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Community-home based care and support services

Presentation to the Social Development Portfolio Committee23/5/2001

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Introduction

• The purpose of this report is to provide the Portfolio Committee with updated information on the progress made in the implementation of the Strategy for Home Community Based Care and Support Services

• The presentation includes the National Integrated Plan for Children Infected and Affected by HIV / AIDS, the home community based care model options and interventions.

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The main challenges regarding HIV/AIDS include:

• Increased number of hospitalization

Increased health budget

Increasing number of children in distress.

Inability of traditional models of surrogate support care to accommodate the number of children in distress;

Inability of poor communities to absorb children in distress into informal care facilities without the introduction of outside support;

The stigma associated with HIV/AIDS i

HIV/AIDS will have a profound impact on social assistance in South Africa.

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Definition of home/community based care and support

• Home care is defined as the provision of comprehensive services, which includehealth and social services by formal and informal caregivers in the home in order to promote, restore and maintain a person's maximal level of comfort, function and health including care towards a dignified death.

• Community based care and support is the care/services that the consumer can access nearest to home, which encourages participation by people, respond to the needs of people, encourages traditional community life and creates responsibilities

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Objectives of home/community based care and support

• To shift the emphasis of care to the beneficiaries - the community

To ensure access to care and follow-up through a functional referral system

To integrate a comprehensive care plan into the informal, non-formal and formal health and social development system

To empower the family / community to take care of their own health and welfare

To reduce unnecessary visits and admissions to health facilities

• To ensure that children and families who are affected by HIV/AIDS access social development services in the community

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Beneficiaries of the service• Asymptomatic HIV positive persons. People recovering from illness and who might be in need

for specific treatment and assistance after being discharged from hospital.

Terminally ill persons. Persons living with HIV/AIDS or any other debilitating

disease and /or conditions All categories of caregivers. Families. Children infected and affected by HIV/AIDS.

• The entire community

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SERVICE PROVIDERS

– The providers of home/community based care and support services could include

the following: Professionals: doctors, nurses, social workers Non-professionals: family members, community

/ care givers, volunteers, traditional healers / leaders,

Community and faith-based organisations.

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Sectoral responsibilities -Health• Provide basic home care supplies and conduct home

visits.Assess care needs (nutrition, physical care, and emotional

support).Train and support care givers.Counselling clients and caregivers.Develop care plans and provide care.

• Provide IEC materials• DOTS supervision• Liaison with health services• Referrals to health providers

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Sectoral responsibilities -social Dev.• Community mobilisation Establish childcare committees Train volunteers Identifying vulnerable children and

families through home visits • Identify community needs and resources

• Provision of material assistance (food, clothing, shelter)

• Identify and provide: Alternative care for orphans. Residential care Foster care– Adoption– Counselling and support– Monitoring and supervision adoption

• Social security Identify eligible persons and

assist access to benefits

• Networking

• Referrals

• Poverty alleviation

• Capacity building training family members training professionals

• training volunteers

• Monitoring

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CORE COMMON FUNCTIONS

• Identifying community needs and resources and mobilisation

• Networking

• Referrals to or from other services

• Identifying eligibility and help access benefits

• Material assistance• Nutrition, clothing, shelter, financial

• Poverty alleviation• Training and emotional support of

families and care givers• Including counselling such as

bereavement, HIV.• Identifying affected and vulnerable

families and individuals.• Monitoring and supervision.

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Special allocation

The Cabinet approved that an amount of R450 million be made available for the implementation of the National Integrated Plan over a period of three years.

An amount of R 13 million was allocated for the financial year 2000 / 2001 for the joint implementation of the home community based care component.

