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Cambodia Home Care Programme
   Last updated: 16.08.02
Implementers
In 1998 as part of the response to the growing HIV/AIDS epidemic, the Cambodian Ministry of Health (MoH) established a partnership with a group of NGOs to develop and implement Cambodia's first HIV/AIDS home care programme. Financial and technical support were provided from WHO and the UK Department for International Development (DFID) in the pilot phase, and from Khana, World Vision and Mary Knoll subsequently.

The Home Care Network Group (HCNG) plays a vital role in the continuum of care by providing education and support services, counselling and nursing care to people living with HIV/AIDS (PLHA) in their homes and communities. Hospitals make and receive referrals, and provide monthly medical supervision in the field. The teams (now 10) are co-ordinated by the HCNG, which includes representatives from the NGOs and the MoH. Teams in two areas of Battambang Province are adapting this home care model for use in rural areas.

Background
Home care is particularly important in Cambodia where a severe shortage of hospital beds, general inability to afford current prophylactic drug therapies and poor nutrition put PLHA at greater risk of opportunistic infections. By allowing PLHA to remain in the community, it also fosters better understanding of HIV/AIDS, correcting misunderstandings about both prevention and care as they arise.

The pilot project launched in February 1998 had a dual purpose; to implement home health care programmes and to determine sustainable ways in which NGOs and government could act in partnership.

In December 1998, a two-week evaluation of the project was carried out by a WHO consultant, who reported that home and community care was essential and recommended that the project be strengthened and expanded.

Objectives and main activities
While the initial home care programme is successful in the city of Phnom Penh, there are many factors to consider in expanding to the more rural provinces. The evaluation of the programme recommended the following objectives for expansion:
• To develop a well-resourced and supportive Home Care Network. HCN groups should be established to co-ordinate teams, possibly on a provincial basis. The mechanism for national co-ordination has not yet been discussed.
• To establish strong partnerships between MoH and NGOs, and these partnerships may well include other ministries, pagodas, etc. • To expand the number of volunteers and providing appropriate training.
• To increase community involvement and ownership.
• To provide adequate technical and financial resources and support.
• To establish a supportive system of medical and management supervision

Resources and timeframe
Partnerships between MoH and NGOs have enabled scarce resources to be shared and contributed to the cost effectiveness of the programme. The average cost of providing urban home-based care services is estimated as $9.28 per home care visit and $14.60 per visit for rural services. This estimate includes all administration, personnel and technical support costs, and this compares favourably both to other home care programmes and to outpatient service.

Outputs/outcomes
The review of the pilot phase concluded that the majority of objectives had been met within the timeframe. Patients, NGO and government partners, health staff and community leaders all reported a high level of satisfaction with the teams' activities. The evaluation conducted in June 2000 showed that this had been built on during the post-pilot year.

Internal organisational implications
The Home Care Teams (HCTs) rely on a large number of volunteers, many of whom are PLHA. Volunteers play a number of important roles in the home care programme and are likely to be a key component in the expansion programme. There has been a high turnover of volunteers, sometimes because they take up paid employment, but often because of illness or death.

Volunteers generally work more than the 10 days per month for which they receive expenses. Most live in the community in which they work in home care and some feel that they are potentially always "on call." Volunteers receive 60 hours of initial training and also on-the-job training. They expressed the need for more training in the areas of stress management and in handling work-related situations that may threaten their personal security.

While some HCTs are expanding their links within the community, this will become increasingly important during expansion. It is suggested that the HCNG develop itself as a more autonomous institution that can then respond to the changing needs of the home care service in a co-ordinated way.

Evaluation
Community response to the programme was overwhelmingly positive. PLHA reported that after home care visits they felt better able to look after themselves. By focusing on better nutrition and early treatment of infections, PLHA enjoyed both better health and more positive outlooks on the future. Family members had an improved sense of confidence. The home care programme has also provided households with significant benefits in terms of financial and time savings.

In addition there is a documented cost saving as compared with hospital stays.

Lessons learned
• Monthly HCNG meetings provide valuable feedback, co-ordination and support to the HCTs and are an important component of the home care programme.
• A competitive selection procedure for HCTs to ensure the right staff with the right set of attitudes toward PLHA is important to ensure quality home care provision.
• A good team requires people with the right balance of skills and experience, who receive comprehensive training and supportive supervision.
• Volunteers play a key role and support from community leaders is critical.
• Participatory reviews and responsive management have played an important role in helping to shape and guide the home care programme.
• Strong NGO/government partnerships are important.

Source: A Question of Scale
This is an extract from A Question of Scale: The challenge of expanding the impact of non-governmental organisations’ HIV/AIDS efforts in developing countries,
by Jocelyn DeJong, published by the Horizons Project of the Population Council with the International HIV/AIDS Alliance in 2001. To view the whole report follow this link.

To download, complete with graphics, in pdf format (which requires Adobe Acrobat software to read it) follow this link (file size 1.43 Mbytes).