Reducing pressure on health systems by more effective home-based care and reducing the burden of care on women and girls
Author: VSO Malawi
Country: Malawi | Eastern and Southern Africa
Countries in Southern Africa face a major shortage in health care workers. Against the desired minimum threshold of 23 health workers per 10,000 in the population, Zambia and Zimbabwe have only around 9 per 10,000. Malawi and Mozambique face even more severe shortages, with roughly 3 health workers per 10,000. The lack of health care workers, coupled with the HIV/AIDS crisis in the region, has resulted in around 80% of those living with HIV being cared for at the household level rather than in hospitals or health centres. This burden is disproportionately borne by women who make up roughly 80% of these care providers.
VSO-RAISA is a regional advocacy programme consisting of six country programmes coordinated by an overarching regional approach. The aim of the advocacy strategy is to improve health system effectiveness in Southern Africa by encouraging governments to increase support for home-based care systems and encouraging more men to volunteer as home-based carers.
In 2009, VSO-RAISA and the WHO Regional Office of Eastern and Southern Africa conducted research across the Southern African region and created a framework entitled ‘The Regional Framework on Scaling up HIV and AIDS Prevention, Treatment, Care and Support and Reduction of the Burden of HIV and AIDS Care on Women, Girls and Older Persons’. These findings were presented to the Southern Africa Development Community Parliamentary Forum (SADC-PF). VSO is now working with the SADC-PF to roll out this framework through advocacy work targeting SADC Members of Parliament. VSO and SADC PF co-hosted a regional workshop for MPs from Malawi, Namibia, South Africa, Zambia and Zimbabwe in 2009. SADC MPs were trained on how they can effectively articulate HIV and AIDS issues in their respective parliaments, with a special focus on the reduction of the burden of HIV and AIDS care on women, girls and older persons, as well as the need to integrate home-based care into the wider health system of each country. The ultimate aim is for Ministries of Health to recognise and support carers as a valued component of health systems.
Namibia already has a policy in place for home-based care, whereby care providers are supported with uniforms, stipends, training and a basic level of medicines. The advocacy work conducted by VSO has raised awareness of MPs in other countries of this system and encourages them to advocate for similar systems in their countries. Malawi appears to moving in the same direction as a result of the advocacy programme. The parliamentary HIV committee in Malawi has drafted a Bill on reducing the burden of care on women and girls, which is to be presented in Parliament in November 2010 and hopefully adopted at a later stage. Progress is therefore being made to relieve pressure on hospitals and clinics through a more effective integration of home-based care services into the overall public health system.
The advocacy work aims to build on the successful system adopted in Namibia where a supportive environment for home-based care has already been established in law. Increasing support for those providing home-based care will ultimately reduce the burden of HIV and AIDS care on women, relieve some of the pressure on public health systems and provide resource and support to those providing healthcare in households.