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Home Care - 5.5 The Home Care Kit
5.5 Home Care Kit
The major resource for clinical management of symptoms and opportunistic infections is the Home Care Kit (see below).
Home Care Kit
Paracetamol 500 mg
Potassium Permanganate 10 mg sachets
10% Iodine Solution 30ml vials
Benzyl Benzoate 30ml
Gentian Violet 15ml vials
Nystatin Suspension 25ml
Loperamide
Primperan
Promethazine 100ml
Multivitamin Tabs
Oral Rehydration Salts
Bicarbonate of Soda 500mg Tabs
Menthol Balm
Coconut Oil
Gloves
Bandages
Scissors
Cotton Wool
Plastic Bags
Elastic Bands
Cloths
Soap Powder
Household Bleach
Hydrogen Peroxide 30ml vials
Matches
Tweezers
Plasters
Micropore Tape
Safety Pins
Talcum Powder
Condoms
Each team has 2 kits so they can divide into two groups for home care visits. The health centre nurses are responsible for the upkeep of the kits and for recording the items used. The HCT Co-ordinators report when the stocks are low and replacement items, which are funded by KHANA through NGO grants, are distributed through NCHADS by the Home Care Network Co-ordinator.
Because Home-based Care Activities are not part of the minimum package of activities (MPA) of the MoH, there is no agreement with MoH Central Medical Stores to provide medicines and other items. At present, supplies for the kits are purchased in bulk from local pharmacies by the Home Care Co-ordinator, with money provided by the NGO grants. The quality and availability of these supplies varies considerably, and the HCTs often complain of shortages and poor quality. Some Health Centres make up this shortfall when they have surplus supplies, but this cannot be relied upon.
It is recommended that MoH further integrates the Home Care programme into procurement plans so that Central Medical Stores are able to resource the drugs for the home care kits through the Health Centres. This would be a phased process which would initially involve the MoH including the drugs in the kits in the essential drugs list. The cost of Home Care Kit supplies for each team is approximately $30 per month. This includes items not available at CMS, such as soap, cloths, etc. which would continue to be provided through the NGO’s programme grants.
It is recommended that MoH includes drugs used in Home Care Kits in the essential drugs list.
It is recommended that Central Medical Stores initiates steps to provide drugs for Home Care Kits through Health Centres.
Many of the home care teams reported that their stocks of some medicines (especially Nystatin, Promethazine, Multivitamins and Paracetamol) are depleted long before the end of the month. Part of the reason lies in some team members responding to the pressure from non-home-care clients, who they encounter in the community, for medicines for pain relief and other minor symptoms. This is justified (by some teams at least) as enhancing community co-operation and avoiding discrimination against AIDS patients.
However, observations of home visits indicated that prescribing medicines by the teams to patients was not always rational, and that there was sometimes a tendency to hand out a standard package of medication without adequate diagnosis. The evaluation team feels that this could be corrected with more frequent and more supportive medical supervision. The issue of supervision will be addressed in section 4.9 of this report.
It is recommended that the HCNG reviews the criteria and rationalises the process of prescribing medicines to patients.
There is one further issue related to medication, which is pertinent to raise at this juncture. Recent research in Africa, supported by WHO and UNAIDS, has endorsed the regular use of cotrimoxazole (marketed as Bactrim) for prophylaxis for PLHA. The recommendation is that prophylaxis should be given life long for HIV+ adults and children, supported by a package of education, monitoring and follow up.
Recently, three of the HCTs have been trialing the provision of Bactrim for PLHA, under the supervision of the medical co-ordinator. This evaluation wholeheartedly supports this initiative, and recommends that Bactrim is provided by all the HCTs to all PLHA, supported by an appropriate package of training for the HCTs, and education, monitoring and follow-up for the patients. During the preparation of this report, MSF were approached to provide Bactrim to the HCTs.
It is recommended that the Home Care Network Group reviews the criteria for home care provision of Bactrim to HIV patients in Cambodia and ensures that there are clear guidelines for selection and monitoring of patients.
