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Home-Based Care

In Africa, there has been a general shift in the model of care provided to people living with HIV. An increasing amount of people are being referred to home-based care due to the pressure the HIV pandemic has placed on public hospitals and clinics.

Fast Facts: Increase in Home-Based Care Budget

46% The SA Health Department increased its budget for home-based and community-based care for people living with HIV from R94.5-million in 2002/2003 to R138-million in 2004/05 Source: Southafrica.info, 2005

According to the 2001 South African Guidelines on Home-Based Care and Community-Based Care, home-based care addresses several problems, including:

  • shortage of hospital beds
  • inadequate number of medical, nursing and allied health professionals in the public sector
  • lack of resources for treatment and drugs
  • hospitals that are crowded and staff who are over-stretched can result in an environment that is unsuitable for managing patients with terminal diseases
  • high costs of institutional care

Key Research

In 2001, research commissioned by the SA National Department of Health found:

  • 628,000 admissions to public hospitals were for AIDS-related illnesses
  • the cost of hospitalising AIDS patients at public facilities was likely to be at least R3.6-billion, or 12.5% of the total public health budget for a financial year

Cited in: Department of Health. An Enhanced Response to HIV and AIDS and Tuberculosis in the Public Health Sector

Home-based care provides an alternative to institutionalised health care. Discharging patients into the care of a home care programme allows for a shorter stay at the hospital, making more beds available for other patients (who may need more urgent treatment) and reducing costs to the institution.

Home-based care can be used to:

  • treat and rehabilitate patients with HIV
  • offer palliative care for AIDS patients that are nearing death

8.1 A Model of Home-Based Care

The need for home-based care for HIV and AIDS patients is usually in the last stages of HIV infection after other treatment interventions have failed. Often, patients need palliative care during this time in order for them to prepare for death.

The Integrated Community and Home-Based Care (ICHC) model, which is used by several hospices in South Africa, illustrates the use of home-based care for patients in the last stages AIDS.

Community based caregivers are trained to support people with HIV and AIDS, including:

  • "distributing medication and vitamin supplements
  • teaching family members or neighbours how to care for the patient, including how to give bed-baths, how to lift the patient, mouth care and other basic skills
  • cooking for the patient
  • providing food parcels and items of clothing where necessary
  • making arrangements to transport the patient to the hospital for medical exams, physiotherapy or other services
  • educating the family and neighbours about HIV and AIDS
  • listening, supportive counselling, and providing human contact in the case of isolated people." (Cadre, 2002. Integrated Community-based Home Care (ICHC) in South Africa)

By using home-based care, costs can be saved in the formal health care system. According to Cadre,

  • The average hospital time for terminal patients has been reduced from two weeks to three-and-a-half days in Port Shepstone.
  • In KwaZulu-Natal it costs hospitals R650 per patient per day. The total cost per ICHC patient at the South Coast Hospice was R1 015 per annum in 2001/2002.
Wits Journalism Anova Health

The project is jointly managed by the Anova Health Institute and the Journalism and Media Studies Programme at the University of the Witwatersrand, and supported by the Health Communication Partnership based at the Johns Hopkins Bloomberg School of Public Health Centre for Communication Programmes and the President’s Emergency Plan for AIDS relief through the United States Agency for International Development under terms of Award No. JH/HESA-02-05.

USAID