FHI Nepal Community and Home Based Care Program Assessment

Abstract

Community and home based care (CHBC) responds to the physical, social, emotional and spiritual needs of people living with HIV (PLHIV) and their families in the home and community environment from diagnosis to death and bereavement. This study was designed to assess the following aspects of the ASHA Project CHBC program in Nepal: To measure the extent of CHBC program service coverage and client retention; To assess the extent of CHBC service quality and; To measure the physical and psychosocial wellbeing of and differences between CHBC clients and non- CHBC clients. The study was carried out in 13 ASHA Project CHBC programs districts and for the control sites, three districts representing Hill, Urban and Terai where currently no CHBC programs are being conducted. Three approaches were taken: a) program data‐based assessment of CHBC service coverage and retention, b) assessment of the quality of the CHBC program through qualitative interviews and assessment checklist c) quantitative questionnaire based assessment of the difference between CHBC and non‐CHBC sites on physical and psychosocial wellbeing. The program data analysis for coverage, retention and mortality from October 2006 to December 2010 among the 13 Implementing Agencies (IAs) showed varying results. The overall cumulative coverage of PLHIV on ART in the 13 districts was 44 percent and in most districts, the coverage was slightly higher for female PLHIV on ART. One of the IA had 100 percent coverage of all PLHIV on ART in their program district. The total cumulative mortality and retention were 8 percent and 86 percent respectively. CHBC is recognized as a key component for HIV awareness, treatment, care and support. The qualitative findings revealed that the CHBC programs being run in the 13 sites continue to benefit the community and to empower and support the PLHIV clients. The services provided by the CHBC program have also enhanced the emotional and social wellbeing of the clients in all districts. The CHBC program has also been able to provide linkages to income generating activities as well as other services such as ART, medical care and counseling, which is contributing to improved quality of life for PLHIV. CHBC has also helped to reduce stigma and discrimination although these attitudes still persist.