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Stretched health system leaves home care as only alternative
IRINnews
2007-07-20
Facilities and staff are being stretched beyond capacity as Swaziland 's public healthcare system buckles under a surge of HIV/AIDS patients, leaving many with home-based care (HBC) as the only alternative, says a new report.
At
health centres and hospitals, health workers reported increased patient loads
attributed to HIV and AIDS, and noted that the HIV and AIDS cases were often
sicker and more complex to manage than others, placing a major strains on
services, which were already weakened by staff shortages, said a study
commissioned by the ministry of health and social welfare. HIV
and AIDS has approximately doubled our case load since the 1990s, one
doctor said in the Study of the Health Service Burden of HIV and AIDS and the
Impact of HIV and AIDS on the Health Sector in Swaziland .
I
cannot give a patient my undivided attention because of the long queue which
also needs to be attended to this impacts on system performance, said
another. The
hospital is always packed and there are no benches people are very weak
there is not enough staff. This place is not conducive to healing, a
hospital matron commented. The
report also noted a substantial increase in tuberculosis cases
since 1990. TB treatment completion rates have dropped to 34 percent,
far below the 85 percent generally required to control TB. Ongoing
difficulties in improving the rates are attributed to increasing death rates
due to HIV and AIDS among TB patients, as well as strain on services.
A
healthcare worker told researchers: If patients consistently see other
patients die, they have no faith in the system. Home-based care the only
alternative Out
of necessity, more and more patients are now receiving treatment at home.
At all hospitals and most PHC [primary health care] facilities visited,
health workers reported significant growth in the numbers of
outpatients, the report noted. Some
patients just never come to the clinic until they are identified and referred
by HBC groups ... mainly because they have given up and think clinics cannot
do anything for them, a clinic nurse said.
We
need to scale up, particularly in care and support. If you look at the
treatment of HIV/AIDS, we need foremost to improve skills there is a huge
challenge of skills, Khanya Mabuza, Project Officer for the National
Emergency Council on HIV and AIDS (NERCHA), told IRIN. We
cannot continue to do things 'business as usual'. We need to come up with a
better way of service: community based, using a grassroots community approach,
using lay people as caregivers. Already we are ... 'offloading' the hospitals
and moving patients into the community, she added. Human
resources are the huge challenge. Family members must be trained. If you have
the money from donors, it is not enough if you haven't the people to operate
machinery and distribute drugs, Mabuza said.
The
health ministry report acknowledged the role of HBC but described it as
very weak, and without adequate coverage. Major
concerns were frequently expressed about quality and sustainability, and some
of the underlying problems for HBC include fragmentation and lack of
coordination, thinly stretched capacity at all levels, limited training and
support, and unreliable HBC supplies. The
coping capacity of families and communities was also questioned. Many
families wait until late in the night to bring relatives with AIDS to
casualty. They know that if it is late they are less likely to send the
patient home, even if the ward is full, a hospital nursing manager said
in the report.
So
the patients spend the night ... sometimes the family stays away and does not
pick them up, just to get a bit of rest from caring. Personnel
shortages worsened this week: seven of the 21 doctors employed by the health
ministry quit their jobs at government hospitals because they had not been
paid on-call allowances for over a year. The doctors, expatriates engaged in specialized
tasks like surgery and radiology, have hired a lawyer to sue the ministry of
health. Some have left the country.
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