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An Evaluation of the MoH/NGO Home Care Programme for People with HIV/AIDS in Cambodiain order to adequately address all thecomponents of the approach• labelling home care services as exclusiveto PLHA can generate negative reactionsfrom others and foster discriminationagainst PLHA• support and care of HIV+ people is vitalto maximise the impact of preventionactivities. Any coherent response to theHIV/AIDS epidemic should seek to linkcare to prevention. 71.2.3 Limitations of home careprogrammesHome care programmes in other countrieshave generally been based on one or other oftwo models. Where there was a strong traditionof Community Based Organisations (CBOs),home care programmes have evolved using agrassroots approach. In other situations, wherethere are established government outreachprogrammes, home care for PLHA hasbeen added as an additional activity. Boththese approaches have limitations. Grassrootsapproaches are often limited in their capacity toscale up, and sometimes fail to make successfullinks with existing health structures. Evaluationsof hospital outreach schemes report that theyare relatively costly, often fail to mobilise communityresources, and do not place sufficientemphasis on counselling and social support 8 .A home care programme which, at the onset,links grassroots organisations with existing publichealth services, and encourages shared ownershipis more likely to achieve sustainability,impact and cost effectiveness.1.2.4 The Cambodia situationThis approach of comprehensive careacross the continuum has provided a successfulframework for both policy and implementationof AIDS-related programmes in SE Asia,India and Sub-Saharan Africa. The approach isparticularly suited to Cambodia 9 , which is characterisedby:• a severe shortage of hospital beds tocope with the number of predicted AIDSpatients (there are less than 1500 beds inPhnom Penh available for all medicalconditions)• a population where only an insignificantminority of PLHA are able to affordcurrent prophylactic drug therapies• a high incidence within PLHA ofadvanced opportunistic infections,largely untreated due to the lowcapacity of health services• existing familiarity with the majorityof common symptoms associatedwith HIV/AIDSCambodia has a rapidly increasing numberof PLHA presenting with a range of commonsymptoms including headaches, fever, diarrhoea,skin and oral infections and weight loss.The typical pattern of illness is a series of minorinfections which will respond if the right treatmentis provided, followed by more virulentinfectious diseases leading to rapid declineand death.Even if sufficient hospital beds werepg 107 Gilks et al. "Care and Support for People with HIV/AIDS in Resource-Poor Settings", 19988 Cost and Impact of Home-Based Care for People Living with HIV/AIDS in Zambia, 19949 Joint Ministry of Health/NGO Pilot Project on Home and Community Care for People with HIV/AIDS, Cambodia, February 1998-February 1999.