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Home Care - 5.1 The Home Care Network
The Home Care Network in Phnom Penh (illustrated in Appendix ll) now consists of 10 Home Care Teams (HCTs), of which seven receive financial and technical support from KHANA and three from World Vision. The teams are based in government health centres, and each is composed of 2 government nurses working 50% time on the programme, and 3 NGO HIV/AIDS staff. One international and 5 local NGOs are involved, and the Home Care Network is co-ordinated through the AIDS Care Unit of NCHADS.
Until March 2000 KHANA supported 2 teams through the MSF-supported CUHCA clinic, but following the closure of CUHCA, the teams themselves have formed their own local NGO, KOSHER, which KHANA is also now supporting. Maryknoll, an international NGO was supporting one team, but following a shift in January 2000 in their focus of activities, Maryknoll handed over the support of their team to WOMEN, a local NGO who were already receiving KHANA support.
The ability of WOMEN to expand the number of teams they manage, and the successful formation of KOSHER to manage 2 HCTs, are both indicators of improved local capacity within the Home Care Network, as direct outcomes of technical support provided by KHANA to the programme.
The teams are located at 9 Municipal Health Centres spread throughout the city. The health centres were selected by the Municipal Health Department, based on location, capacity and degree of commitment of support from the Health Centre Managers.
Monitoring of home care provision is conducted by a committee, representing NCHADS, MHD, KHANA, Health Centre Managers and the 6 participating NGOs, to whom the HCTs submit monthly reports. These reports are compiled by the Home Care Network Co-ordinator at NCHADS and reviewed at monthly meetings of what is presently called the “Project Committee”. It is recommended that this is renamed the “Home-Care Network Group” (HCNG), to better reflect its function and the status of the programme. This term will be used in the remainder of the report.
During the pilot phase the HCNG was co-ordinated by the Project Co-ordinator, based at WHO. From February 1999, this responsibility was taken up by the Home Care Network Co-ordinator at NCHADS, with financial and technical support from KHANA.
5.1.1 Home Care Network Group Meetings
The evaluation team reviewed minutes of the HCNG Meetings (presently called Project Committee Meetings) for the past 12 months. In addition, members of the evaluation team participated in three HCNG Meetings during the course of the evaluation. It is appropriate for this evaluation to acknowledge and highlight the tremendous amount of professional commitment, time and effort put into these meetings by the members of the HCNG. As well as reviewing the monthly HCT reports, participants at the meetings discuss ongoing and emerging issues, mostly raised by the HCTs, related to home care provision. The HCTs are represented at the meetings by the Home Care Network Co-ordinator who also chairs the meetings.
The evaluation team strongly concurs with both the HCNG and the HCTs themselves, that the HCNG Meetings are an essential component of the home care programme. The meetings serve a number of functions:
- they provide a feedback and support mechanism for sharing and addressing ongoing and emerging problems faced by the Home Care Teams. In the 3 meetings attended during the evaluation, the emerging problems of safe abortion for HIV+ mothers, and management of orphaned children were raised.
- they provide a communication mechanism between NCHADS, MHD, NGOs and the HCTs, for programme developments and innovations. Proposed developments include the use of Bactrim for prophylaxis and the establishment of closer linkages with the CENAT DOTS team.
- they provide an overview and facilitate the co-ordination of home care activities within Phnom Penh, and elsewhere in Cambodia
Lesson learned: Home Care Network Group Meetings provide feedback, co-ordination and support to the HCTs and are an important component of the home care programme.
As the Home Care programme expands to meet the increasing demands for care and support, it is clear that a mechanism will be needed to plan for the expansion, co-ordinate activities and monitor outcomes. The Home Care Network Group is ideally placed to fulfil this role. In addition to continuing to provide feedback and support to the HCTs the Home Care Network Group will need to expand its role to provide a mechanism for:
- democratic planning and co-ordinating government and NGO partnerships
- assessing skills development needs and co-ordinating technical support and training
- strengthening links with other components of the referral network, including Voluntary Counselling & Testing, contraceptive services, STI services and TB services
- monitoring inputs, process, outcomes and impact.
