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Home Care - 4.1 Background
4.1 Background
This evaluation sought to estimate the cost savings to patients and families receiving home-based care. The evaluation also attempted to provide a comparison of the costs of providing home care services in the urban and rural programmes in Cambodia. Alternative approaches to providing care to PLHA are being piloted in many countries, in response to the increasing demands of the HIV/AIDS epidemic. The effectiveness of these approaches in improving the quality of life for individuals and families and the cost of delivering care services are being evaluated to assist program planners in understanding the future range of options of care to offer PLHA. Key difficulties cited in many overview papers (30), (31) , on home care include issues of sustainability and concerns related to cost, quality and coverage of services.
At present, there have been few estimates of the costs of providing home-based care, and these are generally limited to programmes in Africa. SAfAIDS reported that the time burden on care givers imposes the highest cost to the household, where caregivers typically spend 2-3 hours per day caring for the ill (32) . In 1993, a WHO study in Zambia found that the cost of a 3 person team home visit was $26 (33).
Estimates in 1994 indicate that the cost of home care in Zimbabwe ranged from $16 - $23 per visit in urban areas and $38 - $42 per visit in rural areas. Further analysis reveals that up to 75% of those costs were transportation costs, particularly in rural areas (34) .
Gilkes, et al (35) concluded that hospital based home care programmes were not cost efficient since they could not cover all beneficiaries in need of care services. For example, in Zambia, the cost of the Chikankata Hospital home-based care programme in rural areas was estimated to be about $1000 per client served. Again, the majority of those costs were transportation costs.
Community-based programmes have been found to be significantly less costly. For the Zambia Catholic Diocese Copperbelt home-based care programmes the cost of services were about $5.50 per beneficiary. The largest item of expenditure (39%) for this community-based programme was welfare support for food, blankets, etc. Community-based programmes are assumed to be more cost-effective due to volunteerism and decreased time pressures of teams providing care as they are located near the communities they serve.
As far as we are aware, there is little or no reliable data on the costs of providing home based care in an Asian country.
The analysis provided in the following sections outlines the costs of delivering the home care programme described in this report. The analysis also provides an estimate of household level costs and the perceived cost benefits of the programme to patients and families.
Footnotes
(30) Woelk G et.al. (1997) Do we care? The cost and quality of home based care ofr HIV/AIDS patients and their communities in Zimbabwe, University of Zimbabwe, SAfAIDS, Ministry of Health & Child Welfare, Harare
(31) Foster, G et.al (1999) Increased scope and cecreased costs of home care. SAfAIDS News, Vol 7 No.3
(32) Lee, T (1999) Cost and cost-effectiveness of home care: Zimbawe experience, SAFAIDS
(33) MoH Zambia/WHO (1994) Cost and impact of home based care for people living with HIV/AIDS in Zambia
(34) Hansen, K et.al (1998) The cost of home-based care for HIV/AIDS patients in Zimbabwe. AIDS Care, Vol 10, No.6.
(35) Gilks et.al. 1998 op.cit.
This evaluation sought to estimate the cost savings to patients and families receiving home-based care. The evaluation also attempted to provide a comparison of the costs of providing home care services in the urban and rural programmes in Cambodia. Alternative approaches to providing care to PLHA are being piloted in many countries, in response to the increasing demands of the HIV/AIDS epidemic. The effectiveness of these approaches in improving the quality of life for individuals and families and the cost of delivering care services are being evaluated to assist program planners in understanding the future range of options of care to offer PLHA. Key difficulties cited in many overview papers (30), (31) , on home care include issues of sustainability and concerns related to cost, quality and coverage of services.
At present, there have been few estimates of the costs of providing home-based care, and these are generally limited to programmes in Africa. SAfAIDS reported that the time burden on care givers imposes the highest cost to the household, where caregivers typically spend 2-3 hours per day caring for the ill (32) . In 1993, a WHO study in Zambia found that the cost of a 3 person team home visit was $26 (33).
Estimates in 1994 indicate that the cost of home care in Zimbabwe ranged from $16 - $23 per visit in urban areas and $38 - $42 per visit in rural areas. Further analysis reveals that up to 75% of those costs were transportation costs, particularly in rural areas (34) .
Gilkes, et al (35) concluded that hospital based home care programmes were not cost efficient since they could not cover all beneficiaries in need of care services. For example, in Zambia, the cost of the Chikankata Hospital home-based care programme in rural areas was estimated to be about $1000 per client served. Again, the majority of those costs were transportation costs.
Community-based programmes have been found to be significantly less costly. For the Zambia Catholic Diocese Copperbelt home-based care programmes the cost of services were about $5.50 per beneficiary. The largest item of expenditure (39%) for this community-based programme was welfare support for food, blankets, etc. Community-based programmes are assumed to be more cost-effective due to volunteerism and decreased time pressures of teams providing care as they are located near the communities they serve.
As far as we are aware, there is little or no reliable data on the costs of providing home based care in an Asian country.
The analysis provided in the following sections outlines the costs of delivering the home care programme described in this report. The analysis also provides an estimate of household level costs and the perceived cost benefits of the programme to patients and families.
Footnotes
(30) Woelk G et.al. (1997) Do we care? The cost and quality of home based care ofr HIV/AIDS patients and their communities in Zimbabwe, University of Zimbabwe, SAfAIDS, Ministry of Health & Child Welfare, Harare
(31) Foster, G et.al (1999) Increased scope and cecreased costs of home care. SAfAIDS News, Vol 7 No.3
(32) Lee, T (1999) Cost and cost-effectiveness of home care: Zimbawe experience, SAFAIDS
(33) MoH Zambia/WHO (1994) Cost and impact of home based care for people living with HIV/AIDS in Zambia
(34) Hansen, K et.al (1998) The cost of home-based care for HIV/AIDS patients in Zimbabwe. AIDS Care, Vol 10, No.6.
(35) Gilks et.al. 1998 op.cit.