• Of this amount R 6.8 million was allocated to the Department of Social Development

• Dept of Health was allocated R6.2million

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GOALS FOR FUNDING COMMUNITY AND HOME-BASED CARE PROGRAMME

• 1 TO DEVELOP AND IMPLEMENT EFFECTIVE AND AFFORDABLE COMMUNITY-BASED CARE AND

SUPPORT MODELS

• 2 TO INTEGRATE POVERTY ALLEVIATION PROGRAMMES IN THE SIX SELECTED SITES IN ORDER TO

MEET THE OVERALL BASIC NEEDS OF FAMILIES OF HIV INFECTED AND AFFECTED CHILDREN

• 3. BUILD CAPACITY ON DIFFERENT LEVELS OF SERVICE RENDERING

• 4. STRENGTHEN EXISTING INTEGRATED PROGRAMMES

• BUDGET R13M FOR 2000/1, R20M FOR 2001/2,, AND R32M

FOR 2002/3

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Progress

• SITES SELECTED

Tonga in Mpumalanga Tsolo in Eastern Cape, De Aar in Northern Cape, Jouberton in North West, Welkom in Free State Pietersburg (Polokwane, Maraba and

Mashahane) in Northern Province.

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National Support to Provinces

• Several capacity building workshops were held jointly with the provinces to:

Ensure that the business plans were integrated, Ensure that funds are utilized specifically for the

integrated Plan for Children infected and affected by HIV/AIDS.

Enable provinces to assume responsibility for the planning, implementation, monitoring, evaluation and sustainability of the programme;

Ensure that both national and provincial offices monitor the initial implementation process.

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Progress national Support

• Appointment of provincial home community based care co-ordinators is in progress in consultation with provinces.

• Situational analyses in the above mentioned six sites have been outsourced. The adjudication process is presently ongoing

• The national departments will conduct an interim nation wide audit of home community based care programmes together with the provinces due for completion by end of June 2001.

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Training and capacity building

A 12 module-training manual including a curriculum and learners handbook has been developed.

90 trainers, that is 10 trainers per province have been trained at to date.

1305 persons trained within provinces already

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Progress

• Provincial personnel including HIV / AIDS co-ordinators were trained on the Public Finance Management Act.

• Provincial staff development: Exposure to international models of home/community based care and support.

• Provincial officials from both Health and social Development Departments were exposed to different international models of home/community based care.

Home / community based care fact finding mission to Botswana Visit to alternate models of care in Uganda

• Attended 1st regional home / community based care conference in Botswana in March 2001

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Material assistance

• Provision of home-based care supplies Distribution protocols have been developed. Five provinces currently providing these basic supplies Gauteng preparing for official launch in June 2001. WHO has donated 24 empty home based care bags LSP is donating second hand gloves Current service beneficiaries stands at 21463

• Poverty Relief• R6 million was made available to faith based organisations and

NGOs by the Dept of Social Development to provide material assistance to infected and affected persons

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Policy and guidelines development

These have been presented to PHRC in March 2001.

Care and support guidelines for children infected and

affected by HIV/AIDS

Development of these guidelines is being outsourced. Tender

process is presently in motion.

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National Children’s forum on HIV/AIDS

The Policy Unit of the University of Cape Town is

planning a National Children’s Forum to be held in

August 2001. The forum will culminate in the children

addressing policy makers and politicians. The

Department of Health is providing financial support to

the amount of R 301 455.00. Besides financial support

the department will be actively involved in the entire

preparation for the forum.

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Provincial Funding for 2000 / 2001 for Department of

Health

PROVINCE ESTIMATEDALLOCATION AS PERBUSINESS PLAN

North West 884 000Eastern Cape 893 000Mpumalanga 831 000Western Cape 238Gauteng 392 000Northernprovince

750 000

NorthernCape

780 000

Free State 850 000National 3 392 000

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Table : PAYMENTS SCHEDULE FOR THE YEAR 2000/2001:

HIV/AIDS (DEPARTMENT OF SOCIAL DEVELOPMENT)

