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‘Who cares in the home?’ An in-depth study of home-based care in Bushbuckridge, rural South Africa

‘Who cares in the home?’ An in-depth study of home-based care in Bushbuckridge, rural South Africa. j. Ilona Sips. Content. Care in the home study Home- based care in Bushbuckridge Challenges in home-base care provision. Care in the Home study.

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‘Who cares in the home?’ An in-depth study of home-based care in Bushbuckridge, rural South Africa

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  1. ‘Who cares in the home?’ An in-depth study of home-based care in Bushbuckridge, rural South Africa j Ilona Sips

  2. Content • Care in the home study • Home-based care in Bushbuckridge • Challenges in home-base care provision

  3. Care in the Home study Studies the quality of care provided to people with chronic diseases within their home environments in rural Bushbuckridge, Mpumalanga, South Africa

  4. Client PCG

  5. Whoprovides HBC? Primary care givers (PCG) Usually family member

  6. Client CCW PCG

  7. Whoprovides HBC? Community Care Worker (CCW) • Recruited from the community • Receive basic training • Volunteers Also referred to as: Community Health Worker Community Caregiver

  8. Client CCW PCG

  9. Health care system Client Spiritual leaders, Traditional healers, Family Friends Neighbors Community organizations /groups (people with HIV/AIDS, orphans, youth and women). CCW PCG

  10. Study Time line • Situational Analysis • Provided content and context surrounding HBC organizations in Bushbuckridge • Qualitative phase • In-depth interviews with care providers (CCWs, PCGs) and care receivers (Clients), about care provision, satisfaction and challenges • Tool development to measure quality of home-based care • Based on information collected in the previous two fases • Quantitative phase • Total of 1800 care providers and care receivers are interviewed

  11. Study Setting • Bushbuckridge (BBR) municipality in Mpumalanga province.

  12. Study Setting

  13. Study Setting • Local population: 500.000 • 65% under the age of 24 • 85% unemployed or economically inactive • 40% has not received any form of education • HIV/AIDS prevalence: 35,1% (national average 30,2%) • One of the 18 Priority Health Districts in S.A. • 3 hospitals, 2 community health centers and 34 clinics and two mobile clinics • Nurse workload: 50% higher than S.A. average at district level in 2006

  14. HBC organizations in BBR • 87 HBC organisations in Bushbuckridge (January 2013) • Employing about 760 CCWs • Caring for about 18000 clients • Employment and clients list are far from comprehensive • Include : • CCWs who are not working or not working as CCW • Clients who are not being provided with care for various reasons

  15. Challanges in care provision

  16. Resources “They don’t show any support because if they did there would be something [gloves] to take with us to our fieldwork. Sometimes they do give us but it can take up to 3 months to get them. We just use plastics for bread in the meantime” (CCW 15)

  17. Resources “Another sacrifice we make is that when we find that the patient doesn’t have any food we take our own maize meal to cook for him so he can eat before taking his pills because most pills nowadays require a person to eat before taking them” • (CCW 5)

  18. Resources “It is difficult to work as a caregiver who is a volunteer and doesn’t get paid when you are a man who has a family to support. I have nothing; I don’t even have a house as we speak. But I am able to take care of another person and sympathize with him. This is what made it more difficult for me because you found that I didn’t have any food or even simple things such as tea bags or matches. Eventually I even became too scared to go and ask for these things from my neighbours”

  19. Themesoftenaddressed Integration of HBC within the health care system

  20. Relationbetween HBC andclinic “It was difficult in the beginning because they didn’t understand what a Home Based Care did. Currently, they do understand what we are doing and we normally have meetings with them and they also give us advice and they tell us to come when we need something to help the patients” (CCW 3)

  21. Relationbetween HBC andclinic “It was good in the beginning but not in the end. One of the reasons that made me leave was that there was a lot of critics where I used to work. I started thinking to myself why I even bothered to work with them because I wasn’t even getting paid. It was as if I was taking their job away. They made me feel as if I was wrong when I asked them questions. Sometimes when I asked for something they would tell me they were too busy. They wouldn’t take my presence into consideration” (CCW 13)

  22. Conclusion Home-based care is poorly integrated within the health care system • Limited contribution to health improvement of clients CCWs feel obligated to use personal resources to guarantee access and adherence to care by clients • Putting CCWs at risk

  23. Policy implementation Risk protection strategies are urgently needed to ensure the sustainability of the current work performed by HBC organizations and the CCW volunteers

  24. Questions

  25. Question Likedmywork? I am looking for a new challenging public health or health care related project

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