Financial incentive to attract home-based HIV/AIDS caregivers

Mozambican health authorities are hoping a financial incentive will encourage more people to become involved in home-based care (HBC) programmes for those living with HIV/AIDS. The ministry of health recently recommended that HBC caregivers be remunerated at 60 percent of the country's minimum wage, which is about US $55 per month. HBC 'activists', as they are known, do not get paid and at best receive a small incentive, such as a T-shirt. It is widely acknowledged that HBC volunteers play a vital role in providing care to the estimated 1.4 million Mozambicans living with the disease, filling an important gap in a country where almost half the population does not have access to adequate healthcare. "There is only one nurse for every 5,000 people, which is one of the lowest ratios in the region," Sandy McGunegill, an HBC technical advisor in the health ministry, told PlusNews. "Many of our health centres do not have nurses, and most of the health workers have a low level of education or training," she commented. The offer of remuneration was also expected to attract men, who have been reluctant to volunteer their time to the HBC programme. "So far most of the volunteers - because of cultural and economic reasons - are women, but with increased financial benefits, more men should come aboard," McGunegill noted. Since the start of the HBC programme three years ago, the ministry of health has prioritised caregiver training. Activists are expected to visit those with AIDS-related illnesses in their homes, to provide health education, counselling and prophylaxis, and promote adherence to the antiretroviral drug regimen. Last year 40 health workers were trained, using a module specifically geared to the better use of ARVs, and they will now be used to train the HBC caregivers. "We are encouraging decentralisation of the training," McGunegill explained. Particular emphasis is laid on training caregivers to recognise some of the more serious side effects of ARVs, and imposing adherence to the medication schedule. Presently 6,000 people receive free ARVs as part of the government's drug rollout programme, and the authorities aim to have 29,000 adults and children on anti-AIDS drugs by the end of 2005. However, this falls far short of reaching the 200,000 people who have already qualified for ARV treatment. Ussamane Dauto, coordinator of the HBC programme, told PlusNews that while caregivers generally perform well, "it's not the volunteers who have a problem, it is sometimes the people they are trying to help," he said. "In the rural areas particularly, many people who fall sick with AIDS-related illnesses believe that someone has cast a spell on them - as a form of revenge - and that is why they are sick," he explained. Louisa, a 31-year-old caregiver in an HBC programme run by the medical NGO, Medicos do Mundo Portugal, agrees that this is a problem even in the city of Matola, 10 km from the capital, Maputo. "It is hard to persuade such people to take ARVs, especially when they start to feel better - they just stop taking the drugs. There are others who will take the drugs twice a day at whatever time they feel like, although I insist that they must listen to what the doctor recommended. However, most of my patients listen to me and do as I advise." Louisa says she plans to continue working as a caregiver, although the pay recommendation will not have affect her because, unlike most organisations, Medicos do Mundo Portugal pays its HBC programme workers a monthly salary of US $100, which is more than most junior nurses receive.