Charity begins at home - community care for HIV and TB patients in Zambia

Hospital care is unaffordable and inaccessible for many HIV patients in sub-Saharan Africa. Home-based care (HBC) provides a practical alternative, but demand is growing rapidly. Can existing services expand to meet this need? What role should governments and non-governmental organisations (NGOs) play? Researchers from the UK Nuffield Institute for Health investigate HBC services in Zambia.

HIV/AIDS is now the leading cause of death in developing countries. Around 65 percent of adult medical in-patients in urban hospitals are HIV-positive in countries such as Zambia. An effective and affordable home care programme takes the pressure off hospitals, reduces the risk of tuberculosis (TB) spread, and has major health and social benefits for patients and their families.

Zambia was one of the first African countries to implement HIV home care services. The researchers conducted case studies on two of the largest and oldest programmes in the country: the Lusaka Family Health Trust HBC Project (FHT-HBC) and the Ndola Catholic Diocese HBC Programme (NDC-HBC). They reviewed programme registers and reports, interviewed staff and clients, and observed programme activities. They found that:

• FHT-HBC covers only seven percent of the chronically ill patients in the target area. The programme was developed with the primary aim of reducing hospital congestion and so tends to care mainly for the severely ill. However it provides invaluable services and coverage is likely to increase as more community volunteers become involved.
• The coverage of NDC-HBC is much higher at 71 percent, thanks to strong community participation and the motivation of volunteers. Patients tend to come from the community and may be at earlier stages of illness.
• Apart from the secondment of government-paid nurses to work with NDC-HBC, there has been very little material, financial or technical support from the Zambian government.

The coverage of home-based care in Africa is unlikely to increase significantly without greater government involvement. Governments should provide some form of basic home-based care services for all communities or strengthen support to other organisations providing such care. They should also:

• incorporate community care into district health service plans
• encourage communities to initiate and develop their own care programmes
• create less elaborate community care models which can be implemented by government health facilities in resource-poor areas where donor funds are unavailable
• integrate HIV and TB services to improve the effectiveness of community care services
• forge innovative partnerships with NGO health facilities.

However, the scaling up of home-based care programmes may present a number of challenges, such as:

• sustaining volunteer motivation when workloads increase substantially
• finding a balance between providing high quality services and maximising coverage and accessibility
• coping with more bureaucratic and inflexible management systems.

Source(s):
'Scaling-up HIV/AIDS and TB home-based care: lessons from Zambia' by E. Nsutebu, J. Walley, E. Mataka and C. Simon, Health Policy and Planning 16 (2001)
Other related sources: 'Assessing and planning for home-based care for persons with AIDS' by S McDonnell, M. Brennam, G. Burnam and G. Tarantola, Health Policy and Planning 9 (1994)
'Estimating coverage of community-based home care programmes' by R. Drew, G. Mgombane, T. Nyaruwa and G. Foster, Tropical Doctor 27 (1997)

Funded by: UK Department for International Development

id21 Research Highlight: 11 December 2001

Further Information:
Emmanuel Fru Nsutebu
Nuffield Institute for Health
University of Leeds
71-75 Clarendon Road
Leeds
LS2 9L UK

Tel: +44 (0)113 2334861
Fax: + 44 (0)113 2336997
Contact the contributor: hssefn@leeds.ac.uk

Nuffield Institute for Health, University of Leeds, UK

John Walley
Nuffield Institute for Health
University of Leeds
71-75 Clarendon Road
Leeds
LS2 9PL
UK

Tel: +44 (0)113 233 6963
Fax: + 44 (0)113 2336997
Contact the contributor: j.d.walley@leeds.ac.uk

Other related links:
HEARD at the University of Natal has resources covering the economic and social impact of HIV/AIDS.

The Medical Research Council of South Africa provides a portal for information relevant to HIV in the region.

This South African site has details of research, services and other information.

This site provides more information on AIDS and Africa.

Refer to the WHO programme on TB.

Stop TB also has many on-line resources.