Community Home Based Care for PLWHA

Advocacy for Community Home Based Care for PLWHA in Cameroon
By James Achanyi-Fontem, Cameroon Link
This project is designed based on the current practices of Community Home Based Care (CHBC) for people living with HIV and AIDS in Cameroon with special focus on the operational challenges and limitations.
The objective is to emphasis on local, community-driven initiatives responding to the HIV/AIDS crisis. Cameroon Link’s project aims at encompassing HIV/AIDS prevention, care and treatment activities.
Research shows that an effective and affordable CHBC for PLWHA has the potential to positively impact the health and social status of patients, families and the community as a whole.
Research also shows the CHBC area faces a multitude of challenges and limitations which not only adversely affect their ability to carry out their activities, but also have the potential to exacerbate poverty and existing gender inequalities among affected families and communities.
The Problems
1.Simple logistics and operational bottlenecks severely affect the access to and provision of ART for community based organisations (CBO).
2.Some CBOs providing CHBC including ARV drug administration face problems from inconsistent supply of drugs to inadequate logistic costs.
3.There is a lack of documented information on the root operational issues which contribute to the overall challenges and limitations.
Results awaited
This advocacy project aims to alleviate challenges and improve the current situation of CHBC programs.
Executive Summary
Cameroon is disproportionately affected by the HIV/AIDS pandemic. Data from UNAIDS/WHO Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections – 2004 update show the following about Cameroon:
•Adults (15 –49) HIV prevalence rate is 6.9 %
•Adults (15 – 49) living with HIV is 520.000
•Adults and children (0 – 49) living with HIV is 560.000
•Women (15 – 49) living with HIV is 290.000
•AIDS deaths recorded stand at 49.000
•Orphans are 240.000
Back Ground
•Undoubtedly, there is a great need for services and support provided by community home-based care (CHBC) program to persons infected and affected by HIV/AIDS.
•In Cameroon, where the HIV/AIDS epidemic is of paramount concern, the nature of the disease, weak health infrastructure, spiraling health costs, and lack of resources has made community home based care a necessity in the continuum of care.
•An effective CHBC program for PLWHA can yield major health and social benefits starting from the patients and their family and consequently to the entire community. However, this needs a continual cohesive commitment between vommunities, organisations and donors.
•Simple logistics and operational bottlenecks severely affect the access to and provision of ART for Community based organisations. There is inconsistent supply of drugs to inadequate logistic costs.
Project Justification
It is imperative to rethink exisitng community home based care models in order not to exacerbate poverty and existing gender inequalities among affected families and communities. Better communication, including advocacy, social mobilisation and programme communication, would help to solve many of the problems surrounding HIV/AIDS. Most of the current programmes do not carry the communication component, and it is still not clear how HIV/AIDS communication is embraced at the health area level.
This project lists a number of communication challenges relating to HIV/AIDS. These include : increasing case detection through public engagement; closing the time gap between the onset of symptoms and seeking of treatment; linking with broader health and development campaigns and movements; addressing HIV/AIDS/TB co-infction, and capitalising on successful AIDS communication interventions; and strengthening health systems.
Priority areas for action include involving affected communities; making creative use of the media; monitoring the effectiveness of communication; linking communication on HIV/AIDS/TB epidemiology; increasing communications capacity; and collating and simplifying communication tools.
Methodology and objectives
•Determine the implementation challenges faced by CHBC programs. To achieve this goal, we have to document current practices of CHBC by community organisations.
•Determine the various approaches including logistics, undertaken to deliver services to PLWHA with concentration on support and adherence of ART by CHBC programs.
•Determine the existing expertise and knowledge and how it is disseminated from NGO, development partners and government to CHBC programs.
Activities
•Information of community populations
•Training of Community Educators
•Material and Supplies: Provide guidelines, manuals for training, drugs, etc..
•Human Resource Support: Organise capacity building for CHBC program staff, conduct training of volunteers, refresher workshops, provide financial assistance for volunteers.
•Organise dialogue network groups for exchange of information and reports of activities.
Challenges and Limitations
•There is an inherently weak referral system between CHBC organisations and the public health sector
•There are few links between CHBC organisations and experienced NGOs in socio-economic, nutritional and OVC’s services for PLWHA.
•The human resource is a key challenge faced by CHBC programs and requires immediate attention in the areas of training, capacity building and technical expertise.
•Volunteers are essential to the sustainability of the CHBC, and they need to be encouraged and motivated.
