The Chikuni Parish Home-Based Care (HBC) program in southern Zambia was awarded for excellence for its new four-phase approach that strives to offer a more individualised and sustainable service to over 1000 people with HIV.
Chikuni HBC was set up in 2000 at a time when many people with AIDS were bedridden and needed physical care that the overstretched Chikuni Mission Hospital could not always provide. HBC caregivers were trained and visited clients every week to offer basic care, listen to their concerns and pray with them.
As clients became healthier thanks to the advent of antiretroviral therapy (ART) and better treatment for opportunistic infections, the need for the caregivers’ role declined. A rethink in the HBC service was called for, to meet the new needs of clients who although no longer weak remained poor and at high risk of reinfection.
Other concerns prompted the HBC to restructure its services, chiefly sustainability and the need to move away from a dependency culture that had been created by decades of church handouts.
In 2012, after consulting its clients, the HBC developed a holistic four-phase approach that aimed to meet each client where s/he was at and to help him/her gradually move towards self-reliance:
PHASE 0: PREVENTION
First of all, the HBC partners with other organizations to offer HIV prevention services. Through Chikuni Mission Hospital, HBC clients have access to prevention of mother-to-child transmission (PMTCT), voluntary counselling and testing (VCT) and male circumcision. A risky behaviour prevention program is offered in local schools. Other partners that help spread prevention messages include Chikuni Community Radio and the Monze Diocese Development Office.
PHASE 1: OUTREACH & HEALTH EDUCATION
The purpose of Phase 1 is to look after the health of people with HIV by offering access to decentralized healthcare services. This is done through the HBC core services of home visits and outreach to treat opportunistic infections and to increase adherence to ART. Some HBC clients have to travel for two days to go to hospital so offering community-based healthcare is a must. A team of 80 caregivers visits the HBC clients in their homes every other week and a nurse conducts outreach visits.
Phase 1 also includes health education for all through seminars in the community, workshops, radio programs, sensitization campaigns and other activities. Topics range from the danger of tuberculosis, to nutrition for people with HIV, to the danger of mixing alcohol with ARVs.
PHASE 2: SKILLS TRAINING & INCOME-GENERATING ACTIVITIES (IGAs)
Most of the 25,000 parishioners of Chikuni are subsistence farmers living in isolated rural communities.
Once HBC clients are healthy enough to work, they are given the opportunity to receive skills training to enable them to earn a living. In 2012, HBC offered workshops in sustainable agriculture, poultry management and small livestock management.
There are seven IGAs at the main HBC centre: the Mukkoche restaurant, the Kasensa Kaluumuno bakery, the Chileleko shop, a garden, solar dried vegetables and the Kamunzya Mulange tailoring lab. The 15 IGA workers are either HBC clients or caregivers. Profits are divided between the workers and the HBC.
PHASE 3: SELF-HELP GROUPS
Once HBC clients are managing their health well and have learned vocational skills, they are invited to join a self-help group (SHG). The SHG concept strives to unleash people’s potential by encouraging them to believe that “I have the capability to improve my situation.”
Each SHG has an average of 16 members and meets weekly or biweekly to save and lend using the village bank model. These groups also discuss personal issues during their meetings, from family issues to challenges of adherence. Key factors that empower members include rotational leadership within the groups, the focus on beginning household-level IGAs, and the responsibility of members to identify their own training needs.
The HBC helps by providing physical capital such as seeds and goats, which members repay. In this way, a revolving fund is being developed to promote the sustainability of the project. Three extension officers work with the SHGs by mentoring the groups and individuals.
The four phases are interlinked and each phase builds upon the previous one. For example, a SHG member who contracts an opportunistic infection has access to a caregiver and outreach visits, and also has access to further skills training.
A total of 330 HBC clients are now members of 22 SHGs and they say they have increased their household incomes. All SHG members have taken out loans from their groups and are also repaying the HBC for the capital they received.
What makes this four-phase approach so relevant is that it recognises the reality that people with HIV deal with their condition in different ways at different times in their lives. The ever-present spectre of donor fatigue makes an approach geared towards self-reliance inevitable, but this is far from the only reason why it makes sense. Ultimately, empowering people to take control of their destiny and to shape a future for their families, is tantamount to affirming their human dignity and unlocking their potential to live lives that are as fulfilling as possible.