Published by the government of Zimbabwe
Roselyne Sachiti
27 October 2009
opinion
Harare — "THERE is a new breed of super grannies in Chiredzi. They are old, their hair is grey yet they are full of life.
"They are almost unrecognisable without a 'troop' of lively quarrelsome, yet defenseless children buzzing around them.
"The immense contribution of the grandmothers to orphaned and vulnerable children has often gone unnoticed, but these grandmothers are currently among the most consistent carers of both people living with HIV and Aids and orphans left behind," read part of a case study from the recently published Research Findings on Community Home Based Care (CHBC) in Zimbabwe.
The grandmothers are among thousands of elderly women who have been playing a key role in taking care of people living with HIV and Aids in their families and communities over the past 10 years.
Recently, various stakeholders heard chilling testimonies of how the impact of HIV and Aids has left many elderly people with increased responsibilities, yet current home-based care packages include little, to address their specific needs.
It has also been established that home-based care programmes have very little focus on children and youths, despite the fact that young people often find themselves taking care of the sick, mostly their parents or siblings.
WHO defines home based care as a programme that offers health care services to support the care process in the home environment of a person with a chronic condition, including HIV and Aids.
Presenting the overview of the community home based care, a consultant, Dr Patrick Mamimine, said the purpose of the report was to document the evolution and changes within eight home based care interventions in Zimbabwe and to identify and analyse 'best practices' in CHBC.
The eight organisations that took part in the study of CHBC included New Dawn of Hope, the Male Empowerment Project, Dananai, Uzumba Orphan Care, The Family Aids Caring Trust; Bekezela Home based care, Batsirai and the Catholic Health Care Commission.
Dr Mamimine said while there is no doubt that home-based care (HBC) has emerged as a critical vanguard in the overall response to HIV and Aids, and tuberculosis (TB) in Zimbabwe, there were important lessons to be learnt.
"A key lesson learnt from implementing CHBC programmes over the years is that, with the appropriate structures in place, it is possible to look after people in their homes and communities, not only in hospital and clinic settings", he said.
Dr Mamimine said the primary challenge of the CHBC is that of overwhelming demand for their services.
"This overwhelming demand has been driven by the HIV and Aids pandemic. While a number of high quality policies have been developed and implemented, the socio-economic environment means there are very limited economic resources with which to implement them," said Dr Mamimine.
He also said that for CHBC to be effective there must be appropriate structures in place to run programmes.
In addition, there must be advocacy for CHBC so that it is accepted at all levels of society without being riddled by stigma and discrimination.
"CHBC activities need to be adequately resourced so that timely and high-quality care is delivered to those in need.
"That is why it is vitally important for the Government, private sector and funding agencies to partner with civil society and to provide significantly more funding to support these projects," he added.
Dr Mamimine said that in each of the eight organisations assessed, project volunteers in rural areas travelled long distances, usually on foot, to reach affected households.
"Every year, enormous amounts of money are dedicated to HIV and Aids prevention, care and treatment globally.
"Much of the money is channelled through governments and well-known international NGOs who are assumed to have capacity to implement programmes.
"However, countless smaller, community-based initiatives, many of which are started by local people in response to an urgent and visible need in their communities, face a continuous struggle to secure funding", said Dr Mamimine.
Dr Mamimine said food packs supplied through donors frequently do not provide the minimum nutritional food basket and are provided inconsistently between organisations. According to Dr Mamimine, people living with HIV and Aids have higher energy requirements than those not infected and these needs are not generally catered for.
"There is a significant time lag between agreements being made and the disbursement of funds to organisations, resulting in funding gaps of as much as six months between one programme ending and the next beginning.
"There is no alternative for programme activities to cease in the interim period, leading to significant suffering on the part of beneficiaries," he said.
He also said that financial resources to cater for all programme activities were extremely limited.
Dr Mamimine revealed that the limited supply of drugs to some people on CHBC is likely to lead to the development of drug resistance, since clients may miss doses, both due to local stock outs and the inability to travel to clinics to collect new supplies.
"The overall socio-economic environment experienced severely affected the services of CHBC organisations, their community volunteers, clients and families.
"The food shortages experienced last year, electricity and water problems make treatment and care much more difficult.
"Families, communities and organisations have adopted a number of mechanisms to cope with the situation," he said.
He also noted that herbal gardens emerged as one of the coping mechanisms for communities that do not have access to anti-retroviral treatment (ART).
"For many communities, clinics, which dispense ART are too far from individuals in difficult financial circumstances, and in poor health to be able to travel (long distances) to receive the necessary treatment.
"By growing herbs and learning their properties, care givers and clients in some areas have learned to self-medicate and effectively treat opportunistic infections and some of the side effects of ART", he added.
He also said that while national guidelines on ART and TB have been established, they do not specifically outline the role that CHBC programmes should play in adherence or counselling support.
Dr Mamimine added that there was also need for gender balance as the burden of home based care was placed mostly on women.
"Though some men are showing increased interest in CHBC, more need to be involved in order to cater for the needs of male clients, who are often uncomfortable with having their intimate care undertaken by women.
"Currently there are no clear guidelines on how men may be encouraged to be involved in care work," he added.
Dr Mamimine said that while the national CHBC standards address issues related to volunteer roles, allowances, good working conditions and skills transfer, there was no standard way of managing and remunerating volunteers.
This has led to many volunteers being taken for granted in the provision of health care services.
"In an ideal situation, CHBC kits consistently contain the basic tools that caregivers require to care for people living with HIV and Aids, as well as protect themselves from infection.
"Basic items include soap, gloves, bandages and simple pain killers.
"Due to limited resources, CHBC kits are not routinely replenished, presenting major challenges to caregivers in delivering appropriate and adequate services to clients," he said.
Deputy Minister of Health and Child Welfare Dr Douglas Mombeshora said his ministry; Zimbabwe Aids Network and the National Aids Council, among others have strived to create an enabling policy environment that supports the development of CHBC initiatives.
"As such, guidelines were developed to support the development of CHBC programmes including the CHBC policy developed in 1998 and the national CHBC standards of 1999.
"More recently, community home based care has been identified as a key component in the Zimbabwe National HIV and Aids strategic plan," he said.
He revealed that Zimbabwe places emphasis on services that mitigate the impact of HIV and Aids, including support to orphans and vulnerable children, nutrition support and ART.
Dr Mombeshora said that while the availability of treatment over the past few years had led to an improvement in the well-being of people living with HIV and Aids, the need for CHBC services could be disregarded as out of 500 000 people in need of treatment only 170 000 were accessing it.
"This shows that the existence of high quality community home based care organisations is essential if we are to achieve our objectives as laid by Zimbabwe National Aids Strategic Plan.
"The Ministry of Health and Child Welfare has played a significant part in the training of community volunteers. With the changes in the HIV and Aids pandemic and a shift in the way we view caregivers, there is need for organisations to review their training programmes," he said.
SAfAIDS Executive Director Mrs Lois Chingandu said there should be appropriate structures in place to run programmes for CHBC to be effective.
According to a Unicef report of 2007, Zimbabwe has nearly 2 million orphaned children, mainly due to HIV and Aids.
An estimated 142 000 children are HIV positive (UNGASS 2007).
Although Government and donor partners have initiated an Orphans and Vulnerable Children Plan of Action, resources are still too inadequate to meet current needs.
Children, especially girls, are also missing out on their education because of their increased caretaking responsibilities at home.
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