•The CHBC programs are unable to implement and adequately deliver services to their clients due to insufficient resources, such as overhead funds, HBC kits, and educational/information materials.
•Transportation and logistics overheads are major limiting factors in the ability of CHBC programs to carry out their activities, such as ART adherence support.
Operational Solutions
Human Resources
The challenges in human resources are essential due to the operational issues in the areas of training/capacity building and social/technical expertise. The CHBC providers should be properly trained, and the number increased to carry out the activities and services effectively. These issues can be alleviated through:
a)Government: Establish and disseminate national guidelines on CHBC and increase public health sector involvement.
b)NGOs: Provide technical expertise and training.
c)CHBC Programs: Conduct baseline assessments; generate community involvement and identify local volunteers.
Referral Systems/Links
CHBC programs require a strong two way referral system and strong links to the public health sector and NGOs.
a)Government: Create a “platform” to allow CHBC to organise referral system with local public health centres.
b)CHBC Programs: Actively develop and maintain links with NGOs, especially for support of socio-economic activities.
Institutional Resources Logistics
There is a lack of institutional resources for CHBC and logistics to deliver appropriate services.
Government: Allow CHBC programs who receive funds to properly allocate funds for transportation within the budget. Provide HBC Kits and Information/Educational materials.
CHBC Programs: Adopt innovative techniques toalleviate issues in transportation, utilise local resources to create HBC Kits.
RECOMMENDATIONS
1.Effective CHBC cannot be provided without realistic financial support for transportation, overheads and logistics.
2.CHBC programs need the financial and technical support with a starting focus on “essential care” activities. These essential care activities have the potential to positively impact the health and social status of PLWHA and prolong their need for additional complex medical care.
Roles and Responsibilities
CHBC programs cannot be successful unless they receive active support and participation from NGOd and communities. The following are the roles and responsibilities each needs to assume:
•Incorporate CHBC into district health service plans.
•Train and educate health care staff in the public health facilities on their necessary active participation in CHBC with an emphasis on the reduction of stigma and discrimination.
•nvolve and encourage other public sector agencies dealing with social welfare, education, food and nutrition as key players and share responsibilities in providing CHBC.
NGOs/Donors can assist CHBC programs with technical expertise in the area of education and training the personnel, volunteer recruitment and motivation techniques, monitoring and evaluation of activities.
Community level: The level of active participation of communities will differ from community to community, as the communities needs and resources will vary. Communities should be encouraged to initiate and develop their CHBC programs, actively participate in recruitment, motivation and compensation of volunteers.
Cameroon’s Sexual and Reproductive Health Rights Bulletin
National Revenue per inhabitant (2002) U.S. $ 1.640
Human Development Indicator (2001) 0,499
Health Expenses per inhabitant (2000) U.S. $ 24
Average Number of Birth per Woman (2003) 5.2
Rate of employed women out of agricultural sector (2000) 10%
Rate of Boys’ Registration in Secondary Schools (2001/2002) 68%
Rate of Girls’ Registration in Secondary Schools (2001/2002) 32%
Number of seats occupied by women in parliament (2003) 9%
Number of women reported to have been victim of physical violence (2003) 892
Maternity Deaths out of 100.000 (2000) 730
Birth in the presence of a qualified health attendant (2001) 56%
National Policy on Abortion – For the preservation of physical health
Still-births out of 1.000 (2001) 96
Married women using contraceptives (2003) 19%
Married women not satisfied with family planning needs 19,7%
Annual birth rate out of 1.000 aged between 15 to 19 years (2003) – 142
Men/women aged between 15 to 24 who know HIV can be transmitted (2001) 63% / 54%
HIV/AIDS rate among male aged between 15 – 24 (2001) 9.8%
HIV/AIDS rate among female aged between 15 – 24 (2001) 12.7%
N.B. According to World Bank sources, these indicators are constantly on the decrease.
Acronyms
AIDS – Acquired Immune Deficiency Syndrome
ART – Anti-retroviral Therapy
CBO – Community Based Organisation
CHBC – Community Home Based Care
CHW – Community Health Worker
HIV – Human Immunodeficiency Virus
NGO – Non governmental Organisation
OI – Opportunistic Infections
OVC – Orphans and Vulnerable Children
PLWHA – People living with HIV/AIDS
PMTCT – Prevention of mother-to-child transmission
STI – Sexually Transmitted Infection
TB – Tuberculosis
VCT – Voluntary counseling and testing