Delivering care to 1600 HIV/AIDS patients in their own homes

NEED

Worldwide, there are an estimated 33 million people who are living with HIV. The AIDS pandemic in the 21st century continues to have its greatest impact in the developing world with Africa carrying about 67 % of the disease burden. South Africa, with an estimated 5.7 million people has the largest HIV positive population of any country in the world, and the worst affected part of South Africa is KwaZulu Natal. The Ugu District, a Presidential Poverty Node in the rural KwaZulu Natal, thus lies at the epicentre of the global pandemic.

Many of those affected by HIV/AIDS living in this area do not have access to decent care due to the difficult terrain and the vast distances to clinics. The South Coast Hospice developed an Integrated Community-based Home Care model which consists of mobile teams of trained home-based carers who travel to patients’ houses in order to provide holistic clinical care, food and support.

OVERVIEW

The Integrated Community-based Home Care programme was developed in response to the growing needs of people living with HIV/AIDS in the community. It offers patients the option of receiving care at home. The care and support offered includes: pain and symptom control, HIV/AIDS counselling and education, education in sexually transmitted diseases (STDs), psychosocial support services, poverty relief (through the distribution of food and care packages), education in nutrition, and early identification of orphaned and vulnerable children.

The Ugu District is characterised by rugged terrain and a lack of infrastructure; the Home Based Care team thus have to rely on robust vehicles to deliver their services. Some of the vehicles currently being utilised are nearing the end of their useful lives. One particular vehicle has covered over 245 000km and maintenance costs have become unsustainable. A new vehicle has thus become necessary. Without this vehicle, many people affected by HIV/AIDS in the Ugu District will not receive vital medical care and other forms of support.

WHAT WE LIKE ABOUT THIS PROJECT

• The project targets men and women in the Ugu District, which has been identified as a Presidential Poverty Node, and where HIV and AIDS prevalence rates are among the highest in the world.
• In addition to providing care and support to the ill, this project trains families provide care to loved ones who are ill on the days that the hospice team is not visiting. This means that the patients do not have to rely on the hospice for all of the support and care that they require.

IMPACT HIGHLIGHTS

This project will be of direct benefit to the 1600 girls, boys, women and men who will be visited by the Home Based Care team. Indirect beneficiaries include the families of these patients; approximately 4800 people. In total, the project thus has an impact on the lives of approximately 6400 people who will benefit from improved access to treatment, improved community knowledge of HIV/AIDS, efforts to fight the stigma associated with HIV and improved collaboration between community stakeholders. Estimated cost per life change is R33.50.

ORGANISATIONAL CAPACITY

South Coast Hospice was started in 1983 and is committed to serving the community of the Ugu District by providing specialised palliative care for patients with severe progressive diseases, as well as their families. They run many programmes that focus on different aspects of the HIV/AIDS pandemic from ARV support, to care for orphans and vulnerable children as well as training programmes.

South Coast Hospice Association has a very clear understanding of the social need that it is trying to address and its role in bringing about change. Their strategy involves pioneering work and quality care, which has been acknowledged at both national and international level. In terms of resources and governance, the organisation is run by a diversely-skilled team which has put in place sophisticated systems to ensure quality of service and financial soundness and transparency. Their work is complemented by an extensive network of partners in the sector. A wide range of income streams ensures the sustainability of the organisation.

RISK PROFILE

Key Strengths

• Concept: The Integrated Community-based Home Care model has gained national and international recognition and has been recognised by the Department of Health as a model of best practice.
• Design: A team of trained individuals that is able to travel to the need is a good way of meeting the need of HIV/AIDS patients and their families living in the rural areas of the Ugu District. It removes the burden of travelling long distances over underdeveloped or non-existent roads to visit primary health care facilities.
• Capability: South Coast Hospice Association has dedicated teams working with HIV/AIDS patients. This hospice pioneered the Integrated Community-based Home Care programme and has built up years of experience in its successful implementation. Through their training centre their will always be a constant supply of qualified home based care workers.
• Control: South Coast Hospice Association has an independent Board, as well as formal systems with appropriate controls in place.

Key Risks - Low

• Sustainability: The holistic, integrated care of HIV/AIDS patients in their communities is a long-term endeavour that will require ongoing interventions tailored to meet the needs of patients with life-threatening illnesses.
• Design: South Coast Hospice is one of the organisational leaders in the practice of home based care. However, home based care programmes are designed in such a way that makes them highly dependent on the use of vehicles. Without functioning vehicles, the project will be unable to deliver its services. However, training family members to provide care during times when the home based care team cannot make visits makes this less of a risk.