PDF File - hivpolicy.org

INPUTSAND PROCESSconsiderably, and the HCTs often complain ofshortages and poor quality. Some HealthCentres make up this shortfall when they havesurplus supplies, but this cannot be relied upon.It is recommended that MoH furtherintegrates the Home Care programme intoprocurement plans so that Central MedicalStores are able to resource the drugs for thehome care kits through the Health Centres. Thiswould be a phased process which would initiallyinvolve the MoH including the drugs in the kits inthe essential drugs list. The cost of Home Care Kitsupplies for each team is approximately $30per month. This includes items not available atCMS, such as soap, cloths, etc. which wouldcontinue to be provided through the NGO'sprogramme grants.It is recommended that MoH includesdrugs used in Home Care Kits in the essentialdrugs list.It is recommended that Central MedicalStores initiates steps to provide drugs forHome Care Kits through Health Centres.Many of the home care teams reported thattheir stocks of some medicines (especiallyNystatin, Promethazine, Multivitamins andParacetamol) are depleted long before the endof the month. Part of the reason lies in someteam members responding to the pressure fromnon-home-care clients, who they encounter inthe community, for medicines for pain relief andother minor symptoms. This is justified (bysome teams at least) as enhancing communityco-operation and avoiding discriminationagainst AIDS patients.However, observations of home visits indicatedthat prescribing medicines by the teamsto patients was not always rational, and thatthere was sometimes a tendency to hand out astandard package of medication withoutadequate diagnosis. Whilst it should be notedthat such practise is widespread in Cambodianhealth services, the evaluation team feels thatthis could be helped by more frequent and moresupportive medical supervision. The issue ofsupervision will be addressed in section 4.9 ofthis report.It is recommended that the HCNG reviewsthe criteria and rationalises the process ofprescribing medicines to patients.There is one further issue related to medication,which is pertinent to raise at this juncture.Recent research in Africa, supported by WHOand UNAIDS, has endorsed the regular use ofcotrimoxazole (marketed as Bactrim) for prophylaxisfor PLHA. The recommendation is thatprophylaxis should be given life long for HIV+adults and children, supported by a package ofeducation, monitoring and follow up.Recently, three of the HCTs have been trialingthe provision of Bactrim for PLHA, under thesupervision of the medical co-ordinator. Thisevaluation wholeheartedly supports this initiative,and recommends that Bactrim is providedby all the HCTs to all PLHA, supported by anappropriate package of training for the HCTs,and education, monitoring and follow-up forthe patients. During the preparation of thisreport, MSF were approached to provideBactrim to the HCTs.It is recommended that the Home CareNetwork Group reviews the criteria for homecare provision of Bactrim to HIV patientsin Cambodia, ensuring that there are clearguidelines for selection and monitoringof patients.pg 51