[procaare] Gaborone CHBC 2001 - Declaration

[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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GABORONE DECLARATION ON COMMUNITY HOME BASED CARE
8 MARCH 2001

PREFACE

The First Regional (SADC) Community Home Based Care Conference was convened by the
Community home Based Care Sub Unit, AIDS/STD Unit, Ministry of Health. The conference was
held in Gabarone, Botswana from the 5th-8th March 2001 and attended by 617 participants
from 10 SADC Countries i.e. Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa,
Swaziland, Tanzania, Zambia and Zimbabwe.


THE THEME OF THE CONFERENCE
"Sharing Responsibilities for Quality Care"

PREAMBLE
We, the participants of the first Regional Community Home Based Care Conference from 10
SADC countries take cognizance that in Sub-Saharan Africa, the burden and impact of
HIV/AIDS threatens all sectors of society.  In view of this, we believe that People Living
with HIV/AIDS (PLWHA) and their families have access to quality physical, psychosocial and
spiritual care in a society free from paralysing stigma.

GUIDING CONCEPTS
Towards this end and in partnership with other stakeholders, we commit ourselves to
promote the following concepts that are intended to guide our commitment to action, so as
to strengthen and improve the quality of community- and home-based care.

1. INCLUSION
We believe that all parts of society e.g. communities, public and private sectors,
non-profit and traditional sectors should share responsibility for the provision of
HIV/AIDS care. We further recommend that community participation be strengthened and
mainstreamed and the role of women, men and youth be recognised, as this is critical to
the understanding, establishment and sustainability of comprehensive home-based care and
support services.

2. QUALITY OF LIFE
We recognise that everyone has a right to respect, dignity, self-determination and
non-discrimination. In partnership with other stakeholders, we commit ourselves to support
and promote the establishment of an enabling environment for positive living. The
environment should facilitate adequate access to basic needs, such as food, clothing,
housing and availability of comprehensive care that meets the psychosocial, spiritual,
physical and nutritional needs of people living with HIV/AIDS and their families.

3. CONTINUUM OF CARE
We take cognisance that the continuum of care should respond to the prevention and care
needs of those infected and affected throughout different stages of the disease and in
various settings. In all settings, including hospitals, clinics, homes and communities,
quality care should be provided in a coordinated and patient-centered fashion. HIV
counselling and testing services and follow-up counseling must be ongoing from the time of
initial diagnosis. In view of this, to achieve a continuum of quality care, there must be
uniformity of procedures and criteria for referral of patients from hospital to home and
vice versa.

4. PEOPLE LIVING WITH HIV/AIDS
We are cognisant that PLWHA are key stakeholders and an integral part of the design,
planning, and implementation of home-based care interventions as both recipients and
providers of care. We are committed to promote their greater involvement through specific
mechanisms. In addition we recognise that PLWHA have a moral responsibility to protect
others from infection and to cultivate a sense of hope and a will to live, through self
care and determination.

5. ORPHANS AND VULNERABLE CHILDREN
We note with great concern that children are increasingly affected by the impact of
HIV/AIDS and bear an increasing burden of providing care. In view of this, we suggest
home-based care services for adults be carefully linked to activities that anticipate and
meet the needs of vulnerable children.  This should begin while parents are still alive
and plans should be made to keep siblings together within the community as much as
possible. In addition, efforts should be made to improve the quality and length of life of
parents as a key strategy in postponing orphanhood. Furthermore, we call on other
stakeholders including teachers, to recognise and support the needs of infected, affected
and/or care giving children.

6. CARE FOR THE CAREGIVERS
We are cognisant that HIV/AIDS creates a major additional burden on caregivers in the
health care system and at home where women are the primary caregivers. We are convinced
that as providers, as well as recipients of care, care givers need to be involved in
devising concrete support systems to deal with these prevalent stresses. We also note that
care and support for the caregivers is an important component of home-based care.  In view
of this, we recommend that care and support for care givers be integrated into the design
and implementation of home-based care programmes.

