daylabour are essential supplements to the proceeds from selling crops. 6

7 number of meals and satiation % 8% impact of pension on nutrition there is no difference eat more often 1 one meal a day two meals a day satiated still a bit hungry still hungry eat more in quantity better food (taste+quality) 33% 4 Three months after the introduction of a pension 8% of older people above the age of 70 declare they live on just one meal a day and only 5 state that the are satiated after a meal. The pension translates directly into the nutrition of older people. While 50% declare that they eat more often and more in quantity, 4 emphasize the better quality of the food. COMMUNITY NETWORK AND SUPPORT which support groups are you part of? 4 21% 9% 1% 1% 5% 0% 13% 1% 18% 13% 38% 55% who supports you when you are sick? 15% 10% 0% 1 support preferred support 73% of all older people would prefer to be cared for when they are sick by their spouse or by their children. The actual support by these groups is much lower (51%). The care-gap is closed by grandchildren, neighbours and relatives. As far as neighbours and relatives are concerned, this is clearly not what older people would prefer. 18% 1 how safe do you feel 25% 15% 53% 3% 13% In a preceding question 8 of all respondents stated that they felt safe or mostly safe during daytime stated they felt unsafe at night. walking alone working in the farm when alone at home on the way from the market collecting the pension feel safe mostly safe not safe for my property Only 3 months since the start of the pension programme the high percentage for 'mostly safe when collecting the pension', may express uncertainty with a new situation with little experience. 7

8 main reasons for not feeling safe health, age, loneliness specific incidences 1 fears without concrete incident 8% 3 46% Land-grabbing, theft and physical violence were mentioned as concrete incidences for not feeling safe. Most often health problems related to age poor eyesight or mobility were expressed as reasons for not feeling safe. EMPOWERMENT AND WELLBEING how satisfied are you with present situation? very satisfied rather satisfied neither sat. rather dissatisfied 13% very dissatified 5% 31% 3 The high percentage of older people who declare themselves very satisfied or rather satisfied with their situation surprises. These answers are likely to be influenced by the fact that the introduction of pensions is very recent. who contributes most to changes in your life? myself my family a group I belong to the village the District the State no answer 1% 1% % can people like you change things in community? fairly easily 20% yes, with difficulty 36% The questions in this chapter belong to those parts in the baseline survey which will be particularly interesting to compare in the future. with a lot of diffculty 30% no not at all 1 status of older people in the community OP are offered help when needed 49% 36% 1 OP are recognised and valued 5 28% 1 OP regularly meet in village 38% 4 18% OP are listened to in committees 5 25% OP used to expressing their needs 5 25% 21% OP are aware of their rights 53% 23% 21% OP involved in decision making 38% 36% 2 OP exempted from comm. charges 7 16% 9% OP exempted seeking legal support 4 26% 31% yes no don't know 8

9 IMPACTS OF PENSIONS IN OVERVIEW In the first study in 2007/8 only older people who had received a pension for at least 18 months were interviewed. While they said that they spent by far the biggest part of their income on food, they stated improved basic needs as the biggest change since they received a pension: soap, kerosene, bed sheets, clothes - for example. A second study in 2013/14 showed that an increasing number of older people were able to invest in their farms and could strengthen their subsistence. support g'children house repairs special food 6% basic food 25% biggest changes for first pensioners in 2007 medical care improved basic needs 5 biggest changes since start of pension expenses for health feeling better 1 strengthened subsistance 1 could support family 5% improved basic needs 3 more and better food 31% How would the impacts of the pensions be described by the entire older population and not just the most vulnerable older people? All interviewed people had received three or four pensions since the start of UPP. The response was surprisingly close to what can be observed of older people in the Kwa Wazee programme who have received a pension for several years: Apart from a better coverage of food and basic needs they often mention the capacity to invest in the farm or in assets. Better psychological wellbeing and social inclusion is also highlighted as one of the biggest changes. give support to family 5% improve the house 26% hoped-for changes in coming years hopes for better health 3% strengthen subsistence 28% improve basic needs 20% have more and better food 16% In a second question the interview respondents could express what they expected or hoped for in the coming years. On the basis of better security of food and basic needs, measures to strengthen the subsistence 'buy a goat' or 'improve the farm' were most often mentioned, followed by measures to improve their housing. Despite the fact that in an question health and age were mentioned as the biggest concerns, a consistent finding was that few believed that they could do much about their health. 9

