[procaare] Reaching Out, Scaling Up: Track C Report

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Reaching Out, Scaling Up: Track C Report
- SA HCBC Conference, Rustenberg
********************

Track C:  Report :  Partners for Care

# Introduction
Next month we will once again celebrate the Partnership Against AIDS, so it is timeous
that we are here discussing one of the keys to the success of HCBC - Partners for Care.
There has been consensus for several years that partnerships are essential in our response
to the HIV/AIDS epidemic, and there is certainly no disagreement that partnerships in the
area of HCBC are equally important. However, what has emerged from our discussions over
the last two days is that partnerships in this context need to be developed, nurtured, and
comprehensively managed if they are to have any meaningful impact on our work in the
long-term.

# Critical Cross Cutting Issues
A comment from one delegate in Thursday's plenary highlighted one of the key challenges to
effective partnerships. Following presentations from two government departments, in which
the speakers both indicated that their respective departments were working closely
together, the delegate noted the overlaps and duplication of the information in their
presentations and questioned how well they were in fact communicating. This in a nutshell,
highlighted a problem that affects all sectors and efforts to develop and implement HCBC
programmes - a lack of communication and information sharing between relevant
stakeholders. Time and again in both plenary and small group discussions the issue of poor
communication arose as a barrier to effective and sustainable implementation of HCBC.
Clearly, to upscale our work, greater efforts are needed from us all in this regard.

>From the plenary discussions and the various case studies that were presented during the
day, it emerged that there are models for HCBC that are up and working, both in South
Africa and the Sub-Saharan region. These models are often holistic in their approach to
caring for the infected and affected and creative in their efforts to build partnerships
within the community and beyond. This reinforces the point that the wheel does not need to
be reinvented when we talk about HCBC, rather a crucial task is to make people aware of
the programmes in different sectors that are up and running successfully and to build on
existing models wherever possible.

A recurring focus of discussions in this track was the need to care for caregivers
themselves. Issues relating to conditions of service, counselling and support for
volunteers, the meaningful participation of people living with AIDS in HCBC, as well as
the integration of men into service provision were raised on several occasions in both
plenary and small group discussions. Psychosocial support for caregivers was highlighted
as imperative to the sustainability of all HCBC programmes.

Strengthening linkages across sectors in the continuum of care giving was another issue
continually emphasised. The multi-sectoral approach to HCBC has been talked about and in
some areas of the country is being effectively implemented. Yet, there are still enormous
gaps from national to community level, particularly around inter-sectoral referral
systems, which are presently uncoordinated and incoherent, knowledge and sharing of
existing resources, access to donor and government funding, and around policy and
guidelines for management and cross- sectoral cooperation. A recurring recommendation from
almost every small group discussion was the need for comprehensive and accessible national
databases containing information about existing services and resources. Pooling resources
is more economical and promotes a spirit of sharing and mutual support that is key to up
scaling and sustaining our partnership work.

The multi-sectoral approach also implies the recognition and inclusion of traditional
healers and traditional medicines in the care and support of the infected and affected. A
key challenge noted in both case study plenary and small group discussion, is the need to
reinforce traditional healers as partners in the continuum of care, building on the
relationships that have been developed thus far, and standardising training and
registration procedures. Recognising the vital role that traditional healers play in the
health and well being of millions of South Africans, will reinforce their role as partners
in care and their effective participation in HCBC service delivery.

The prevalence of stigma and discrimination both in the community and the workplace is an
issue that needs to be addressed on a daily basis in our work. In both plenary and small
group discussions the role that stigma plays in limiting the potential for effective
partnerships for HCBC at different levels and across sectors was raised.

Up scaling HCBC requires the promotion of the work as an integral part of our response to
the epidemic at all levels and across all sectors. Too often the emphasis of debate and
discussion, as well as active policy implementation, is on other aspects of treatment or
support. At this conference delegates are clearly calling for HCBC to be acknowledged and
practically integrated as a fundamental pillar in our struggle against HIV/AIDS.

# Specific issues and recommendations from small groups:
* FBOs, CBOs and NGOs:
The commitment and compassion of individuals within these organisations came through
strongly in the discussions. However, a key challenge for organisations within this sector
is to overcome the dangerous and debilitating rivalries and competition for resources that
undermine the fundamental work of HCBC.

