BOTSWANA: Home-based care hailed as a success

gaborone, 20 November 2001 (PlusNews) - The Botswana government's home-based care programme has become an essential tool in the country's response towards HIV/AIDS, local activists told PlusNews.

The rapid rate at which AIDS cases have been growing in Botswana has put pressure on hospitals and other facilities in the health system. The care of terminally ill patients has created a demand for health care beyond what the existing facilities can provide.

"In 1995, hospitals were not coping because of HIV/AIDS, patients were being discharged before they were ready so the government responded by adopting the home-based care programme," Boipuso Mandanga of the Community Home Based Care (CHBC) Unit, told PlusNews.

Now there are home-based care programmes in every district of the country and the initiative has been hailed as a success by communities and people living with HIV/AIDS.

"These people have taken care of my son, he eats well and he gets medicines and they come and talk to us every month," said 62-year-old Boitshoko Diphaka, who has been taking care of her HIV positive son for the past four years.

According to Mandanga, the Botswana family structure is ideal for the CHBC programme because the culture dictates that families support and care for the sick and dying. "The concept of home-based care has been in our tradition for years, it was just a case of us now placing emphasis on caring for those with HIV/AIDS," said Mandanga.

A study conducted by the Ministry of Health's AIDS/Sexually Transmitted Infections (STI) Unit found that the Motswana household's capacity to care for terminally ill HIV/AIDS patients was relatively high. Most of the caretakers interviewed during the study listed financial support as the only help they needed, as they received assistance from other family members.

To address poverty, the CHBC Unit supports community initiatives such as income generating projects. Mandanga related how a village situated 20 km away from the capital, Gaborone, has created a day-care centre for terminally ill HIV/AIDS patients. The centre provides respite for the caretakers, so that they can sell produce or tend their vegetable gardens.

Diphako told PlusNews that a typical "food basket" provided by the government contained two butternuts and a sack of oranges for the month, "so I have to grow my own vegetables and sell some of them, so that we can eat other things". Diphako is the only breadwinner, as her son is too ill to work. She also takes care of her son's two children, who are still in primary school.

A CHBC package contains basic medical supplies as well as food. Treatment required for opportunistic infections is only available at clinics but nurses and family welfare educators usually bring medicine to terminally ill patients. Counselling services are provided by these welfare officers but there was still a need for better counselling training, said Mandanga.

The success of the project so far can largely be attributed to the contribution of various stakeholders in the community, said Mandanga. Community-based organisations and other support groups have been part of the government's community mobilisation drive.

Total Community Mobilisation (TCM) is a separate NGO-led initiative that is currently being implemented throughout the country. It is a partnership between Humana People to People - an international development organisation - the National AIDS Coordinating Agency (NACA) and BOTUSA (Botswana-USA) project.

TCM field officers walk from house to house and educate and inform communities about how to take control of the epidemic. The officers network and support projects on the ground such as home-based care programmes, mother to child transmission (MTCT) and peer education. "We hope that the programme will increase the demand for HIV/AIDS related services," Anne Dorte Hojrup, division commander for TCM, told PlusNews.

"Our major problem, was educating the communities because many of them were not aware of what AIDS was," Mandanga said. The information, education and communication programme has held "kgotla" meetings with village elders and other community stakeholders and the message seems to be slowly getting across.

Mandanga admits, however, that there is still a need for a better referral system that will allow the "smooth information flow" from clinics to hospitals to households. Without such information, it is still difficult to monitor the quality of the CHBC programme, she added.

Theme (s): Care/Treatment - PlusNews,

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