A THESIS SUBMITTED IN FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY OF SOKOINE UNIVERSITY OF AGRICULTURE. MOROGORO, TANZANIA.The Government of Tanzania has exempted the elderly from cost sharing in health service delivery as it is stipulated in the National Ageing Policy and in the National Strategy for Growth and Reduction of Poverty in Tanzania. However, the majority of the elderly do not get the services freely. The main objective of this study was to assess factors influencing access of the elderly to free health services. The study was conducted in Iringa and Makete Districts. A cross-sectional design was adopted in the study. Quantitative data were collected using a structured questionnaire involving 240 elderly. Qualitative data were collected through in-depth interviews, focus group discussions, and key informant interviews. Quantitative data were analysed using IBM Statistical Package for Social Sciences (SPSS) Statistics software by computing descriptive statistics including frequencies, percentages, averages, minimum and maximum values of individual variables. Qualitative data were analysed through content analysis and categorised based on the research objectives. The majority of the elderly had poor health status which was linked to their decreased ability to perform activities for daily living. Their health statuses were significantly influenced by their socio-economic characteristics (p ≤ 0.05). The health services received by the elderly were of low quality as their expectations on health services were higher than their perceptions of the same. The difference between expectations and perceptions was statistically significant (p ≤ 0.01). The health statuses of elderly had no significant association with their access to free health services (p > 0.05). The most important predictors of access to free health services by the elderly were awareness to free health services and income (p ≤ 0.001), and age (p ≤ 0.01). The elderly were inadequately informed about their right to free health services and hence had negative attitude towards the free health service delivery system. The health workers had negative attitude towards the elderly; hence they were discriminative against the elderly in the latter's efforts to get access to free health services. It is recommended that the government of Tanzania; through the Ministry of Health, Community Development, Gender, Elderly and Children; should evaluate the exemption process and develop appropriate mechanisms, including creation of awareness of the services, to ensure that the elderly receive free health services