|Community Home-Based Care in Resource-Limited Settings - A Framework for Action (WHO - OMS, 2002, 100 p.)|
|A policy framework for CHBC|
Decisions must be made about CHBC administration. The following questions should therefore be considered.
· How can the government or international or national donor agencies share responsibility for the CHBC services, or will the government involve other agencies and organizations in providing CHBC? That is, how will NGOs, faith-based organizations and the private sector be involved in developing, implementing and managing CHBC?
· How will national AIDS councils and primary health care committees be involved in programme development?
· How will NGOs, faith-based organizations and the private sector be supported or contracted and/or subcontracted?
· How will guidelines and procedures be developed that outline the responsibilities of the government, NGOs, faith-based organizations and the private sector in providing CHBC?1
1 All possible partners need to be made aware of the opportunity to develop contractual relations within the context of the national health policy. Such contracting requires a legal framework, coherent contractual policies and evaluation mechanisms that will monitor equitable access and the quality of care. To avoid fragmentation and to ensure the coherence of all health and home-based care within the health system, collaboration should be based on trust, responsiveness and openness and clearly indicate the objectives sought, the commitment of each party and how these commitments are to be respected (WHO. The role of contractual arrangements in improving health systems' performance (www.who.int/gb/EB_WHA/PDF/EB109/aeb1095.pdf). Geneva, World Health Organization, 2002 (document EB109/5; accessed 13 June 2002).
· How will the services of these organizations be monitored?
· Who will be responsible for delivering services? Will there be a CHBC team, or will people be drawn from the existing pool of community health workers?
· How will responsibilities be determined to avoid duplication or gaps in services to CHBC?
· Who will be responsible for planning care? Who will assist the ill person and family in planning care: health workers, a health team or a case manager?
· Where will the focal point for coordinating CHBC be?
· Will there be a case manager to supervise the provision of care?
· Will traditional healers be considered part of the CHBC team?
· How will care providers be educated, supervised and possibly licensed for specific CHBC services?
· Will family caregivers be provided with education? If so, how will this education be managed, and who will educate the caregivers?
· What will be the defined criteria for assessing the establishment and regulation of quality standards?
· How can consumer (or community) input be incorporated into quality assurance criteria and regulations?
· How will quality assurance be managed?
· How will CHBC be evaluated? Will informal and formal outcomes of CHBC be evaluated? When or at what intervals will this evaluation be undertaken?
· Who will conduct formal CHBC evaluation?
· What CHBC information systems (such as record-keeping) will be established?
· Who will monitor these systems?
· Who will monitor the costs of CHBC?
· Who will monitor material benefits (such as food and bedding) or cash allocation to families in CHBC (where feasible)?
· If day-care centres or other respite care provisions are part of CHBC, how will these services be monitored, supervised and evaluated?
· Based on the evaluation of services, how will the necessary changes to the CHBC programme be made?
· Who will be responsible for making the necessary changes to the CHBC programme?
The roles and responsibilities of government and other complementary organizations should be decided at the planning stage. These complementary organizations include NGOs, faith-based organizations, community-based organizations and others. General agreements should also be made on how they will partner and communicate with one another. Thus, the roles, responsibilities and types of communication should be determined and partnership agreements made at the onset of planning a CHBC programme. Establishing and maintaining relationships between organizations (especially public and private) as well as between sectors can be challenging and staff-intensive, requiring diplomacy and frequent communication.
Quality assurance and evaluation are generally agreed to be difficult activities. However, without these standards, programmes might continue unchecked and, over time, cease to meet the needs of the target population. Quality assurance standards and methods of evaluation should therefore be developed at the planning stage. Nevertheless, quality assurance standards might change as the programme evolves. Any changes should be made based on sound evidence.
Managing information systems, supervision and technical support are important components in CHBC. Collecting data and recording information are important for policy-making, planning and managing care. In addition, determining the type and level of supervision required for CHBC and the type of technical support required is important.