Haga was diagnosed with HIV/AIDS seven years ago at the age of 63 years after becoming bed ridden with opportunistic infections.  Due to her age both her family and doctors had not suspected that she could be HIV positive and it only occurred to them that she could have contracted HIV when she developed full blown symptoms. Upon diagnosis the doctors advised her family to take her home as a continuous hospital stay would end up being too costly. 

One of her daughters took her into her house to provide the necessary care. With the support of a nurse who made weekly visits to the house to monitor how Haga was responding to the medication, Haga’s condition was successfully turned around. She is back to in her house and is living a full life apart from her monthly visits to the doctor for her anti retroviral therapy. This situation is quite common to many families in Kenya, who are affected by HIV/AIDS.

It is a widely acknowledged fact that home based care offers a more viable alternative for providing care to persons living with Aids (LWA’s) as opposed to hospital based care. In sub Saharan Africa, the high prevalence of HIV/AIDS continues to exert pressure on already weak health care delivery systems leaving them severely constrained and grossly under sourced.

Poor and run down facilities, lack of enough medication, overcrowding, and a shortage of health care providers are some of the challenges that characterize public health institutions. The increasing numbers of people getting infected and requiring care can only weaken the system further.

Home based care then becomes a more viable option of easing pressure on hospital based care. Apart from being less costly, it also adopts an integrated approach that combines clinical and nursing care with psycho- social support. Thus it enables the creation of a social support network of family, relatives and friends of the infected person, while integrating a medical approach where the patients access medication and the health workers on a regular basis.

Other advantages are that by caring for the sick at home those who offer support get to learn more about HIV and ways of prevention. The benefits of HBC therefore far outweigh the much more costly hospital system and an increasing number of agencies have adopted HBC as a model of providing care for PLWA’S. According to CARE international:

Governments too have adopted home based care and articulated policy documents promoting the concept as a way of easing pressure on the already overstretched health care facilities. They have moved step further and invested resources in development of guidelines and manuals for use in training of community based care givers.

While the Non Governmental Organisation (NGOs), the Faith Based Organisations (FBO’s) and the Community Based Organisations (CBO’s) have stepped in to train the care givers and in some instances offer them material or financial support, One thing that however is a glaring gap in this approach is the failure by governments to articulate how the care givers will access the items and materials required in offering care to the sick. Besides material support there is also a silence on who is responsible for meeting the nutritional care needs of those with HIV leaving this important component again to CBO’s, NGO’s, FBO’s and community members.

However, home based care thrives on voluntary services rendered by care givers and accounts for a significant community contribution to the fight against HIV. Expecting them to shoulder an additional burden of food provision in circumstances of high poverty levels is unrealistic. It is therefore instructive to note that some countries that have enacted policy and legislative frameworks like Kenya fail to acknowledge the significant role played by care givers in offering care and prevention in HIV/AIDS.

Section 2 of The Kenya HIV/AIDS Prevention and Control bill of 2006 elaborately defines the various categories of health care providers and health services but completely fails to mention home based care givers as a key pillar to health service provision in relation to HIV/AIDS. Indeed there is no mention of home based care in the entire Act and Section 19 also talks of access to health care services and upholds the principle of non discrimination in health service provision on the basis of ones HIV status.

Subsection 2 calls upon the government to take steps to ensure access to essential health care services including access to affordable medicines for those living with and those exposed to the risk of HIV infection. Again here there is a failure by government to take responsibility in rendering support to home based care services. In addition, the fact that home based care givers are not included in the category of providers implies that despite the risk of exposure to infection they would be unable to access medication should the need arise. Needless to say the needs of women who are in most cases the care givers to their infected partners, children and extended family members do not find expression in this law.

The omission of home based care is a failure by the government to take cognizance of the fact that  home based care system currently sustains most of the sick people and it also contradicts the already established far reaching policy guidelines for home based care provision in the treatment of HIV/AIDS.

It would appear it’s a case of giving with one hand and taking away with the other.

There is therefore need to get governments to realize that whether care is provided in a hospital setting or within a home care setting, caring for the sick requires having the necessary tools of tradeand home based care should not be viewed as a quick fix solution to the burden of care. It should also not provide an avenue for governments to abdicate their primary responsibility of health service provision to their populations. To give the policies developed meaning, governments have to invest in development of various models of providing HBC and conduct cost studies on them to acquire the necessary information on costing and make commitments for scaling up. Coming up with viable and cost effective models of implementing HBC will  lessen the burden of care on home based care givers and enable them do the work with minimal difficulties.