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An Evaluation of the MoH/NGO Home Care Programme for People with HIV/AIDS in Cambodia5.9 SupervisionSupervision is provided at two levels in thehome care programme in Phnom Penh. Eachteam has a Team Coordinator for day-to-daysupervision and receives twice-monthly visitsfrom external supervisors. In addition to dailysupervision of their own HCTs, they are alsoresponsible for communicating informationbetween the HCTs and the Home Care NetworkCo-ordinator.The Team Co-ordinators were initiallyselected by the Project committee, but are nowelected by their own teams.At the start of the pilot project, two medicaldoctors visited the teams once each month, tosupervise team activities and provide clinicalassistance to difficult cases. After the 6-monthreview, supervision was split into one visit formedical consultation, and one to supervise teammanagement. Simple forms are used to assistthe supervisors to give feedback on each aspect,and these are collated by the Home CareNetwork Co-ordinator and included inthe monthly reports to the HCNG.At present, management supervision isprovided by some members of the HCNG andsome of the Health Centre Managers. Medicalsupervision is provided by doctors on a rota basisdrawn up each month by the Home Care NetworkCo-ordinator. However, it is becoming increasinglydifficult to find doctors who are willing to providemedical supervision, even with the provisionof a small honorarium to cover travel expenses.Discussions with the HCTs clearly indicatethat the HCTs place great value on supervision,and visits by supervisors are welcomed. All theHCTs were emphatic that they would like moremedical supervision to assist them in dealing withdifficult medical cases and to help them improvetheir clinical and diagnostic skills, especially forTB. Enhanced management supervision wouldhelp to address issues of reporting and planningdiscussed earlier.Lesson learned: supportive supervision is akey component of the home care programmeand is highly valued by the home care teamsGiven the present difficulties of finding supervisors,it is difficult to see how the demands for moresupervision can be met using the existing system.Policy changes to integrate home care provisioninto the MoH system may help to facilitate theallocation of medical supervisors. However, thesupervisory needs of the HCTs are for morefacilitative and supportive supervision, rather thanjust more frequent supervision. Earlier sections ofthis report identified needs of the HCTs forrefresher training and a supportive approach tosupervision in a number of areas:- assessment ofsymptoms; analysis of needs; dispensingmedication; reporting; prioritising; planning visits.Following an earlier recommendation (Section4.6) that each HCT is "attached" to an existingreferral hospital, it is further recommended thateach hospital is responsible for providing supervisorysupport to their HCTs. In order to providegood supervision, the supervisors themselvesmust be resourced and trained in supportiveapproaches to supervision. A set of tools andapproaches has been developed by AVSCInternational which may help to address thisissue.It is recommended that the referral hospitalsprovide supportive medical supervisionpg 56
INPUTSAND PROCESSto their partner HCTs. The supervisors mustbe resourced and trained in facilitativesupervision.There is also a possible pool of resourceswithin the international and local NGO communitieswhich could be drawn upon to providesupervision to the HCTs and which could beresourced through the Home Care Network.It is recommended that the Home CareNetwork identifies and resources a pool ofsupervisors from government and NGOs toprovide facilitative supervision to the HCTs.Volunteers 5.10Beginning in August 1998, each HCT recruited 5Volunteers to assist the team with their work.Each Volunteer is expected to work approximately10 days per month, for which theyreceive a stipend of $12.The Volunteers are recruited from thecommunities in which they live. They are oftenrecommended by the local authorities in thecommunity, and are interviewed by the HCTsand selected on merit as part of the recruitmentprocess. The interviews assess their knowledgeof HIV/AIDS and their