Because of the important links between HIV/AIDS and TB, it is recommended that CENAT should be included in the list of collaborating institutions of the Home Care Network. It is further recommended that a representative from the Home Care Network Group is invited to be on the HIV/TB working group that is chaired by NCHADS.
It is recommended that CENAT is included in the list of collaborating institutions of the Home Care Network
It is recommended that a representative from the Home Care Network Group is invited to be on the HIV/TB working group chaired by NCHADS
The evaluation strongly recommends that organisations wishing to provide home-based care should be federated to the Home Care Network. This will go some way to ensuring quality, avoiding duplication of effort, facilitating co-ordination of activities and monitoring overall impact of home care provision.
It is recommended that organisations wishing to provide home-based care are federated to the Home Care Network.
In order to help the Home Care Network Group to begin to meet the increasing demands of expanding home care provision, the evaluation team recommends that the existing Home Care Network should be strengthened and institutionalised. However, there are dangers inherent in “over-institutionalising” the Network, perhaps by making it into a public sector committee. It is vital that the Home Care Network remains a responsive feedback, support, planning and co-ordination mechanism, as opposed to a bureaucracy.
It is recommended that the Home Care Network is strengthened and institutionalised.
5.1.2 Institutional base for the Home Care Network Group
Because of the previous limited resources within the Municipal Health Department, the HCNG meetings have been held at NCHADS, and chaired by the Home Care Network Co-ordinator, who is also from NCHADS. The evaluation notes that, whilst NCHADS has done an excellent job in co-ordinating the Home Care Network, from an institutional perspective this responsibility should lie with the Municipal Health Department (MHD).
As the Home Care Teams are located in the MHD Health Centres, and given the expanded capacity of the MHD, the evaluation recommends that the Municipal AIDS Office would be a more appropriate institutional home for the Home Care Network Group. This relocation would be in line with ongoing Health Sector reforms and would enable the present Home Care Network Co-ordinator at NCHADS to devote more time to issues related to programme expansion.
It is recommended that the Municipal AIDS Office begins to assume responsibility for co-ordinating the Home Care Network in Phnom Penh.
5.1.3 Resourcing the Home Care Network Group
Support to the Home Care Network Group itself is presently limited to salary and administrative support, provided by KHANA, to the Home Care Network Co-ordinator. The HCNG itself has no independent funds, and its ability to expand its role is therefore constrained.
In keeping with the recommendation to strengthen the Home Care Network, it is further recommended that the Home Care Network Group should become an autonomous unit, with its own resources and financial support.
It is recommended that the Home Care Network Group becomes an autonomous unit, with its own resources and financial support
In recommending that the HCNG becomes autonomous, it is important to acknowledge the key factors which contribute to its current effectiveness. Although the Network is co-ordinated from NCHADS, it retains external financial and technical assistance – originally from WHO, and since 1999 from KHANA. In moving the institutional base of the Home Care Network Group, as well as expanding its role, it will be important to ensure that this assistance not only continues, but is enhanced.
In the light of the proven track record of KHANA, and the experience of the home care programme of KHANA's current Technical Advisor, it is suggested that KHANA is approached to provide financial and technical support for an initial period of 6 months. It is suggested that funds would include salary and administrative support to the Home Care Network Co-ordinator, as is presently the case, together with additional resources to enable the Home Care Network Group to establish an independent identity. Technical support should be made available, initially to assist the transition from NCHADS to the Municipal Aids Office, and then to build the capacity of the Home Care Network Group as a democratic planning and implementing partnership of NGO and government representatives.
It is recommended that KHANA is approached to provide technical and financial support to facilitate the expansion and relocation of the Phnom Penh Home Care Network Group
Given the important co-ordination role presently performed by the Home Care Network in Phnom Penh, the evaluation further recommends the establishment of Provincial Home Care Networks to co-ordinate the expansion of home care activities in the provinces. A key function of the Phnom Penh HCNG would then be to build the capacity of future Provincial Home Care Networks.
It is recommended NCHADS considers establishing Provincial Home Care Networks to co-ordinate the expansion of home care activities to the provinces.