YOU ARE HERE:
Home Care - 7.1 Key Components
   Last updated: 08.08.01
7.1 Key Components

Section 5 of this report reviewed the inputs and processes involved in establishing and maintaining the existing Home Care programme. It will be useful to summarise here the key components of the programme which have contributed to its success, and which should ideally be incorporated in its expansion. These include:

  • A well-resourced and supportive Home Care Network

  • The establishment of strong partnerships between MoH and NGOs

  • Selective team formation and composition

  • Expansion and integration of volunteers into the programme

  • Close linkages with the community, increasing community involvement and ownership

  • Appropriate initial and ongoing training

  • The provision of adequate technical and financial resources and support

  • Ongoing reviews, monitoring and evaluation

  • The establishment of a supportive system of medical and management supervision


Each of these will be briefly reviewed in the sections below:

7.1.1 The establishment of strong partnerships

This evaluation has noted that good partnerships exist at a number of levels in the Home Care programme:

  • between MoH/NCHADS, KHANA and the international NGOs who support the programme and local NGOs who participate in the programme

  • between KHANA and their partner NGOs who support the Home Care teams

  • between the Home Care Teams and the Health Centres at which they are based

  • between the Home Care Teams and leaders of the communities in which they work

  • between the government and NGO Home Care Team members who implement the programme


These partnerships have enabled scarce resources to be shared, and have ensured that the comparative advantages of each of the players have been effectively utilised.

Lesson learned: partnerships have enabled scarce resources to be shared, and have ensured that the comparative advantages of each of the players have been effectively utilised.

Basing the HCTs in MoH Health Centres has assisted in convergence with the public health system, and has gone some way to promote a sense of shared ownership of the programme between MoH and NGOs. More equitable sharing of financial responsibilities and commitments between government and NGOs will further enhance shared ownership. However, the implications of transferring (at least some of) the responsibility of financial support from KHANA and the NGOs to MoH has not been evaluated.

Partnerships between the Home Care programme and referral hospitals in Phnom Penh have been less successful. It will be important to establish and maintain good links between the Home Care programme and referral hospitals and health centres in the Provinces.

7.1.2 Selective team formation and composition

Findings from this evaluation indicate that the selection of the right personnel and achieving the right mix of skills and experience in the HCTs is critical to successful team working.

Combining staff with medical backgrounds and those with experience in AIDS prevention and counselling in the Home Care Teams has been instrumental in providing a comprehensive service to PLHA and their families. It has also fostered cross-learning and improved understanding between the MoH and NGO staff. Using a process of competitive selection has ensured that the right staff with the right attitudes are recruited onto the teams.

7.1.3 Expansion and integration of volunteers into the programme

This evaluation found that Volunteers are increasingly fulfilling a number of important roles in the Home Care Programme:

  • They are proving to be the major source of referral of new patients

  • They often occupy positions of trust within the community and are well placed to facilitate good access to local authorities, pagodas, phum leaders, etc.

  • They are well placed to develop links other community level initiatives, such as micro-credit and food distribution programmes

  • They are well placed to identify and facilitate placements of orphans within the community

  • They 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


It is recommended that Volunteer involvement is expanded and strengthened and that Volunteers begin to assume most of the social support responsibilities of home care provision, in addition to many of the non-patient-related activities

7.1.4 Close linkages with the community, increasing community involvement and ownership

During a participatory review of the Home Care programme the Home Care Teams identified the support from community leaders as the most important factor contributing to the successful implementation of their work. This was reiterated during discussions held with HCTs during this evaluation.

Lesson learned: support from community leaders is an important factor contributing to the successful implementation of the work of the HCTs

In addition to helping to ensure support from local authorities, establishing close linkages with the community is important in accessing existing community-based welfare initiatives and in mobilising community resources to support programme activities.

7.1.5 Appropriate initial and ongoing training

On recruitment, very few of the HCT staff were familiar with the key aspects (clinical, psychological, social and educational) of home care provision. Initial training, including community placement, in the essential aspects of home care was therefore essential preparation for work in the HCTs. In addition, during the two years of the programme, KHANA has supported and/or provided up to five further orientations and updates for the home care staff. These training sessions have been in response to identified needs to update or provide new skills.

The evaluation team believes that adequate and appropriate initial training, supplemented by responsive, preferably on-the-job, refresher training are key components to maintain professionalism of home care provision.

7.1.6 Provision of adequate technical and financial resources and support

Since the WHO pilot period, technical and financial support has been provided to the participating local NGOs and government team members by KHANA with support from MoH and the AIDS Alliance, while World Vision and Maryknoll have supported their own HCTs, both with donor support. This support has resulted in increased capacity of the NGOs to manage their Home Care Teams, and of both MoH and NGO staff of the HCTs to manage their work programmes. This evaluation recognises the importance of this support and emphasises that it will be an essential component in the expanded programme. It will be important to identify the appropriate mechanism to ensure continuous financial support to the home care programme.

There are some indications that a number of donors are expressing interest in supporting the home care programme. This would provide an excellent opportunity to trial a sub-sector-wide approach of donor support to a health programme and the evaluation recommends that this approach should be explored.

It is recommended that donors explore the possibility of trialing a sub-sector-wide approach to funding the Home Care Programme in Cambodia.

7.1.7 Ongoing reviews, monitoring and evaluation

Participatory and external reviews, monitoring and evaluation are essential components of any programme, and especially an evolving programme. This evaluation notes that the many reviews and evaluations have helped shape and improve the Home Care programme. It is to the credit of those involved in managing its implementation that they have demonstrated flexibility and responsiveness in modifying the programme to accommodate evaluation findings.

Lesson learned: participatory reviews and responsive management have played an important role in helping to shape and guide the Home Care programme.

Developing and establishing a participatory review system, which monitors both process and impact, and includes appropriate indicators, will be an essential component of an expanded Home Care Programme. Identifying appropriate technical resources will be a necessary first step in establishing an impact monitoring system.

7.1.8 Establishment of a supportive system of medical and management supervision

Good supervision has been shown to be a key factor in the provision of quality services, and yet is often the missing link in service delivery programmes. The findings of this evaluation demonstrate the importance of, and demand for a supportive supervisory system to address the management and medical needs of the providers of home-based care.

A supportive supervisory structure will be particularly important in the rural areas where long distances between centres and villages are likely to result in greater isolation of home care providers from resource centres

7.1.9 A well-resourced and supportive Home Care Network

The evaluation notes that the establishment and maintenance of the Home Care Network in Phnom Penh has been critical in helping to ensure co-ordination of support, improve linkages and assist the programme to better meet the increasing demands for improved care and support at low cost.

The establishment of similar Home Care Networks at Provincial level will be beneficial to help manage and co-ordinate the expansion of home care activities in the provinces. They are likely to play an important part in co-ordinating activities, avoiding duplication and ensuring co-ordination of technical support and training, establishing and maintaining links with other initiatives and institutions and facilitating monitoring of process, outputs and impact.