PROVINCE

AMOUNTGAZETTED

1st tranchAMOUNT PAID

1st November2000

2nd tranchAMOUNT

PAID23rd

November2000

3rd tranchAMOUNT PAID21st January 2001

Eastern

Cape

Western

Cape

Northern

Cape

North West

Northern

Province

Free State

Kwa-Zulu

Natal

Mpumalang

a

Gauteng

R950 000

-

R 1 000 000

R1 000 000

R800 000

R910 000

-

R960 000

-

R380 000

-

R400 000

R400 000

R320 000

R364 000

-

R384 000

-

R475 000

-

R500 000

R500 000

R400 000

R455 000

-

R480 000

-

R95 000

-

R100 000

R100 000

R80 000

R91 000

-

R96 000

-

TOTAL R 5620 000 R2 248 000 R 2 810 000 R 562 000

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BLOCKAGES EXPERIENCED

Lack of human resource capacity within provinces

Lack of understanding of accessing funds from national

Late submissions of business plans (due to lack of

understanding of how to develop business plans)

The national funds were earmarked for the payment of

provincial co-ordinators. The appointment process is

currently underway.

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Progress made by provinces regardless of financial and

human resource constraints include the following:

Sites identified in all six provinces

Provincial and local co-ordinating structures established

Participation and involvement of the communities.

Identification of beneficiaries is in process in all sites.

Some provinces have begun awarding social relief to

beneficiaries.

Community members from the sites trained

Funds have been committed and rolled over.

Each province is intending to roll out the plan to at least 3

sites

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ALLOCATIONS FOR 2001 / 2002

HOME COMMUNITY BASED CAREPROVINCES HEALTH SOCIAL

DEVELOPMENTGauteng 1 000 000 1 000 000Northern Province 1 350 000 1 500 000Northern Cape 1 350 000 1 500 000North West 1 350 000 1 500 000Western Cape 1 000 000 1 000 000KwaZulu-Natal 2 000 000 1 500 000Free State 1 350 000 1 500 000Mpumalanga 1 350 000 1 500 000Eastern Cape 1 350 000 1 500 000Total 12 100 000 12 500 000

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CHALLENGES

Lack of funding for the implementation of the model options.

Acceptable business plans were received late thus leading to

late transferral of funds and under expenditure.

Lack of understanding of the integration of the components

and the development of an integrated business plan. The

respective heads of department did not sign off plans, which

were received.

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Apathy at community level and lack of understanding of the

processes. Communities feel that they are entitled to services

without necessarily participating in the processes of

implementing these services.

Lack of human resources at all levels.

Lack of knowledge of legislation such as the Public Finance

Management Act and processes in accessing funds.

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CHALLENGES

Insufficient institutional arrangements for implementation of

the programmes.

Lack of understanding of the link between the National

Integrated Plan and the implementation of the model options.

Territorial protection and conflicting relationships between

the Departments of Health and Social Development. This

leads to lack of communication and a delay in the

submission of business plans as each department develops

the plan separately and expects inputs from the other

department.

Turn over within provinces affects continuity.

The magnitude of the impact of HIV / AIDS, eg the

increasing funeral, and medical costs and the increasing

number of children in distress.

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WAY FORWARD

The National Integrated Plan will be implemented in all nine

provinces, and at least in three sites in each province.

The model options will be implemented nation wide to fast

track the implementation of home community based care and

support services. A consultative process with the provinces

and non-governmental organisations will be undertaken to

develop provincial roll out plans for the implementation of

home community based care and support services.

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The CSIR will submit a business plan to conduct an audit and

mapping in the province of Mpumalanga on 8 May 2001.

Health Systems Trust is has compiled a business plan to

conduct an audit of home community based care and clinical

care programmes and mapping and zoning in at least 2 districts

per province.

The provision of appropriate social assistance to children who

are affected by HIV/AIDS.

The finalisation of the comprehensive Child Care Act to

provide for the needs of children who are affected by

HIV/AIDS

Strong linkage of the poverty eradication programme with

HIV/AIDS programmes

Establish new and or strengthen existing implementing

structures at all levels.

Research on impact, monitoring and evaluation.