[procaare] Gaborone CHBC 2001 - Impressions from Malawi

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

1st SADC Conference on Community Home Based Care
5th - 8th March 2001
Gaborone, Botswana
- HDN KC Team
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"The HIV epidemic has created a humanitarian disaster..."
- Impressions from Malawi - Interview with Clive Bacon

Clive Bacon is an  HIV programme manager for Blantyre Christian Church in Malawi. The
home-based care programme began in 1992 and has 25 staff working amongst a local
population of 800,000 in both rural and urban surroundings.

Q. How has the conference been?

A. Very interesting. This is the first time there has been a conference focusing on
home-based cares in the region and it has been a good opportunity to meet other people
working on the same issues in the region. The conference has been very relevant to my
work.

Q. What issues struck you as being most important at the conference?
The importance of partnerships, particularly working together with government hospitals.
It is so healthy and important to share the information we have in order to learn from one
another.

A. The session on volunteers was very useful to me. We have over 100 volunteers and the
session raised key issues in terms of supporting and sustaining them. However we have
succeeded in involving men in as volunteers whereas other delegates still say that almost
100% of their volunteers are women. We decided to actively recruit men as volunteers and
now almost one third of our volunteer workforce is male.

Q. How did you do it?

A. We positively discriminated towards men and strived to have at least one man in each
area initially. Once one man was in place others followed.

Q. It has been said in this conference more than once that men will not volunteer as they
expect to earn an income from their work. Was this an issue with the men you recruited?

A. Yes, you need to be upfront when recruiting volunteers that the work is unpaid and many
men refuse.  The volunteers all support several families in the community and the work is
hard. Some of the volunteers are HIV positive themselves and two members of staff are open
about their HIV status in order to provide support to the positive volunteers who need it.

Another important issue that was raised in this conference was that of stigma. We have not
yet done anything specific to address issues relating to stigma but I will go back and
think about it.

The issue of discharge and referral is a key concern in our work. We are working in
partnership with a hospital but we often go to the ward and find that our client has been
discharged without our knowledge and without preparation and training for the family.

Clients also need much better information about what will happen to them when they are
discharged. They need to know and understand that they are not being dumped or abandoned
but that they will receive the support that they need.

One major problem that we face did not come up at the conference at all and that is
nutrition. How do we get food to people who need it? Where can we get food? The World Food
Programme is not mobilised to respond to caring for people with HIV related illnesses or
anything related to home based care.

I have also recognised the need for us to begin to document what is happening at the
household level. As a programme we need to evaluate what a specific household has, does
not have and what is needed. This would give us the hard facts with which to mobilise
donor support and funding. At the moment we do monitor our activities in terms of number
of visits each month, which services were offered to whom but there is a need to do more
analysis at the household levels.

We have also been struggling with the question of how we can measure the impact of our
home-based care programme. It is very difficult to standardise and measure the impact.
Could SADC produce guidelines on this? It has not come up at the conference but is very
important.

Q. In the session on the World Bank you asked whether HIV should be seen as a humanitarian
crisis in order to mobilise more funding and resources. Could you elaborate what you think
about that from your perspective of working in Malawi?

A. HIV is clearly a development issue as people with HIV and the need for home-based care
will be with us for many years to come. So developing mechanisms and capacity of community
organisations to deliver home based care is essential. However, we are facing a
humanitarian crisis, as we cannot respond to the high levels of need. We have inadequate
access to food to address hunger and malnutrition. We cannot access even essential drugs
to treat opportunistic infections or to treat common conditions such as malaria and
diarrhoea.

Medicines are not reaching those of us working at community level. Much pilfering goes on
and drugs intended for communities often end up in private clinics. We need a tracking
system to monitor what comes in and how it is distributed from central stores to clinic
level.

Malawi has so few resources and many people live in abject poverty. The HIV epidemic has
created a humanitarian disaster that has affected the whole country. There is an urgent
need for a short-term humanitarian response to get food and medicines to the people that
need them as well as a longer-term development response.

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

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

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