Volunteer caregivers being exploited, says study

As a result of the South African government's promotion of voluntarism, the majority of home-based care programmes make use of unpaid and often insufficiently trained helpers. A new study has argued that voluntarism was "cheap way out" that was unsustainable in the long term, and the government should instead pay salaries to care givers. The study by the Health Economics and AIDS Research Division (HEARD) of the University of KwaZulu-Natal in Durban, also said that several home-based care programmes were inadequately developed and their effectiveness questionable. Many were simply "a response of crisis management", argued HEARD research consultant Olagoke Akintola. The South African Department of Health should review current primary health care models in the face of an HIV infection rate of over 21 percent, Akintola said. It needed to refine volunteer-based programmes, provide stipends and assist caregivers to ultimately obtain formal employment. "Governments and health departments need to acknowledge that home-based care is not a cheap option," Akintola stated in his study. "In South Africa ... the costs are hidden and defrayed onto the caregivers and communities who are least able to carry the burden." Since the numbers of people infected with HIV have risen rapidly in Africa, there has been a gradual shift from hospital-based care to home-based care. In South Africa, most care programmes rely on otherwise unemployed volunteers from the affected communities. These volunteers are usually female and not paid or, in a few cases, paid small stipends. "Those who are willing to volunteer are already burdened because they are [predominantly] poor and affected by AIDS," Akintola said. Volunteerism further worsens their poverty, as many carers share their food with the patients they visit, and spend long days working free of charge instead of looking for a paid job. Caregivers generally do much more than nurse the sick. They take over domestic chores, counsel, provide child-care services for sick parents, organise material support for affected families, arrange funerals and help patients and their relatives to access social grants. "The current approach is unsustainable," he added. "The government is exploiting the volunteer system." Akintola suggested the government should set aside a budget for regular caregiver salaries and "make home-based care a career" similar to that of government-employed community health workers. Health ministry spokesman Sibani Mngadi told PlusNews, "We encourage unemployed volunteers, who come from poverty-stricken or AIDS-affected households, to join the community health worker programme. We have recruited about 40,000 health workers across the country, who are paid a minimum stipend of R1,000 (about US $167) a month - some provinces, such as KwaZulu-Natal, pay about R1,700 ($283.68)". Last week the government announced plans to spend an additional R500 million ($83 million) annually over the next five years to create jobs for caregivers. Of the 150,000 jobs expected to be created by the programme, 122,000 would be in community-based home-care projects, with an additional 90,000 short-term workers recruited at existing sites. "NGOs funded by the government are required to pay anyone they hire for help," Mngadi said. Although the health department provides free training for home-based caregivers, which Akintola said was beneficial, the training curriculum needed to be reviewed to enable them to gain deeper medical knowledge. They are currently trained in basic nursing, but experts argue that more advanced healthcare expertise is needed to tend HIV/AIDS patients at home. "Caregivers need to receive better training, similar to that of nurses, to be able to administer basic medication. Otherwise, the ways in which they can help AIDS patients in their homes are very limited," said Patience Mavata, who manages groups of home-based caregivers in the Valley of a Thousand Hills in KwaZulu-Natal. Caregivers are currently not even allowed to administer painkillers. "We need more cooperation between government hospitals and NGOs to solve this problem," Akintola told PlusNews. "Home-based caregivers need to have direct access to, and network with, hospitals." He recommended that South Africa should adopt the Ugandan system of home-based care as a model. In Uganda, volunteer caregivers identify sick people and provided basic care but are supported by a team of health care professionals, including doctors, nurses, paramedics and clerics for spiritual care. "Comparison of programmes in the two countries shows that South Africa is way behind Uganda with regards to understanding and meeting the challenges to home-based care," noted Akintola. South Africa should transform its "community-based" approach into a "community-oriented" strategy, he added. Over a three-year-period, Akintola analysed home-based care projects in two semi-rural communities 35 km north of the port city of Durban, on South Africa's eastern coat. He interviewed home-based carers and programme coordinators, local health committee members, councillors, as well as people living with HIV/AIDS and their families. He also studied home-based care programmes in Uganda. Akintola found that caregivers needed psychosocial support, because their work was exceptionally stressful on an emotional, physical, psychological, social and economic level. He also noted that the home-based care programmes entrenched traditional gender inequalities, as caregivers were generally women and young girls. The use of young girls as primary or secondary caregivers affected their education because they were often withdrawn from school to help, or had little time to study.