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Home Care - 5.10 Volunteers
5.10 Volunteers
Beginning in August 1998, each HCT recruited 5 Volunteers to assist the team with their work. Each Volunteer is expected to work approximately 10 days per month, for which they receive a stipend of $12.
The Volunteers are recruited from the communities in which they live. They are often recommended by the local authorities in the community, and are interviewed by the HCTs and selected on merit as part of the recruitment process. The interviews assess their knowledge of HIV/AIDS and their attitude towards PLHA, and whether their families will agree to them working in this field.
The HCTs provide 60 hours of training, and the Volunteers are then attached to the teams. Most HCTs reported that they have identified many people keen to work as Volunteers. Some of the HCTs felt that they could use more Volunteers, but were restricted to a maximum of five by financial and management constraints.
Discussions held separately with the HCTs and with the Volunteers clearly demonstrated that the Volunteers are well integrated and play a number of important roles in the existing home care programme. It is felt that the role of Volunteers will be a key component of the programme when it is expanded to the provinces.
Lesson learned: Volunteers play a number of important roles in the home care programme and are likely to be a key component in the expansion programme
The HCTs were unanimous and unstinting in their praise for the work performed by the Volunteers. Because they are drawn from the community in which they live, the Volunteers are well placed to facilitate links with other community activities, to ensure access and accessibility of HCTs, and they are major sources of referral of new patients to the HCTs.
Unfortunately, there is quite a high turnover of Volunteers. Sometimes this is because they take up paid employment, but often it is because of illness or death, as many of the Volunteers are themselves HIV+. A number HCTs however, still have some of their original Volunteers from August 1998.
It is clear that the Volunteers generally work far longer than the 10 days per month originally allocated, with many working up to 20 days per month. In our observations of the home care activities, the Volunteers appeared to be professional and committed in their dealings with the patients.
Discussions with a representative sample of 16 volunteers drawn from eight of the HCTs revealed that they come from a variety of backgrounds. Some were village leaders, others were students, while others were professionals willing to give spare time to the programme. A number revealed that they were HIV positive.
In addition to their work as part of the HCTs, the Volunteers felt that they were better placed to perform some roles which the HCTs were less able to undertake. The evaluation concurs with this view and notes that the Volunteers:
The Volunteers also made the valid point that, because they live in the community in which they work in home care, they are always potentially on call by the community.
“ We are on duty 24 hours a day, 7 days a week” [Male Home Care Volunteer, Phnom Penh]
The Volunteers expressed the need for more training in stress management – for both the patients and themselves, and said they sometimes felt at risk in their work. One said that she had been repeatedly threatened by a brothel owner, who refused access to his sex workers; another had been involved in a motorbike accident while taking a patient to hospital; another had contracted TB since joining the programme. To address these issues, the Volunteers requested a basic package of health cover from the programme.
“We take risks to take care of patients; sometimes we are exposed to dangers; we need some protection”. [Female Home Care Volunteer, Phnom Penh]
When asked why they continued to work as volunteers, despite the low remuneration and the perceived risks, their responses were unequivocal:
“The future of Cambodia is in the hands of Cambodians; we want to help our people” [Female Home Care Volunteer, Phnom Penh]
“AIDS is a kind of cold war that we need to fight” [Male Home Care Volunteer, Phnom Penh]
“If we don’t try to prevent AIDS and don’t take care of its victims, there is no future for us or our children” [Female Home Care Volunteer, Phnom Penh]
The Volunteers and the full-time HCT members all made a strong case for increasing the stipend for Volunteers from $12 to $20 per month, and for providing a basic package of health cover to all Volunteers. The consequences of adopting these suggestions however, should be carefully considered. A stipend of $20 per month, and the provision of health cover both signify a movement from ‘volunteer status’ into ‘employment status’. This reduces community participation, increases the level external intervention and raises issues of sustainability.
