[procaare] Gaborone CHBC 2001 - Lessons Learned from Home Care

[HDN KC Team <correspondents@hdnet.org>]

1st SADC Conference on Community Home Based Care
5th - 8th March 2001
Gaborone, Botswana
- HDN KC Team
******************

Lessons Learned from Home Care Programs

In a world where death
is the hunter, my friend,
there is no time for regrets or doubts.
There is only time for decisions.
(Carlos Castaneda)

The overall objectives of the conference was to review of best practice and lessons learnt
on the provision of comprehensive care and support to people living with HIV/AIDS. This
was a tremendous task which Eric van Praag - from Family Health International - attempted
to throw light on.

Dr van Praag's presentation was one of the definite highlights of the conference. He took
the packed conference hall from the history of home-based care through the current
challenges and opportunities and then to the future of community based care. His slide
show presentation is available at http://www.hdnet.org
(Please go to the section for the Gaborone Conference and click on HDN Session Reports,
then Plenary presentations and then on the presentation by Eric van Praag)

Community Home Based Care (CHBC) is a critical component of the response to AIDS, which is
increasing in need as more people get sick and as the health services collapse under the
sheer volume of patients with AIDS. This has led to the burden of caring falling on
families and community members.

Dominated by women, caring happens within the context of the household and does not get
the same level of coverage and publicity as the large awareness campaigns or the marches
against the giant pharmaceuticals. In terms of funding, community based care is not as
sexy as the vaccine initiative or a large media campaign targeting the youth.

The overall profile of community home based care remains painfully low and needs to be
increased in the eyes of funders and planners as more and more countries experience the
wave of the AIDS epidemic. And to do this well, it is paramount that care initiatives are
not only monitored closely but evaluated and cost effectiveness determined.

Over the past 10-15 years we have seen a range of different models of home based care
being developed. The trend has moved from models that radiate from a hospital setting, to
those which are solely based and driven by the community, to increasingly developing an
integrated model that is a combination of the two.

In terms of needs, Dr. van Praag highlighted those that have been around since the 1980s
such as the needs of people with HIV/AIDS, the importance of material and medical
assistance as well as spiritual needs. More recently the pyscho-social needs of carers and
the need for legal assistance (writing wills, property rights) have come into the
spotlight.

A recent evaluation undertaken in Malawi revealed that although basic needs remain
absolutely valid, other issues cannot be ignored any longer. These include issues of
patients being informed of their positive status and diagnosis, the need for proper
nursing and medical care and the importance of spiritual care. On the latter, many
patients have become depressed or attempted suicide upon knowing their status as testing
has not been accompanied by proper counselling or support.

It is clear that a comprehensive home care model must look at the needs of the patient and
family in a more holistic manner. The set of activities should cater for the
socio-economic, pyscho-social, medical and legal needs, This can only be achieved if all
stakeholders work in partnership. One example of such a model is the development of HIV
friendly clinics and hospitals being piloted in India - a model that should be closely
monitored.

The issue of stigma once again raised its ugly head and it was suggested that the
hierarchal model of the hospitals should be used to break down the negative attitudes of
health care workers. Dr van Praag suggested a very practical intervention to deal with
stigma from health professionals as identifying a supportive senior medical doctor who
could lead by example and set a trend of greater acceptance.

He stressed, as well, that strategies to support carers to prevent burnout must be
developed, as must be effective interventions to introduce ARVs in resource poor settings.

The challenges are enormous and it is important to keep view of the little triumphs so
that hope and motivated are restored and continue to provide us with the strength to carry
on the fighting.

Dr. van Praag's presentation can be found at www.hdnet.org under the session reports for
the Gaborone CHBC Conference

HDN KC Team
E-mail: correspondents@hdnet.org
www.hdnet.org

*******************
The conference organisers and Health & Development Networks (www.hdnet.org) are grateful
to UNAIDS for their support to this initiative



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