Health

Bridge the home-care health gap

29 November 2010

Caregivers like Sr Gladys Tshayinca of South Coast Hospice in KwaZulu-Natal take home-based care to isolated patients and families

This article was written by Erica Webster for the Sunday Times, originally published on 28 November 2010.

Home-based care is a crucial component in the fight against HIV/Aids; without it the formal healthcare system would not be able to handle the epidemic, says Adam Boros, CSI practitioner at Tshikululu Social Investments.

The World Health Organisation defines home-based care as “the provision of health services by formal and informal caregivers in the home to promote, restore and maintain a person’s maximum level of comfort, function and health, including care towards a dignified death”.

The national guideline on home-based and community-based care supports this definition, stating that there needs to be strong collaboration between the formal and informal health sector.

“That collaboration needs to happen at every level in the system, but especially at the primary healthcare level, which is generally in communities that have just a clinic or a mobile clinic,” says Boros, who recently completed his master’s thesis on the interface between the formal and informal health sectors.

“Informal home-based caregivers aren’t able to provide comprehensive healthcare to people with HIV or anyone with a chronic illness.

“At the same time, the formal health sector in SA is struggling with capacity and limited resources. Our biggest challenge, therefore, is to create a strong, co-operative, integrated link between the two.”

He says one possibility is the use of directly observed therapy supporters, who are employed by the home-based care organisation, but are stationed at the clinic to act as a go-between.

Another option is creating partnerships between home-based care organisations.

“Many caregivers work in vulnerable communities and are isolated from other services, so it’s useful to have access to an umbrella organisation that can help them make those connections.

“A good example is the Hospice Palliative Care Association of SA, which works with hospices all over the country, many of whom provide home-based care support services,” Boros says.

A major challenge facing home-based care organisations is funding and capacity, he says.

Many caregivers provide services along the lines of home visiting rather than home-based care.

“That’s still very helpful – they go in and do cleaning and cooking, and perhaps some informal counselling – but they lack the training necessary to help someone through HIV and all the challenges that come with it.”

Boros says what lies at the heart of the problem is a lack of systems that could facilitate a more co-operative relationship between the two.

“This would include things like communication, monthly meetings, reports between the home-based care director and the head nurse and clinic.

“The study I did was quite small – just two clinics and two home-based care organisations – but in most cases no official referral forms were used.

“In one case, seven different referral methods were used in a home-based care organisation that had only 15 caregivers.”

He believes the departments of health and social development need to provide clear guidelines on how that relationship should work, what kind of communication is required and how frequently reporting needs to take place.

“It really needs to come from the top, with a lot of input from the bottom on which systems will facilitate better communication and a better relationship between the two,” he says.