The evaluation team believes that increased volunteer input would be highly beneficial to the programme, but also believes that the costs and liabilities of increasing the number of days worked per month by the volunteers outweigh the benefits. The evaluation therefore suggests that there should be no upper limit on the numbers of volunteers who are attached to a HCT, but recommends that an increase from 5 to 10 would be sensible as a first step. One of the HCTs has already recruited an addition 5 Volunteers (who are all PLHA). The evaluation further recommends that Volunteers are reminded that they are not expected to work more than 10 days per month.
Because of the essential package of activities provided by the Volunteers, at minimal cost, we strongly recommend expanding and strengthening Volunteer involvement in the home care programme, both in Phnom Penh, but particularly in the provinces. The following measures are suggested:
In addition, outside of urban settings, it is suggested that Volunteers are attached to the village, rather than to the Home Care Team. This issue is dealt with at greater length in Section 7.2 of this report.
These measures would then enable the professional Home Care Team staff to move up to the next level of service provision, focusing on assessment, providing medical care and psychosocial support to PLHA, and management and supervision of the Volunteers. The “buddy system” could provide a support mechanism for day-to day activities of the Volunteers. It is clear that an expanded system of Volunteers would need careful planning and adequate resourcing, and would need to evolve over time.
Beginning in August 1998, each HCT recruited 5 Volunteers to assist the team with their work. Each Volunteer is expected to work approximately 10 days per month, for which they receive a stipend of $12.
The Volunteers are recruited from the communities in which they live. They are often recommended by the local authorities in the community, and are interviewed by the HCTs and selected on merit as part of the recruitment process. The interviews assess their knowledge of HIV/AIDS and their attitude towards PLHA, and whether their families will agree to them working in this field.
The HCTs provide 60 hours of training, and the Volunteers are then attached to the teams. Most HCTs reported that they have identified many people keen to work as Volunteers. Some of the HCTs felt that they could use more Volunteers, but were restricted to a maximum of five by financial and management constraints.
Discussions held separately with the HCTs and with the Volunteers clearly demonstrated that the Volunteers are well integrated and play a number of important roles in the existing home care programme. It is felt that the role of Volunteers will be a key component of the programme when it is expanded to the provinces.
Lesson learned: Volunteers play a number of important roles in the home care programme and are likely to be a key component in the expansion programme
The HCTs were unanimous and unstinting in their praise for the work performed by the Volunteers. Because they are drawn from the community in which they live, the Volunteers are well placed to facilitate links with other community activities, to ensure access and accessibility of HCTs, and they are major sources of referral of new patients to the HCTs.
Unfortunately, there is quite a high turnover of Volunteers. Sometimes this is because they take up paid employment, but often it is because of illness or death, as many of the Volunteers are themselves HIV+. A number HCTs however, still have some of their original Volunteers from August 1998.
It is clear that the Volunteers generally work far longer than the 10 days per month originally allocated, with many working up to 20 days per month. In our observations of the home care activities, the Volunteers appeared to be professional and committed in their dealings with the patients.
Discussions with a representative sample of 16 volunteers drawn from eight of the HCTs revealed that they come from a variety of backgrounds. Some were village leaders, others were students, while others were professionals willing to give spare time to the programme. A number revealed that they were HIV positive.
In addition to their work as part of the HCTs, the Volunteers felt that they were better placed to perform some roles which the HCTs were less able to undertake. The evaluation concurs with this view and notes that the Volunteers:
- are a major source (perhaps the major source) of referral of new patients
- are trusted by the community and have good access to local authorities, pagodas, phum leaders etc
- often know about, and are able to develop links other community level initiatives, such as micro-credit and food distribution programmes
- are well placed to identify and facilitate placements of orphans within the community
- often have good relationships with traditional healers, and are in a good position to help break down the mutual mistrust which sometimes exists between traditional healers and orthodox medical practitioners
The Volunteers also made the valid point that, because they live in the community in which they work in home care, they are always potentially on call by the community.