10 HEALTH 4.1 How would you describe your state of health in the last three months? Total number of repondents: 183 = without exception all older people 70 years or older from the two pilot villages Ikondo and Nsisha in Muleba District /Tanzania. state of health last 3 months Comparison felt sick most of the time often felt sick 16% 31% In a survey carried out by Kwa Wazee in 2007 in the same District, 68% of older people - pensioners and non pensioners from the age of 65 - had stated that they felt sick often or most of the time. sometimes felt sick had no health problems 50% Important difference: the survey included less than 20% of the older population: most vulnerable older people who had been selected for the pension scheme. most frequent health problems joint pains 5% 59% back pains 46% eyesight problems 10% 51% headache 3 teeth pains 3% 29% ulcer / stomach 1 3 self declared blood pressure 15% diagnosed malaria 8% weak bone' 1 fever, cold, flu 1% 18% various mental conditions 0% 1 heart problems 11% People were asked whether they had been examined and diagnosed and whether they had been in hospital. In most cases with a diagnosis this had been the case. Some of the diseases which could be expected to have a higher prevalence were not reported at all or in just a few cases. Non communicable diseases like asthma (0) or diabetes (6) or infectious diseases like hepatitis (4), syphillis (2) HIV/AIDS (0). Remarkably low incidences of diarrhea (2) or forms of incontinence (5) were reported. To what extent are answers influenced by stigma or shame? Few cases were reported of tuberculosis (3), typhoid (4). 83% quality of drinking water Besides river, sources for getting water included: wells (), rain collection (6%), communal tap (5%). 2 53% 4 46% None of the respondents applied purification forms like SODIS or water guards. get water from the river water from sources used to purify water water is not purified boiling water forms 10

11 Annex 1: Most frequent health problems (overview of all answers) 4.2 (for those who stated they had felt sick in the last three months): Can you describe your health problems? Interviewing technique: first step: enumerators listen to what the interviewed person mentions. In a second step they can show a 'bodymap' ("if you think of your head, your upper body and your lower body. Which parts of your body have given you trouble in the past months?) 4.3 In a second part of the question respondents were asked which of the mentioned problems are most serious for them. self reported health condition, health problem (main symptoms or name of disease) no. of patients suffering from a health problem % of all resp. 4.3 patients for whom it was the biggest health issue no. patients diagn. (went to hospital or health station) % diag. remarks joint-pains % % 1 'arthritis' back pains 84 46% 41 7 weak bone (osteoporosis) teeth eyes / sight problems 93 51% % hearing nose bleeding throat / neck blood pressure heart problem lung infection ulcer stomach skin disease chestpain 'coughing' prostate enlargement 'sugar' / diabetes fever, cold, flu headache malaria anxiety / panic attack feeling dizzy dementia 'Alzheimer disease' 1 'mentally challenging' injury / accident only few cases reported allergy stroke urinary tract infection diarrhea hepatitis syphilis TB swollen limbs / glands typhoid lepracy numb limb appendix just once or never mentioned HIV asthma weak bladder cancer bone cancer kidney disease abscess

12 Annex 2: Not feeling safe examples stated 5.6 If you feel not safe (or are worried), could you give us an example? number of interviewed pensioners who made respective statements (out of total 183) sick and poor and no support (15); health problems (7) living alone (5) (mainly: eyesight, walking, being weak) HEALTH, AGE, LONELINESS 27 SPECIFIC INCIDENCES 7 "My nephew wanted to grab my land" "..village comittee took land".."two years ago I was beaten by someone, he was brought to court and was penalized". "During certain months my property was stolen - afraid they come back". "I have a case with a village chairperson and was threatened." "I had a case about land which I used for 17 years, now I have lost it." "The children of the second wife of husband wanted to kill me because of the land." FEARS WITHOUT CONCRETE INCIDENT 20 "I'm afraid of losing property by a thief" (2) "fear somebody steals the crop" "I fear that my land is grabbed" "I don't own my house, I fear to be chased" "afraid, that assets are stolen" (2) "afraid of attackers at night, after stories I heard." "if you move at night the risk is higher." "am afraid of my grandchild, he could attack me, but never happened." "afraid of young people around the house with no work" "afraid of being attacked when alone outside" "my grandchild is not supportive" "danger doesn't knock - anything can happen" "because I'm old I cannot help when I'm attacked" - "walking alone, if I fall down nobody can support me" "if I go to the shop and nobody with me" "because I live without cooperation with people". "bats get in and out of my house." "I'm suffering from a disease which is my secret - when it comes out I am really suffering." OTHER "because I think of children who passed away" because I worry about the future" "weak and full of thoughts - afraid that I could have an accident." " I have no children and feel alone." 12