attitude towards PLHA,and whether their families will agree to themworking in this field.The HCTs provide 60 hours of training, andthe Volunteers are then attached to the teams.Most HCTs reported that they have identifiedmany people keen to work as Volunteers. Someof the HCTs felt that they could use moreVolunteers, but were restricted to amaximum of five by financial and managementconstraints.Discussions held separately with the HCTsand with the Volunteers clearly demonstratedthat the Volunteers are well integrated and playa number of important roles in the existinghome care programme. It is felt that the role ofVolunteers will be a key component of the programmewhen it is expanded to the provinces.Lesson learned: Volunteers play a number ofimportant roles in the home care programmeand are likely to be a key component in theexpansion programmeThe HCTs were unanimous and unstinting intheir praise for the work performed by theVolunteers. Because they are drawn from the communityin which they live, the Volunteers are wellplaced to facilitate links with other communityactivities, to ensure access and accessibility ofHCTs, and they are major sources of referral of newpatients to the HCTs.Unfortunately, there is quite a high turnover ofVolunteers. Sometimes this is because they takeup paid employment, but often it is because of illnessor death, as many of the Volunteers are themselvesHIV+. A number HCTs however, still havesome of their original Volunteers from August 1998.It is clear that the Volunteers generally workfar longer than the 10 days per month originallyallocated, with many working up to 20 days permonth. In our observations of the home careactivities, the Volunteers appeared to be professionaland committed in their dealings with thepatients.Discussions with a representative sample of16 volunteers drawn from eight of the HCTsrevealed that they come from a variety of back-pg 57
Page 1 and 2:
An Evaluation of the MoH/NGOHome Ca
Page 3 and 4:
CONTENTSipg 1pg 2Abbreviations and
Page 5 and 6:
CONTENTSpg 626 Battambang pilot6.1
Page 7 and 8:
ACKNOWLEDGEMENTSThis evaluation cou
Page 9 and 10:
EXECUTIVESUMMAR YImpactThe findings
Page 11 and 12: EXECUTIVESUMMAR YKey ComponentsThe
Page 13 and 14: EXECUTIVESUMMARY• The draft train
Page 15 and 16: BACKGROUNDConcepts of Home-Based Ca
Page 17 and 18: BACKGROUNDavailable, there is a str
Page 19 and 20: BACKGROUNDgiven the opportunity to
Page 21 and 22: EVALUATION DESIGNAND METHODOLOGYDes
Page 23 and 24: EVALUATION DESIGNAND METHODOLOGYBat
Page 25 and 26: EVALUATION DESIGNAND METHODOLOGYtho
Page 27 and 28: EVALUATION DESIGNAND METHODOLOGYwit
Page 29 and 30: IMPACTPeople Living with HIV/AIDS (
Page 31 and 32: IMPACTWhen asked (in an open-ended
Page 33 and 34: IMPACTThe community leaders were un
Page 35 and 36: IMPACTFor the 34% who acknowledge t
Page 37 and 38: IMPACT3.5.1 Access/coverageWithout
Page 39 and 40: COSTANALYSISMethods and Results 4.2
Page 41 and 42: COSTANALYSISCost Implications for H
Page 43 and 44: COSTANALYSISof Health study 37 on t
Page 45 and 46: COSTANALYSISLimitations of the Cost
Page 47 and 48: INPUTSAND PROCESSthe monthly HCT re
Page 49 and 50: INPUTSAND PROCESSIn recommending th
Page 51 and 52: INPUTSAND PROCESSIt is recommended
Page 53 and 54: INPUTSAND PROCESSEach HCT splits in
Page 55 and 56: INPUTSAND PROCESSand the feeling pr
Page 57 and 58: INPUTSAND PROCESSconsiderably, and
Page 59 and 60: INPUTSAND PROCESSEach of the referr
Page 61: INPUTSAND PROCESSIt is recommended
Page 65 and 66: INPUTSAND PROCESSstipend of $20 per
Page 67 and 68: INPUTSAND PROCESSCaring for the Car
Page 69 and 70: BATTAMBANGPILOT PROJECTlonger-stand
Page 71 and 72: BATTAMBANGPILOT PROJECTremaining 88
Page 73 and 74: EXPANSIONOF THE HOME CARE PROGRAMME
Page 81 and 82: 8 SUMMARY OF KEYCOMPONENTS, LESSONS
Page 83 and 84: SUMMAR Y OF KEY COMPONENTS,LESSONS
Page 85 and 86: APPENDICESpg 79
Page 87 and 88: APPENDIX1a4. a) How often do they v
Page 89 and 90: APPENDIX1a10. If you didn't have Ho
Page 91 and 92: APPENDIX1a22. What other material a
Page 93 and 94: APPENDIX1b9. What difference (if an
Page 95 and 96: APPENDIX1c• What are your estimat
Page 97 and 98: An Evaluation of the MoH/NGO Home C
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