The HIV epidemic is shaking up Zimbabwe, like many countries in sub-Saharan Africa, and the shock is being reflected in the collapse of the public health-care system.
According to the World Health Organization’s (WHO) 2006 World Health Report, the African continent bears 24% of the global burden of disease but has only 3% of the global health-care workforce and 1% of the world’s financial resources.
The report identifies 57 countries that cannot meet a widely accepted basic standard for health-care coverage by physicians, nurses and midwives; 36 of these ‘critical countries’ are in sub-Saharan Africa.
The WHO estimates that it will take an additional 2.4 million physicians, nurses and midwives to meet current needs, along with an additional 1.9 million pharmacists, health aides, technicians and other auxiliary personnel.
In simple terms, the public health-care system can no longer accommodate the millions of ill people who require medical attention, care and support. Ironically, the money that is flowing into Zimbabwe to combat HIV has done little to resolve the problems of the poor and weakened public health systems – problems made worse by the ‘brain drain’ of qualified medical personnel.
Critically ill people, it seems, are being offloaded from the public health system onto the community. Increasingly, the burden of HIV care is being borne at the community level, particularly at the household level, where much of the care work and support costs for people living with HIV (PLHIV) are now being taken on.
Caring for sick relatives has been a traditional practice in Zimbabwe, but only at an informal level. Today, it is a bulwark that is indispensable in efforts to respond effectively to HIV and TB.
As the HIV epidemic mushroomed in 1990, it became apparent that there was a need to institutionalize the process of home-based care to cater for the huge numbers of people in need. Consequently, community-based organizations have emerged to fulfil the need for the care and support of PLHIV.
Throughout Zimbabwe, innovative programmes are emerging to compensate for the shortages in the health-care system. More often than not, women are in the vanguard of care and support work for sick people. Men have tended to remain in the back seat in performing care work. A key challenge for community-based organizations has been how to influence men’s involvement in the care of sick people in the community.
Caregivers need to be adequately trained and equipped to make a difference to their clients. Currently, caregivers have to make do with very few resources and this significantly undermines the work that they do.
When caregivers lack adequate supplies in their home-based care kits, it can increase their risk of HIV exposure and the respect that they garner within the community can be diminished.
In addition, many caregivers are very poor, and the time that they commit to care work could be devoted to raising incomes for their households. As the HIV epidemic unfolds in Zimbabwe, it is clear that there will be greater demands on the services that caregivers provide. This will mean that caregivers will need to be fully equipped with the appropriate knowledge to enable them to cope with these new demands.
More importantly, home-based care programmes will need to develop innovative ways to support the livelihood needs of volunteer caregivers so that they can fulfill their roles within the community without distraction.