|Community Home-Based Care in Resource-Limited Settings - A Framework for Action (WHO - OMS, 2002, 100 p.)|
|A policy framework for CHBC|
The exact purpose of the CHBC programme must be identified first. This purpose has to be clearly identified to develop policies, guidelines and implementation strategies that match this precise purpose. The overall purpose statement must include a description of the service, the target population, the locations for CHBC and a time line. Deriving this clear statement of purpose requires considering the following questions.
· Who is the target population? Only people with HIV/AIDS? People with HIV/AIDS and/or other chronic illnesses and disabilities? Will specific chronic illnesses be targeted, or will all chronic illnesses and disabilities be covered? Will the definition of chronic illness include communicable and noncommunicable diseases, or only one of these?
· Will orphans be included in the target population?
· Will people with mental disorders be included in the target population?
· Will people with substance abuse problems be included?
· Will people suffering from common "acute" illnesses such as malaria and dysentery be included?
· Will the CHBC services directly assist family caregivers and ill people or indirectly by assisting community organizations and their existing care programmes? Is the focus on assisting one of these target groups over another?
· Are there existing policies and guidelines for CHBC?
· If existing policies and guidelines have been used, how useful were they? Can they be adapted or revised to the present circumstances?
· How will CHBC become integrated into the overall health and social welfare system, especially into the local community health and welfare systems?
· Are the CHBC services to be delivered throughout the country from the onset, to selected sites or through a pilot project initially?
· When will specific services be initiated? What is the time frame for implementation?
· Based on the answers to these questions: what will be the precise nature of the CHBC services? Can the purpose, goals and objectives for CHBC be clearly identified?
It is very important that senior administrators and policy-makers decide on a clear statement of purpose for CHBC. The exact nature of the programme should be stated briefly and clearly. Then the goals and objectives for CHBC must be identified to address measurable and achievable outcomes.
Decisions also have to be made about who will benefit from the CHBC services. This means that the target population must be clearly identified. Ideally, all ill people or orphans needing care within the home should be included, whether directly or indirectly through assistance to community organizations and grassroots initiatives. However, such an inclusive policy is unlikely to be possible. Policy-makers must therefore decide who will (and who will not) receive CHBC services.
The locations for CHBC support must also be determined. Again, ideally, CHBC services would be implemented throughout the country, but this might not be possible for a number of reasons. Policy-makers might decide to start with a few pilot projects so that lessons can be learned and adaptations made to better provide more efficient and effective services (see the final section of this document). In addition, funding might only be available to start CHBC in some parts of the country. For example, decisions might be made to start CHBC in large urban settings and to leave rural areas for later development. Another option might be to develop CHBC where a functioning community health system exists. Some countries have poorly developed local health systems, whereas others have systems that are well integrated into the overall health care system. Finally, decisions might be made to implement CHBC only where active community-based organizations, NGOs, faith-based organizations and others involved in home-based care exist. In this way, the services can strengthen existing nongovernmental CHBC services. Nevertheless, underserved or unserved areas are the very ones that often most need professional assistance in CHBC. These are therefore just a few examples of the decisions that have to be made about the location of the CHBC programme.
Finally, clearly setting a time frame for programme development is important: a time frame for starting CHBC and one for expanding the programme.