“ We are on duty 24 hours a day, 7 days a week” [Male Home Care Volunteer, Phnom Penh]
The Volunteers expressed the need for more training in stress management – for both the patients and themselves, and said they sometimes felt at risk in their work. One said that she had been repeatedly threatened by a brothel owner, who refused access to his sex workers; another had been involved in a motorbike accident while taking a patient to hospital; another had contracted TB since joining the programme. To address these issues, the Volunteers requested a basic package of health cover from the programme.
“We take risks to take care of patients; sometimes we are exposed to dangers; we need some protection”. [Female Home Care Volunteer, Phnom Penh]
When asked why they continued to work as volunteers, despite the low remuneration and the perceived risks, their responses were unequivocal:
“The future of Cambodia is in the hands of Cambodians; we want to help our people” [Female Home Care Volunteer, Phnom Penh]
“AIDS is a kind of cold war that we need to fight” [Male Home Care Volunteer, Phnom Penh]
“If we don’t try to prevent AIDS and don’t take care of its victims, there is no future for us or our children” [Female Home Care Volunteer, Phnom Penh]
The Volunteers and the full-time HCT members all made a strong case for increasing the stipend for Volunteers from $12 to $20 per month, and for providing a basic package of health cover to all Volunteers. The consequences of adopting these suggestions however, should be carefully considered. A stipend of $20 per month, and the provision of health cover both signify a movement from ‘volunteer status’ into ‘employment status’. This reduces community participation, increases the level external intervention and raises issues of sustainability.
The evaluation team believes that increased volunteer input would be highly beneficial to the programme, but also believes that the costs and liabilities of increasing the number of days worked per month by the volunteers outweigh the benefits. The evaluation therefore suggests that there should be no upper limit on the numbers of volunteers who are attached to a HCT, but recommends that an increase from 5 to 10 would be sensible as a first step. One of the HCTs has already recruited an addition 5 Volunteers (who are all PLHA). The evaluation further recommends that Volunteers are reminded that they are not expected to work more than 10 days per month.
Because of the essential package of activities provided by the Volunteers, at minimal cost, we strongly recommend expanding and strengthening Volunteer involvement in the home care programme, both in Phnom Penh, but particularly in the provinces. The following measures are suggested:
- Volunteers should begin to assume most of the social support responsibilities of home care provision, in addition to most of the non-patient-related activities
- review and upgrade the skills of the Volunteers, to enable them to provide basic counselling to PLHA and to support peer counselling by PLHA
- provide I.D. cards containing the name and photograph of the Volunteer
- provide more opportunities for regular sharing of experiences and problem solving
- provide funds and other management resources to allow HCTs to increase the number of Volunteers attached to them from 5 to 10
- trial the use of a “buddy system” for Volunteers. A Volunteer would be initially paired with a full time member of the HCT, but eventually Volunteers will be paired with each other and work together as a mutually supportive team.
- It is recommended that the Volunteer involvement in the Home Care programme in Phnom Penh and the Provinces is strengthened and expanded
- It is recommended that HCTs increase the maximum number of Volunteers per team from 5 to 10, and Volunteers are encouraged not to work more than 10 days per month
- It is recommended that Volunteers begin to assume most of the social support responsibilities of home care provision, in addition to most of the non-patient-related activities
- It is recommended that HCTs should review and upgrade the skills of the Volunteers, to enable them to provide basic counselling to PLHA and to support peer counselling by PLHA
In addition, outside of urban settings, it is suggested that Volunteers are attached to the village, rather than to the Home Care Team. This issue is dealt with at greater length in Section 7.2 of this report.
These measures would then enable the professional Home Care Team staff to move up to the next level of service provision, focusing on assessment, providing medical care and psychosocial support to PLHA, and management and supervision of the Volunteers. The “buddy system” could provide a support mechanism for day-to day activities of the Volunteers. It is clear that an expanded system of Volunteers would need careful planning and adequate resourcing, and would need to evolve over time.