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The vision is to integrate HCBCinto other health services so as toprovide a holistic, sustainable, stigmafreeand high quality continuum ofcare that is accessible to all those inneed and supported by motivatedcommunity and health facility careproviders.1.2 Purpose and Rationale ofthe HCBC FrameworkComing at a time when theMinistry of Health is shifting itsfocus through the CommunityStrategy 1 by strengthening healthcare provision at level 1 (thecommunity – village/households/families/individuals), this frameworkaddresses HCBC as an integral partof the Community Strategy. HCBC iscontinually evolving as health serviceproviders respond to the changingneeds of clients, families andcommunities.For example, with the availabilityof highly effective anti-retroviral drugs(ARVs), more and more bedriddenpatients are recovering and regainingtheir health, thereby graduating fromdebility to mobility and returning toactive roles in the community. Withsuch patients being on life-long ARVtreatment and requiring comprehensivecare, the need to go beyond thehome to community level care iscritical. This is the root of the changeof focus from home-based care tohome- and community-based care.1Taking the Kenya Essential Package forHealth to the Community: A Strategy for theDelivery of LEVEL ONE SERVICES, publishedby the Ministry of Health, June 2006 (hereafterreferred to as the Community Strategy).-Community-based health careoccurs when community memberstake on the responsibility of initiatingand sustaining their own health care.It implies the use of locally availableresources and the community’s fullparticipation and involvement indecision making for the planning,organizing, implementing, monitoring,and evaluating of these services.According to the Kenya EssentialPackage for Health (KEPH), 2 thereare six levels of care at which HCBCwould be integrated for different careprovision activities. These are:• Level 1: Community: village/households/families/individuals• Level 2: Dispensaries/clinics• Level 3: Health centres,maternities, nursing homes• Level 4: Primary hospitals –District and sub-district hospitals• Level 5: Secondary hospitals –Provincial hospitals• Level 6: Tertiary hospitals –National hospitalsThe rationale for the HCBCimplementation framework is to guideprogramme implementers by definingthe minimum standards and a modelof care that best serves the needs ofclients, families and communities. Theminimum package and model of carewill be supported by strong systemsof capacity building, linkages,networking, M&E, coordination andsupervision.2Reversing the Trends: The Second NationalHealth Sector Strategic Plan of Kenya – TheKenya Essential Package for Health, publishedby the Ministry of Health, July 2007.2 HOME- AND COMMUNITY-BASED CARE IMPLEMENTATION FRAMEWORK