7. NETWORKING
We recognise the urgency and importance of building and strengthening mechanisms and will
promote and support learning from each other and sharing of information and experiences on
home-based care at all levels. This strategy will enhance the quality and quantity of
community home-based care services and avoid duplication of efforts. We, the participants,
are committed to create an enabling environment that will facilitate effective,
participatory, and multi-sectoral networking.

8. ACCEPTANCE/SOLIDARITY
We, the participants, are concerned that stigma continues to be a major impediment to
HIV/AIDS care and prevention. We believe that is the responsibility of all individuals,
families, communities, and sectors of society to promote openness, acceptance, and
solidarity.  Towards this end, the experiences and involvement of PLWHA is an important
strategy that will require an enabling environment and appropriate support. We recognise
that health care institutions are well positioned to provide an example of openness and
acceptance, while maintaining the usual patient confidentiality.

*COMMITMENT TO ACTION*

In furtherance of the above guiding concepts, we the participants, commit ourselves and
encourage other stakeholders to join us in:

1. Sharing the responsibility and commitment to strengthen existing programmes and
partnerships and to develop new strategies between all stakeholders in the provision of
home-based care, including the private, public, non-profit, and traditional sectors;

2. Facilitating greater community ownership and involvement in home-based care
initiatives, and thus increase their sustainability;

3. Encouraging and supporting greater involvement of men and youth in community home-based
care initiatives;

4. Ensuring adherence to existing charters, declarations, conventions and the development
of new frameworks that promote rights and dignity, equal access to care, the rights of
privacy and confidentiality, duty of care, and non-discriminatory workplace practices,
regardless of individual HIV status;

5. Considering the current socioeconomic status of home-care recipients as a primer for
action, and coordinate with partners to ensure provision of basic needs, such as
nutrition, clothing, and housing;

6. Developing, evaluating and maintaining appropriate and sustainable home care kits;

7. Improving the existing discharge planning and referral systems to more efficiently link
those involved across the continuum of care, including establishing criteria for referring
patients from hospitals to their homes and vice versa. CHBC should not be used as a way of
decongesting hospitals, but rather as a strategic component in the continuum of care;

8. Empowering patients and their families in making decisions on utilising existing
continuum of care services that effectively and efficiently link recipients between
hospital/clinics and their homes;

9. Ensuring access to nutritional assessment, education and support as well as access to
appropriate medical care and essential medicines, including those for treating
opportunistic infections, preventive therapy and palliative care;

10. Promoting and supporting research, and the sharing of study results, lessons learnt
and best practices within the framework of home-based care;

11. Building, strengthening, and consolidating existing and/or new, innovative models of
partnerships and programmes through a multi-sectoral and participatory approach;

12. Developing and maintaining clearly defined support systems for PLWHA, their families,
caregivers and volunteers to alleviate stress and increase their capacity to cope;

13. Recognising PLWHA as care providers, addressing their specific needs for the provision
of care thus facilitating their capacity to play key roles in HIV/AIDS prevention, care
and education;

14. Building bridges between the organisations providing community home-based care and
those involved with the care of orphans and vulnerable children, including the education
and legal sectors (e.g. guardianship, fostering, inheritance);

15. Ensuring adherence to existing charters, conventions and declarations and the
development of new frameworks that promote and support the rights and dignity of orphans
and other vulnerable children. Such instruments should equally ensure equal access to
care, the rights to privacy and confidentiality, and a non-discriminatory environment for
growth and development of children regardless of their HIV status;

16. Providing a safe environment for all caregivers, whether in the workplace or at home,
through the dissemination and availability of the necessary equipment, medications,
information and supplies;

17. Addressing attitudes and practices of care providers toward PLWHA and their families
within the healthcare system and the community. It is important to recognise and share the
positive experiences and lessons learnt by experienced providers of care utilising them as
mentors and role models;

18. Creating mechanisms for stigma to be openly discussed and researched, and for the
sharing of collective experiences in an attempt to increase not only the understanding of
stigma, but also to implement measures to alleviate this stigma as a significant obstacle
to HIV prevention, diagnosis, care and support.

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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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