Introduction

The essential elements of CHBC have been developed using case examples, research, observations from practice and CHBC evaluations in different regions of the world. These essential elements are divided into seven main categories: provision of care; continuum of care; education; supplies and equipment, staffing, financing and sustainability; and monitoring and evaluation. Each of these broad categories contains many subcategories that provide details of the elements that are important in ensuring sustainable and effective CHBC. To provide clarity, each category and subcategory stands alone. However, in reality, all these elements are integrated in holistic CHBC. For example, the first category, provision of care, has the subcategories of basic physical care, palliative care, psychosocial support and counselling and care of affected and infected children. However, the health care team needs to be educated to provide these elements of care, and education is a different category.

The essential elements of CHBC outlined here are the ideal. Implementing all these elements at once might not be possible in resource-limited settings. However, this section provides guidance on the factors that are important in establishing and maintaining CHBC in resource-limited settings. Some communities might have to start by setting priorities among these elements and then work toward achieving the full complement of services over the long-term. In other communities, "piggybacking" some of these elements with other community resources might be possible. CHBC might already be well established in some settings. In this case, this document will be useful as communities begin to coordinate and scale up their CHBC efforts.

This section includes several case studies to highlight how different CHBC programmes have developed and implemented a variety of strategies for effective and sustainable CHBC in resource-limited settings.

As with other sections of this document, this section should be viewed in relation to the other three sections. Policy-makers (see the first section) should understand these elements as they develop overall policies for CHBC. In addition, the roles and responsibilities of national, district and local administration (see the second section) should reflect these essential elements. The final section provides a framework for action, placing the essential elements of CHBC within a framework for establishing and maintaining CHBC in resource-limited settings. Thus, the information in this section should be applied to issues related to policy formation, administration and management and to establishing CHBC at the community level.

Needs change and issues evolve in all effective programmes. For example, the need for CHBC was first established as increasing numbers of people became sick and died from HIV/AIDS. Unfortunately, this problem is now escalating, and other relevant issues are gaining importance. Orphan care is now an increasing challenge, with some communities reporting 5-10 children becoming orphaned each month. In addition, antiretroviral treatments are now more common, especially for preventing mother-to-child transmission. These new challenges require additional resources and education for the CHBC team. Therefore, although this section addresses the essential elements of CHBC in resource-limited settings, these priority needs will change as the epidemic evolves. The final section on the action required to establish and maintain CHBC addresses this evolutionary process.

Table 2 provides an overview of the essential elements of CHBC together with the relevant categories and subcategories.

Table 2. Essential elements of CHBC