# Key recommendations include:
* Fair sharing of financial resources for HCBC service providers needs to be addressed in
a more coordinated manner
* A policy on the management of HCBC volunteers/caregivers needs to be developed * More
funding specifically for training and retraining of volunteers should be made available

# Mentoring
* It is clear that few NGOs have the capacity to mentor and mentoring is carried out
unevenly. New organisations are mushrooming across the country, but lack the capacity to
deliver effective services or to sustain their work in the long-term

# Key recommendations include:
* Mentoring must take place at all levels and cross sectorally in HCBC.
* National guidelines around mentoring must be developed and made available as a matter of
urgency. There is a need for best practice mentoring models in the development of these
guidelines
* A system to deal with issues of malpractice needs to be put in place

# Volunteers
Volunteers are vital to the success of HCBC, but currently they lack support in almost all
areas of their work. Volunteer services related to HCBC are fragmented and although policy
guidelines around care exist, there is little to support the coordinated management of
volunteers.

# Specific recommendations include:
* Financial incentives in the form of standardised stipends for all caregivers must be
considered a high priority.
* Promoting the involvement of HIV+ men as caregivers should be given more attention
* The development and implementation of a comprehensive management policy around
volunteers is essential and a matter of urgency. This policy would help give clarity on
such issues as remuneration, care and support for caregivers, supervision of volunteers,
recruitment and selection criteria, and integration of volunteers across programmes (e.g.
TB/DOTS), amongst others

# Traditional Healers
The mistrust, misconceptions and power struggles that dominate the relationships between
traditional healers and other relevant stakeholders have to be seriously tackled in order
for traditional healers to take their rightful place as partners in care. Many millions of
South Africans consult traditional healers on daily basis and yet their services remain
complementary to mainstream medical practice.

# Specific recommendations:
*  Traditional healers must define their roles in the community to become more visible
partners in care
* Traditional medicines to be recognised and registered for use in treatment in the HCBC
setting.
* Promote traditional healing and medicine as an integrated part of community health care
so that communities become aware of its role in HCBC and in HIV/AIDS work in general.
* DOH must actively involve traditional healers in care and treatment and develop training
manuals for traditional healers around HCBC.

# Government departments
Presently Health, Social Development and Education are the key government partners in
HCBC. There is acknowledgement of the need to bring other key departments on board,
including Housing, Agriculture, and Home Affairs. Policy and infrastructure to guide HCBC
at intersectoral level are in place but in many cases the poor quality of implementation
is impacting negatively on efforts to upscale the work.

# Specific recommendations:
* Unpack the core business of each role player, particularly in the Intersectoral Task
Team
* Appoint a national coordinator at Director level to eliminate fragmentation and enforce
integration of services and interdepartmental cooperation and coherence
* Ensure that Provincial Treasuries are on board as key role players to enhance financial
coherence and accountability
* Directors General must ensure buy-in to HCBC from politicians
* Work to broaden the role of PLHA's in HCBC service provision

# Private sector
HCBC programmes dominate in a single industry - mining - and in provinces where the
industry is strongest. Several pilot programmes are being run that embrace HCBC, but
serious ethical issues relating to employee benefits, repatriation, and sustainable follow
up care in the home community are pressing. These are exacerbated by the lack of
communication and in some cases the antagonism between the private sector and other
stakeholders. Relationships must be extended beyond the gates of the employer if HCBC is
to be enhanced and quality of life for the infected employee is to be guaranteed.

# Specific recommendations
* Broaden efforts to extend HCBC further into the private sector
* Structured and efficient referral systems must include employers, public health service
and communities
* Formalise and improve relationships between private sector, health system and community
* Restructure benefits and repatriation packages to include HCBC in communities to which
workers are returning.
* Reduce stigma around disclosure by involving more openly PLHA's in policymaking and
implementation of programmes
* Increase emphasis on income support groups and counselling

# Conclusion
There are no quick solutions to the challenges that have been raised in our discussions.
Our recommendations require immediate action if they are to be meaningful for our work and
for those we serve. There is an acknowledgement that if we are to achieve the goal of up
scaling HCBC, we must come together, pool our many strengths, value and nurture our
existing partnerships and seize the opportunities to develop new ones wherever possible.

Acknowledgements:
Rapporteur team: Andrea Meeson : Sibambene Development Communications
All participants that attended the group discussions in Track C.


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