The major resource for clinical management of symptoms and opportunistic infections is the Home Care Kit (see below).
Home Care Kit
Paracetamol 500 mg
Potassium Permanganate 10 mg sachets
10% Iodine Solution 30ml vials
Benzyl Benzoate 30ml
Gentian Violet 15ml vials
Nystatin Suspension 25ml
Loperamide
Primperan
Promethazine 100ml
Multivitamin Tabs
Oral Rehydration Salts
Bicarbonate of Soda 500mg Tabs
Menthol Balm
Coconut Oil
Gloves
Bandages
Scissors
Cotton Wool
Plastic Bags
Elastic Bands
Cloths
Soap Powder
Household Bleach
Hydrogen Peroxide 30ml vials
Matches
Tweezers
Plasters
Micropore Tape
Safety Pins
Talcum Powder
Condoms
Each team has 2 kits so they can divide into two groups for home care visits. The health centre nurses are responsible for the upkeep of the kits and for recording the items used. The HCT Co-ordinators report when the stocks are low and replacement items, which are funded by KHANA through NGO grants, are distributed through NCHADS by the Home Care Network Co-ordinator.
Because Home-based Care Activities are not part of the minimum package of activities (MPA) of the MoH, there is no agreement with MoH Central Medical Stores to provide medicines and other items. At present, supplies for the kits are purchased in bulk from local pharmacies by the Home Care Co-ordinator, with money provided by the NGO grants. The quality and availability of these supplies varies considerably, and the HCTs often complain of shortages and poor quality. Some Health Centres make up this shortfall when they have surplus supplies, but this cannot be relied upon.
It is recommended that MoH further integrates the Home Care programme into procurement plans so that Central Medical Stores are able to resource the drugs for the home care kits through the Health Centres. This would be a phased process which would initially involve the MoH including the drugs in the kits in the essential drugs list. The cost of Home Care Kit supplies for each team is approximately $30 per month. This includes items not available at CMS, such as soap, cloths, etc. which would continue to be provided through the NGO’s programme grants.
It is recommended that MoH includes drugs used in Home Care Kits in the essential drugs list.
It is recommended that Central Medical Stores initiates steps to provide drugs for Home Care Kits through Health Centres.
Many of the home care teams reported that their stocks of some medicines (especially Nystatin, Promethazine, Multivitamins and Paracetamol) are depleted long before the end of the month. Part of the reason lies in some team members responding to the pressure from non-home-care clients, who they encounter in the community, for medicines for pain relief and other minor symptoms. This is justified (by some teams at least) as enhancing community co-operation and avoiding discrimination against AIDS patients.
However, observations of home visits indicated that prescribing medicines by the teams to patients was not always rational, and that there was sometimes a tendency to hand out a standard package of medication without adequate diagnosis. The evaluation team feels that this could be corrected with more frequent and more supportive medical supervision. The issue of supervision will be addressed in section 4.9 of this report.
It is recommended that the HCNG reviews the criteria and rationalises the process of prescribing medicines to patients.
There is one further issue related to medication, which is pertinent to raise at this juncture. Recent research in Africa, supported by WHO and UNAIDS, has endorsed the regular use of cotrimoxazole (marketed as Bactrim) for prophylaxis for PLHA. The recommendation is that prophylaxis should be given life long for HIV+ adults and children, supported by a package of education, monitoring and follow up.
Recently, three of the HCTs have been trialing the provision of Bactrim for PLHA, under the supervision of the medical co-ordinator. This evaluation wholeheartedly supports this initiative, and recommends that Bactrim is provided by all the HCTs to all PLHA, supported by an appropriate package of training for the HCTs, and education, monitoring and follow-up for the patients. During the preparation of this report, MSF were approached to provide Bactrim to the HCTs.
It is recommended that the Home Care Network Group reviews the criteria for home care provision of Bactrim to HIV patients in Cambodia and ensures that there are clear guidelines for selection and monitoring of patients.