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Feature - Problems implementing HIV/AIDS caregiver grant
Saturday 7 May 2005
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SOUTH AFRICA: Feature - Problems implementing HIV/AIDS caregiver grant

[This report does not necessarily reflect the views of the United Nations]

©  iThemba Lethu

The need for care has become more urgent

DURBAN, 7 May (PLUSNEWS) - As the number of South Africans infected with HIV/AIDS rises, home-based care programmes need to be persistently expanded, but most such projects are run by NGOs using volunteers due to a lack of funding, and without an income the unpaid caregivers have trouble supporting themselves and their families.

In March the Department of Health decided to assist caregivers, rolling out a policy framework for community health workers that makes available grants to volunteers employed by government-sponsored NGOs, while still emphasising that "the spirit of voluntarism should be encouraged".

The scheme is meant to empower communities to improve their basic health status, but in practice the government's funding criteria do not always match the situation of caregivers working in the field.

NGOs may apply for a "minimum stipend" of R1,000 (about US $144) per trained, community-based, generalist health worker in the fields of health promotion, primary health care and health resource networking and coordination.

The amount of the grant depends on the geographical area, the number of health workers and their socioeconomic status, the health department explains.

To qualify for the grant, a caregiver should cover between 80 and 100 households in rural areas and between 100 and 150 households in urban areas, but may not be responsible for more than 250 households to ensure quality of care.

The reality is often very different from the regulations drawn up at a conference table. For example, the Hillcrest Aids Centre Trust, an NGO 30 kilometres north of the coastal city of Durban, runs a home-based care service with more than 60 unpaid volunteers, supported by six registered nurses.

The caregivers receive food parcels instead of a salary, which helps them and their families to survive, but CEO of the Aids Centre Julie Hornby sees her organisation in an "ethical dilemma, because people are poor - they cannot work for nothing".

She would like to receive the newly available stipend for the centre's volunteers, but they do not quite fit the government's policy framework - they have been trained in basic nursing skills, but are not health educators as such. When the Hillcrest Aids Centre was founded in 1991, the emphasis was on HIV/AIDS education, "but now that the pandemic is full-blown, we have purposefully shifted our focus to care" - education was important, but the need for care had become more urgent, Hornby explained.

Another difficulty was fulfilling the health department's requirement that each health worker visit a certain number of households. Each of the Aids Centre's trained caregivers visited five to 10 patients a day - but often the same households were visited many times if the sick needed long-term care, or more than one person per household needed assistance. This kept the number of households visited per health worker low, while the number of visits exceeded the requirements by far.

Caregivers were not assigned to a specific area. "It depends on where the immediacy is, and which households are in whose reach," Hornby said.

After numerous phone calls to explain their problems, the Department of Health verbally agreed to fund some of the Aids Centre's caregivers, but said it could not give grants to all. The centre now faces the dilemma of possibly receiving funding for only half its 60 volunteers. "Whatever amount we get, we'll split it up so everyone will get a share," said Hornby. "We cannot pay some of our caregivers and let others go empty-handed."

Apart from home-based care, the Hillcrest Aids Centre offers HIV/AIDS testing, feeding schemes, and grants for funerals and school fees.

It provides up to 700 counselling sessions every three months, and a number of HIV positive volunteers give more than 500 educational talks on HIV/AIDS in both English and Zulu to communities every year.

The Centre also runs a number of income-generating projects to help people affected by HIV/AIDS, such as teaching them how to produce fuel-efficient stoves, and do beadwork, pottery and sewing.

A second-hand clothing scheme is also creating greater independence - the first bag of donated clothing is given free of charge to a needy person, who sells them and then buys a second bag with the proceeds, and so forth.

A gardening project to fight poverty and malnutrition grows vegetables that are distributed to the poor, and provides seedlings for vegetable gardens in townships and rural areas.

A horticulturalist teaches families good farming practices - the vegetables can feed a family cheaply and some of the produce can also be sold to generate income.


Recent SOUTH AFRICA Reports
Project empowers rural communities to shape own HIV/AIDS programmes,  3/May/05
Clinic tackles urgent need for AIDS/TB treatment,  2/May/05
Voices of mothers on preventing HIV transmission ,  11/Apr/05
Initiative to alleviate effect of AIDS on education,  7/Apr/05
Shared breastfeeding and poor medical hygiene fuels HIV/AIDS,  6/Apr/05
Le portail d'informations générales de la Côte d’Ivoire
The Global Fund to fight AIDS, Tuberculosis & Malaria
Mothers and HIV/AIDS

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