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EXPANSIONOF THE HOME CARE PROGRAMMEthis model can be significantly higher than thecost of providing similar services in urban areas.It is clear that HIV infection is well-establishedand has reached the general populationin every province 39 . Given the current prevalencerate, it is estimated that a typicalOperational District (O.D.) will have between1000-2000 PLHA. Using the present Battambangpilot/Phnom Penh model, where the rural HCThas a patient load of 60 per month, this wouldindicate that between 10-25 HCTs per O.D.would be necessary to give the degree of coveragepresently provided in Phnom Penh. Giventhe limited infrastructure and human resourcesin the provinces, and the uncertainty of financialsupport, it is unlikely that this approach willbe feasible.There are a number of alternative partnershipand funding options for expansion ofthe programme to the provinces. Based on thefindings of this evaluation, four possibilities aresuggested below:Option 1Adapt and scale up the existing model toselected provinces, maintaining the current keycomponents:• Home Care Team structure consistingof government nurses, NGO staff andcommunity volunteers.• co-ordination by a representative networkgroup, through the Provincial AIDS Office• funding through NGOs with donor support• external Technical Assistance toco-ordinate the networkBased on lessons learned from the ruralpilot, the adaptation could conceivably involve:• A 4-person District-level Home Care Teambased at the Referral Hospital (OperationalDistrict Level) rather than Health Centre(Commune Level)• The District-level HCT liases directly with 2person Commune HCTs based at eachHealth Centre• Commune HCTs liase with Village HomeCare Volunteers (1 or 2 per village), who willbecome the grass-roots providers of homebasedcare.It is estimated that the above adaptations tothe rural environment will enable up to 1,500patients to be visited per O.D, an average of 3times a month, at a programme cost of between$50-70,000 a year.Option 2The model outlined above would beemployed, but all funding would be providedthrough the government, rather than throughNGOs. It should be noted that whilst this optionis entirely possible, it has not yet been tried. It islikely that external Technical Assistance wouldstill be required to co-ordinate the Network andprovide training to Home Care staff.Option 3Again, use the above model, but with governmentfunding the government component, whilstthe NGO component is funded from non-governmentsources. Again, while this mechanism ispossible, it has not been tested.39 Consensus workshop on HIV/AIDS in Cambodia, Phnom Penh, 1999 op.cit.pg 71