Home Based Care services in Tanzania
Home Based Care (HBC) is defined as provision of comprehensive services, including health and social services by formal and informal caregivers in the home. HBC includes physical, psychosocial and spiritual care. The service also focuses on reducing stigma and discrimination, prevent further spread of HIV and to mobilize community resources for People Living with HIV/AIDS (PLHAs) and their families, provide hope and comfort through good quality and appropriate care that helps patients and families improve the quality of life. HBC extends from health facilities to the home and viseversa.
Benefits of HBC
HBC has benefits to the patients, family and the community. For patients it enables patients to be cared for in a familiar environment, as well as allowing them to participate in and contribute to family life and make them part of their families and community. HBC reduces the cost of caring for patients away from the family. For the family it helps to holds the families together with the objective of caring for the patient. It helps the family to accept the patient's condition thus making it easier for care and support. It reduces costs of care as well as enabling the family to attend to other tasks as they care for the patient. For the community, it raises awareness about HIV/AIDS, reduces stigma and thus prevent spread of HIV and gets rid of myths and misconceptions about HIV/AIDS and thus help communities to understand HIV/AIDS. It makes it easier to provide support, by tapping all possible community resources and helps to bring the community together to combat HIV/AIDS and advocate for more services.
Minimum package of HBC services
Realizing that the needs of a chronically ill and especially a person with HIV/AIDS are varied, it is obvious that there is no single organization that can meet all the needs comprehensively. As such, referral and networking is a critical element in any HBC programme. The minimum package of a HBC service includes:
- Prevention awareness raising, community mobilization, promotion of safer sex, VCT, condom distribution.
- Advocacy to fight stigma and increase community resources work with community leader, Faith Based Organizations (FBOs), youth groups, and schools.
- Nursing care to promote and maintain good health through hygiene, nutrition, pain control, comfort and end of life care.
- Referral to health facility for further care of opportunistic infections, monitoring of HIV progression and to and other social economic services.
- Counseling spiritual and emotional support to reduce stress and anxiety, promoting possible living, and helping individuals make informed decision on HIV testing, planning for future, changing behavior and support through the grieving process.
- Skill transfer transferring skills to home care givers in areas such as basic nursing care, hygiene, positive living, nutrition, emotional support, infection prevention, referral and networking.
- Social support information and referral to support groups, welfare services, care for OVC, material assistance.
Caring for patients in the homes is traditional, but in relation to HIV/AIDS and chronically ill patients, formal HBC services by the health sector started in 1996 in eight districts. Since 2003, there has been a concerted effort by the Government of Tanzania (GOT) to scale up care, support and treatment for its HIV/AIDS patients, including HBC. As at the end of 2007, the services had been established in 71 districts of Tanzania mainland. The main implementers of HBC have been Non Governmental (NGOs), FBOs and Community Organizations with support from several donors. At the end of 2007, the National AIDS Control Program (NACP) reported that over 50,000 patients had benefited from HBC. Various actors have roles to play in HBC; the family is the main actor in HBC. The family Chooses among them at least one person who will be trained on the specific elements in the care of the patient. The community provides supportive role in all aspects of care, treatment and support for the chronically ill including AIDS patients and their families. While the health facilities through trained HBC providers train and supervise volunteers and community resource persons and monitor HBC services in their catchments areas.
- There has been a realization of HBC as a core service in care and treatment and inclusion in the HIV/AIDS strategic Framework as well as in the Health sector HIV/AIDS strategy.
- The number of organizations who provide support for HBC has gradually increased.
- Guidelines, curricula and monitoring tools are in place as part of standardization, harmonization and quality control.
- Providers have been trained from health facility, FBOs, private sector, NGOs, community volunteers.
- Demand has been created and number of patients, providers as well as partners has increased gradually.
- Several reviews have been conducted to determine the status of implementation and reports are available
- Implementation of HBC is mainly dependent on donor funding and implemented as time limited projects.
- Demand for services is increasing due to increasing numbers of chronically ill as well as HIV/AIDS patients.
- HBC has not been prioritized by and thus not included in majority of comprehensive health plans.
- Weak link between health facility and community services.
- Inadequate coordination of HBC implementation leading to duplication of services in some districts.
- Inadequate human resource, and lack of strategies to retain the trained volunteers.
- Scaling up the programs especially to comprehensively cover the districts that have established the services and to reach those who have not.
- Strengthening referral systems between CHBC and other services including strengthening of linkage between clinical and community so as to ensure the continuum of care.
- Further efforts to effectively coordinate programs and enhance standardization and uniformity in both training and service provision.
- Strengthening districts to support, monitor and supervise CHBC programs.
- Improve monitoring anghd supervision and strengthen recording and reporting for effective data production and use capacity of health care workers in the catchment areas.
- Improving the care of the carers.