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care is continuous from the healthfacility to the home and communitylevel, and is not simply restricted totreatment. The key elements ofcomprehensive care include clinicalcare, nursing care and palliative care.Other aspects are psycho-socialsupport, counselling and HIV testing,and spiritual support. Underliningthese are family care and support oforphans and vulnerable children(OVC), and care of the caregivers.Finally, food and nutrition support andeducation, as well as programmemonitoring and evaluation, are criticalcomponents.Minimum Care PackageTo ensure that the patient and familyreceive quality care regardless oforganizational constraints, a minimumcare package has been identified thatincludes: nursing and palliative care,clinical care that emphasizestreatment literacy and sustainability ofcare, family care and OVC support,capacity building, and monitoring andevaluation. To ensure that all theelements of the minimum carepackage are addressed, a strongreferral and networking system linkingthe patient and family to otherservices is required.Strengthening Support SystemsStrong systems will strengthen andsupport the implementation of theminimum package for HCBC andtherefore maintain the provision of ahigh quality continuum of care.Personnel, administration and qualitycontrol are among the essentialsystems. For example, it is necessaryto maintain an optimal number andquality of staff, strengthen administrationand supervision, and provideconsistent monitoring and evaluation.Other systems are quality assuranceand accreditation, leadership, coordination,integration of services,logistics and supplies. Referral,linkages and networking at all administrativeand health care levels areother essential contributors to thesystem.Target AudienceThis framework targets three levels ofaudiences:• Policy makers and senioradministrators, middle managers,and those who develop and runHCBC programmes.• Government officials at thevarious levels who will need theframework to monitor, guide andsupervise the implementation ofHCBC programmes.• Civil society implementingpartners, who will be required touse this framework for theimplementation of HCBC activitiesin line with the relevant district’spriority areas.With this framework for a recommendedminimum package for HCBCand a nationally recommended HCBCimplementation model, it is anticipatedthat standards and quality of care willbe maintained and the quality of lifeof all those affected will be improved.All partners implementing HCBCprogrammes should adhere to thestandards and criteria stipulated ineither the comprehensive or theminimum health care packages.xHOME- AND COMMUNITY-BASED CARE IMPLEMENTATION FRAMEWORK