While community home based care is the preferred means of providing care for people living with HIV in many parts of Southern Africa, it comes with massive costs especially to caregivers in terms of time, effort and commitment, according to a study published recently in the Journal of the International AIDS Society.
According to the study which focused on Botswana, providing caregivers with financial and material support is an urgently required public health imperative. The study revealed that providing caregivers of people living with HIV and AIDS with financial and material support will ensure that caregivers are not demoralized in rendering care services to their clients as well as attract more people into caregiving.
Though the Botswana government provides caregivers with financial support amounting to US15,26 this far lower than what caregivers spend to look after clients, says the study. Results from the study showed that the cost of providing care per client per month to caregivers was approximately US 184,17. Yet, in spite of this gigantic gap between what they obtain from government and what they expend, caregivers soldier to provide care to people living with HIV and AIDS, relying on their own meager resources.
“Providing incentives, such as mealie-meal and food baskets and loans for income-generating activities, and lending a sympathetic ear to their plight will help boost the morale of caregivers and attract others to caregiving,” states the report.
In Botswana, as in many southern African countries, community home based care (CHBC) has emerged as a critical vanguard in the provision of care to people living with HIV and AIDS but at a serious cost to the lives and livelihoods of caregivers, mainly poor and marginalized women and girls. The offloading of patients to the community in many parts of the region has been necessitated by public health systems facing a myriad of challenges, including limited financial and logistical support, ongoing brain drain, competing national priorities and diseases such as AIDS, TB and malaria.
“While CHBC may be seen as a cheap alternative mode of health care delivery, it is certainly not affordable for families and caregivers,” says the study. “It is important for government to consider how best costs of providing care can be shared between them and those who provide care.”
According to the study, the overall costs of increasing monthly allowances to caregivers and support provided for the families of clients would be quite low for the government of Botswana compared with the huge sum of money budgeted each year for healthcare and for HIV and AIDS.
Suffice to state, caregivers are largely invisible in the global AIDS infrastructure despite the fact that they are at the frontline of the response to the epidemic in many countries across the world. They have to make do with little to no resources, face poverty, and incur huge costs in the provision of care to clients. Often, they are also unable to adequately voice their needs, to seek redress against injustice and influence policies that ultimately will shape their lives.
The findings from the study in Botswana showed that caregivers are compelled to provide their clients with supplies, such as food and washing soap, transport them to hospitals or clinics to collect their drugs, and cover costs of caring for clients. According to the study, community home based care is not a cheap endeavour and the cost of caregiving has shifted from the government to families and caregivers, who now incur enormous expenditure in care giving activities.
There is no doubt that, in Botswana, as in many parts of sub Saharan Africa, an over-reliance on caregivers to support people living with HIV is not only unsustainable but also promotes poverty and inequality. For women and girls, the burden of caregiving constitutes an additional layer that promotes gender inequality.
In view of this, governments in the region need to put in place policy and legal frameworks as well as budgetary mechanisms that protect the lives and livelihoods of caregivers. International donors also need to seriously consider increasing the financial support targeted directly at caregivers.
Indeed, in Botswana, as in many parts of Southern Africa, the absence of financial incentives constitutes a serious drawback to the effectiveness of care programmes for people living with HIV and AIDS. It is critical for governments in the region to develop policy and legal frameworks as well as budgetary mechanisms that empower caregivers to properly cater for clients. International donors also need to seriously consider increasing the financial support targeted directly at making caregivers do their work better and not at the expense of their own lives.