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SOUTH AFRICA: Volunteer caregivers being exploited, says study
Plusnews
2005-01-21
Many people with HIV/AIDS cannot afford treatment at hospitals
Many South African healthcare NGOs are exploiting volunteers providing home-based care, according to a new study.The study by the Health Economics and AIDS Research Division (HEARD), of the University of KwaZulu-Natal in the east-coast city of Durban, also found that South African home-based care programmes are often inadequately developed and their effectiveness is
questionable.Such projects were often simply a response of crisis management, argued HEARD research consultant Olagoke
Akintola.
The South African government promotes voluntarism as an answer to the demand for home-based caregivers to cope with the rising number of people infected with HIV: an estimated 21.5 percent of the country's population is HIV positive.
The health department needs to review primary health care models in the face of HIV/AIDS, said Aktintola. It should refine volunteer-based programmes, provide stipends and assist caregivers to ultimately obtain formal employment.
Governments and health departments need to acknowledge that home-based care is not a cheap option, Akintola stated in his study.
Most care programmes in South Africa rely on unemployed volunteers from affected communities, who are usually female and unsalaried or, in a few cases, paid a small stipend.
Those who are willing to volunteer are already burdened because they are [predominantly] poor and affected by AIDS, he explained. Volunteer work aggravates their poverty, as many caregivers share food and other material goods with the patients they visit, spending long days working free of charge instead of looking for a paid job.
We have a very high turnover of caregivers, and have to constantly recruit and retrain new people - nobody can work for free for a long time, because our caregivers are poor themselves, said Zanele Sithole, head of the Hlangabeza Home-Based Care and Women's Co-op in Mnini on the KwaZulu-Natal south coast.
Akintola, who also studied home-based care programmes in Uganda, analysed home-based care projects in two semi-rural communities over a three-year period, interviewing home-based caregivers and programme coordinators, local health committee members and councillors, as well as people living with HIV/AIDS and their families.
Caregivers need psychosocial support because their work is exceptionally stressful on a physical, psychological, social and economic level. They typically also take over domestic chores, offer counselling, provide child-care services to sick parents, organise material support and food for affected families, arrange funerals and help patients and their relatives to access social grants.
Experts argue that while voluntarism is the cheap way out, it is unsustainable in the long term. Akintola suggested the government should set aside a budget for regular caregiver salaries and make home-based care a career, similar to that of government-employed community health workers.
Health ministry spokesman Sibani Mngadi told PlusNews, We encourage unemployed volunteers, who come from poverty-stricken or AIDS-affected households, to join the community health worker programme. We have recruited about 40,000 health workers across the country, who are paid a minimum stipend of R1,000 (about US 167) a month - some provinces, such as KwaZulu-Natal, pay about R1,700 (283.68).
This week the government announced plans to spend an additional R500 million
(83 million) annually over the next five years to create jobs for caregivers. Of the 150,000 jobs expected to be created by the programme, 122,000 would be in community-based home-care projects, with an additional 90,000 short-term workers recruited at existing sites.
Mngadi said the department had not come across instances of exploitation of volunteers. NGOs funded by the government are required to pay anyone they hire for help.
Although the health department provides free training for home-based caregivers, which Akintola said was beneficial, the training curriculum needed to be reviewed to enable them to gain deeper medical knowledge. They are currently trained in basic nursing, but experts argue that more advanced healthcare expertise is needed to tend HIV/AIDS patients at home.
Caregivers need to receive better training, similar to that of nurses, to be able to administer basic medication. Otherwise, the ways in which they can help AIDS patients in their homes are very limited, said
Patience Mavata, who manages groups of home-based caregivers in the Valley of a Thousand Hills in KwaZulu-Natal. Caregivers are currently not even allowed to administer painkillers.
We need more cooperation between government hospitals and NGOs to solve this problem, Akintola told PlusNews. Home-based caregivers need to have direct access to, and network with, hospitals.
He recommended that South Africa model its home-based care on the Ugandan system, where volunteer caregivers are supported by a team of healthcare professionals, including doctors, nurses and paramedics, with clerics for spiritual care.
South Africa should transform its community-based approach into a community-oriented approach, as in Uganda, he said, because the intense cooperation between hospitals and NGOs in Uganda has reduced the burden on voluntary caregivers.
Akintola also found that South African home-based care programmes entrenched gender inequalities, because caregivers are generally women and young girls, mainly due to the traditional role of women. Young girls recruited as caregivers are often deprived of an education, which impacts on their economic independence in the long term.
Click on the following link to download a pdf summary of the HEARD Policy Brief, Olagoke Akintola: The Gendered Burden of Home-Based
Care giving:
http://allafrica.com/sustainable/resources/view/00010373.pdf
http://www.nu.ac.za/heard/presentations/default.asp
(Souce: Plusnews, January 14, 2005)
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