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AVERT Research Project on Home Based Care in South Africa
Introducing the research project in South Africa
AVERT co-funded a research project between 2010 and 2013 on quality of care provided in the home to people living with HIV in rural South Africa. AVERT was keen to support this project as it has a strong potential for advocacy to strengthen home-based care (HBC), and ultimately health systems, in South Africa, and potentially more widely in Southern Africa. The Care in the Home Study (CHoS) was implemented by the Rural AIDS & Development Action Research Programme (RADAR), affiliated to the University of Witwatersrand, South Africa.
What was the project context?
HIV and AIDS have had a profound effect on health services in South Africa, exacerbating a problem of weak and vulnerable health systems, particularly in rural areas. HBC was presented as a potential solution, but practice-based evidence of quality care in the home is limited and no suitable instruments to measure quality are available.
South Africa’s National Strategic Plan for HIV and AIDS (2007-2011) recognised the strengthening of health systems as key to expanding access to services and placed specific emphasis on the role of community careworkers. It was in this context that RADAR carried out a situational analysis to provide a contextual overview of the strengths, weaknesses, opportunities, and threats of HBC at all levels (NGOs, government, policy), to form the basis of their study.
What was the objective of the research?
The main objective of the RADAR research project was to examine the relationship between the community careworker (vast majority of whom are women), primary caregiver (often a family member) and the client (people living with HIV), while also investigating the quality of care provided to clients. Bushbuckridge sub-district (Mpumalanga province), a rural area of South Africa, was used as the study sample.
RADAR set out to investigate what constitutes quality of care, primarily from the perspective of the client, while also exploring the viewpoints of the primary caregiver and community careworkers. The framework used measures the quality of care taking into account how important services are to beneficiaries (acceptability) and the frequency (availability) of services. The quality of HBC was measured by looking at what is needed by clients at various different levels, what is provided and how well.
Throughout the study project staff held regular meetings with local organisations and provided updates on their research at meetings with high-level stakeholders to report on key learning and gaps identified. They were also regularly invited to participate in regional and national health policy debates, and have been approached for the research to inform current healthcare reforms, particularly around access to healthcare.
What were the findings of the research?
A total number of 1,790 participants were interviewed as part of the research; this was made up of community careworkers, primary caregivers and recipients of HBC. The qualitative and quantitative data is currently being analysed by the team and the research outputs will available here soon.
Some of the key issues revealed by the CHoS study are listed below - all of these challenges have a knock-on effect on the quality of care provided to people living with HIV and AIDS in their homes:
- There has been a ‘mushrooming’ of HBC organisations locally brought about by need, making it very challenging to monitor how many organisations exist and what their scope and impact is – RADAR was able to conduct a comprehensive mapping exercise and establish a database as part of the study.
- Only 50 percent of NPOs receive funding - the Department of Social Development (DSD) and the Department of Health (DoH) both provide a certain level of funding for these organisations (in addition to other private funders), but it is not realistic for them to monitor and keep track of them.
- Lack of funding for these organisations means around 50 percent of community careworkers do not receive a stipend and those that do are receiving different amounts.
- Community careworkers have very heavy workloads, cannot always visit all of their clients, and often do not receive the support they require themselves.
- HBC organisations are not adequately involved in decision-making and often lack the time and knowledge to comply with reporting and other regulations and successfully apply for funding.
- There is a lack of communication between organisations, which creates overlap, highlighting the need for organisations to network and collaborate more effectively – they have recently established a forum. This also highlights a need for higher coordination of this sector, by those with the authority - mainly local government structures.
- Lack of linkages between HBC organisations and clinics is a significant challenge as it does not facilitate referrals – over 80 percent of community careworkers meet their clients by going door-to-door in the community.
- Often community careworkers use their own resources to pay for transport, food or phone costs for their clients.
Results of the study will be used to inform opportunities for capacity-building and health systems strengthening so as to better position HBC to relieve the burden on the formal health system.
RADAR is working with local and national government and HBC organisations to ensure greater collaboration and communication between the different stakeholders to overcome the issues raised. It is hoped that the momentum and consensus mobilised by this research will be sustained and learning translated into action to support and strengthen HBC organisations, and ultimately improve the quality of care provided in the home.
AVERT is working with RADAR to share the research more widely at international level.
Find out more:
- In June 2013, the RADAR team held a conference to present research findings to key local and national stakeholders from government, NGOs, academia and home-based care organisations and discuss how to translate learning into action. Access the conference presentations and a policy discussion document.
- Care in the Home study methodology overview.
- Read more about the Care in the Home Study in an overview document prepared for the AIDS 2012 conference in Washington DC.
- The research coordinator, Mosa Moshabela's article entitled 'HIV/AIDS care begins at home' also explores home-based care.
- For further information about the research please contact Mosa Mosabela or AVERT’s Programme Manager.
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