AIDS home care: a baseline survey in Zimbabwe

The research was undertaken during the first half of 1992; and data sought on 150 organisations throughout Zimbabwe. Of these; 25 organisations nationwide were visited by the research team and the rest were sent questionnaires. At least 24 are providing AIDS home care services; and a further 30 or more have investigated developing home care; have trained nursing and other staff in home care; and/or are just beginning to implement a programme. Organisations with AIDS home care programmes included AIDS service organistions and NGOs; mission hospitals and clinics and district hospitals. By the end of 1992 over 50 AIDS home care programmes should operational in Zimbabwe. In addition to visiting agencies; the researchers made 21 home visits with various home care teams; and were able to interview relatives or patients in 15 homes. This provided valuable opportunities for seeing the teams in action; and gaining first hand insights from the families themselves about their needs and how the services had assisted them. The organisational base and structure of the programmes varies considerably. Some programmes are community based and others are institution (hospital) based outreach programmes; and programmes exist in rural and urban areas. Some are staffed entirely by professional health workers; and others utilise volunteers with varying levels of training. Home care for AIDS; usually part of a wider home care programme for the chronically sick and others; but there are also vertical programmes only catering for patients with AIDS. [abstract terminated]

AIDS home care : a baseline survey in Zimbabwe

The research was undertaken during the first half of 1992; and data sought from 150 organisations throughout Zimbabwe. Of these; 125 nationwide were visited by the research team and the rest were sent questionnaires. 24 are providing AIDS home care services; and a further 30 or more have investigated developing home care; have trained nursing and other staff in home care; and/or are just beginning to implement a programme. Organisations with AIDS home care programmes included AIDS service organisations and NGOs; mission hospitals and clinics and district hospitals. By the end of 1992 over 50 AIDS home care programmes should be operational in Zimbabwe. In addition to visiting agencies; the researchers made 21 home visits with various home care teams; and were able to interview relatives or patients in 15 homes. This provided valuable opportunities for seeing the teams in action; and gaining first hand insights from the families themselves about their needs and how the services had assisted them. The organisational base and structure of the programmes vary considerably. Some programmes are community based and others are institution (hospital) based outreach programmes; and programmes exist in rural and urban areas. Some are staffed entirely by professional health workers; and others utilise volunteers with varying levels of training. Home care for AIDS; usually part of a wider home care programme for the chronically sick and others; but there are also vertical programmes only catering for patients with AIDS. A common finding on most schemes was that poverty is often the primary concern of the patient and family; and that home care must involve the provision of basic food; medication and; perhaps; money for essentials. Large amounts of money have been spent on training workshops for home care staff; but in most cases little finance is available for these basic welfare needs of patients and their families; and in some cases the training does not appear to be utilised. This raised the question of whether too much has been spent on training staff; and too little on programme implementation and follow up; and meeting basic welfare needs. The types of care provided through home care services include: medical care; the provision of food and other material goods; counselling and spiritual care; and training for care-givers in the family. The frequency of visits varies considerably; with some schemes normally making only one; or at most two; visits per family; and one or two providing an intensive service with daily (or more frequent) visits and needs demand to a small number of patients and families. Occasionally the service includes transporting patients home from hospital but in most cases this in so offered and a follow up may only be made weeks; or even months later when the patient may already be dead. The schemes that are operating most effectively tend to be ones in which the home care providers were involved in the planning and establishment of the service itself. Those that appear to have most difficulty are those in which existing staff; such as hospital nurses; have been coopted into counselling and home care on top of their other duties; and fell unable to make time for home care; or hold equivocal views about its value. Interestingly; certain rural home care services; operating under greater constraints than their urban counterparts; are among the most well developed. A particular problem observed with several schemes is that of coordination and communication between the various agencies involved; including problems to do with patient referral where the home care service is not provided by the hospital itself. Confidentially was cited as a problem in many programmes; with staff ensure how to work with patients' demands for strict confidentiality; and their own uncertainty about criteria for passing the information to others