1. 1 Community-home based care and support services Presentation to the Social Development Portfolio Committee 23/5/2001

2. 2 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.

3. 3 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.

4. 4 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

5. 5 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

6. 6 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

7. 7 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.

8. 8 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

9. 9 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

10. 10 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.

11. 11 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

12. 12 GOALS FOR FUNDING COMMUNITY AND HOME-BASED CARE PROGRAMME 1TO DEVELOP AND IMPLEMENT EFFECTIVE AND AFFORDABLE COMMUNITY-BASED CARE AND SUPPORT MODELS 2TO 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

13. 13 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.

14. 14 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.

15. 15 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.

16. 16 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

17. 17 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 1 st regional home / community based care conference in Botswana in March 2001

18. 18 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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