The view that community-based care and support programmes are the most cost-effective way to address the impacts of HIV as a cheap alternative to hospital care is being increasingly questioned.
Government is favouring community-based care as the solution to hospital beds that are being occupied by patients with AIDS-related illnesses.
A study released by the University of the Witwatersrand’s Centre for Health Policy shows that while certain forms of home-based care may be less expensive than in-patient hospital care, home-based care requires the investment of resources, even if programmes rely mainly on volunteers.
Also, community-based care responses may actually increase the pressure on formal health and welfare services, by raising awareness of available services and motivating clients to access those services, the report found.
In a study conducted in Zimbabwe, home-based care was found to be almost as costly as hospital care. In one rural programme, the cost of a three-month illness spent at home, with two visits per week, equaled the cost of a 76-day stay in the district hospital.
The cost of three months of home-based care in an urban area was equivalent to 33 days in a district hospital. Each home visit cost the same as one to three hospital in-patient days.
The study found that home visitors spent the majority of their time travelling to their patients’ homes, especially in rural areas.
Unproductive time spent travelling and transport costs were major items of expenditure.
However, it was noted that if home-care providers were based in the same community as their patients, travel costs were reduced considerably and more time could be spent with patients rather than in transit to patients’ homes.
The study echoed the finding of an earlier study conducted in Zambia, comparing the costs of hospital initiated and community initiated home-based care versus maintaining a patient in hospital.
Community initiated home care was cheapest at US$2 per day, as compared to between US$3 and US$8 per day for a patient in hospital, and US$40 per visit for participation in hospital initiated home-based care.
“From both these studies it is clear that, while certain forms of home-based care may be less expensive than in-patient hospital care, home-based care requires the investment of resources, even if the programmes rely mainly on volunteers,” the report said.
Michele Russell, co-author of the report entitled, “A rapid appraisal of community-based HIV/AIDS care and support programmes in South Africa”, said studies to date had also not measured the “opportunity cost” to the in-home caregivers.
Within households, the burden of care of a person with a terminal illness will most often fall on a female household member who, because of caring for a family member will spend less time on other activities such as income generation, sowing and harvesting.
Children may also be removed from school to assist in caring.
“Community-based care and support should not be seen as an alternative to care and support through formal structures, but rather as one element in a co-ordinated and integrated continuum of care”, Russell said.