13 Annex 3: What older people would like to change most summarized overview and examples 6.2 If you think of your life: What would you like to change most for the incoming two years? Total number of repondents: 183 = all older people 70 years or older from the two pilot villages Ikondo and Nsisha in Muleba District, Kagera Region. more food better food tastier food better satiated have food security n. (out of 183) % FOOD 49 2 better clothes (4); purchase matresses (39); bedsheets (8); domestic utensils (6); improve basic needs purchase of mobile phone - TV - solar lamp - radio get treatment for health (3); get free medication (4); can go to hospital (2) get cataract operation; wish to get cured BASIC NEEDS 58 3 CONSUMER GOODS 4 "I went to hospital five years ago, I was asked to pay 50,000 (TZS) which I did not have. Since then I'm discouraged to go to hospital." "I wish to be cured from my disease so that I can visit my neighbours." enable grandchildren to go to school (6); I can care for grandchildren; I can empower the children to invest small business; get enough food for the family (3); purchase land for my grand children. "I will pray in church, that my only remaining son will live on longer." "I purchased a sewing machine for my daughter" "I want to marry" HEALTH 11 FAMILY 14 INVESTMENT / SUBSISTANCE 84 46% purchase animal/extend livestock (6); buy cow (7); buy goat (36); buy poultry (19) improve the farm (21); purchase land (3); fertilize land (2); extend agriculture (3); cultivate mixed crops (5); pay daylabour (3); saving for future "I want a big shop plus a mini bus for business" "would like to construct a house as investment". improve the house (45); repair house (9); construct/repair house parts (6) build a new house (16) "I would like to purchase furniture, chairs and a floor". "construct a house that I don't need to live with my children" PSYCHOLOGICAL / SOCIAL "that I sleep well" - "that I not have to sell my farm". "that I get credit for milk" "I cannot change things, I'm too weak". HOUSE

14 Annex 4: The meaning of a pension (summarized overview and selection of statements) 7.1 (final question of interview) It is now about 3-4 months since you started receiving a pension: could you please describe what it means for your life? number of interviewed pensioners who made respective statements (out of total 183) FOOD 76 more meals a day more food better food tastier food better satiated have food security "I don't need to tight my stomach with a rope because I eat more than once, have more energy" "I'm sure to get food!" "Now I can eat twice" "since the pension I drink tea with sugar the pension has supported us specially during shortage of food". "Pension gives hope for the future, I can borrow food because traders trust me" "I feel stronger and better satiated" "Now I can eat what I like" BASIC NEEDS 84 more / better basic needs, house utensils, clothes (6); bedsheets (6) "We discussed what we would buy; my wife advised to buy saucepan and food." HEALTH 6 get medecine or treatment "I hope to get cure from eyesight problem" "I managed to go to hospital" "I paid 15,000 TZS for insurance (Community health fund)" FAMILY 12 purchase school material or meet school needs of g'children (8) support family (4) "I'm more proud because I can buy school material for my g'children this is a good direction for my life and I'm being trusted by small shops that I can pay back my money." "pension is a blessing! we are more respected and valued by our families." "I'm living in my sons house, when I receive the pension he buys food and we are both happy" "it improves the budget for my family." "I am now able to buy food for the whole family" INVESTMENT / SUBSISTANCE 35 bought daylabour (5); bought agricultural tools (hoe, machete) (5); bought poultry (7); bought goat, mini pig, (2) joined mutual support group (3) bought seeds; income generating activities (2) get a loan (2) get credit from shopkeepers (3) make savings (2) purchased a door (2) "pension helps me to start planning for the future in (group with) revolving fund." "In all my life I never kept an animal but with the pension I managed to buy two chicken (72) cash is very supportive" "I can lead a court case (against land grabbing)" PSYCHOLOGICAL / SOCIAL 29 "I have more hope (3)" "I sleep better (2)" "I don't need to beg for salt" "it reduces stress (3)" "I'm feeling good, because I am not forgotten" "I will now live longer" "everything goes smoothly now" "I feel more valueable" "I feel comfortable" "it reduces hardships of life (2)" "I manage to fulfill church comittments" "now I have a good life" "I can buy what I want, what I need - have money to spend (6)", "I'm happy because we meet the expenses (3)" can now wash my clothes "For my life it has a big meaning. Nowadays I'm like a (government) worker, meaning that I get every month an allowance which I use to purchase sugar and needs incl. food." RESERVATIONS - THANKS 3 "but it is not enough to plan for future" "money is not enough for whole month" "pension makes no change" "I so much thank this man!" (President of Tanzania?) "I do pray for those who support that God makes them earn more for their work" 14