The HIV/AIDS pandemic continues to gather momentum in many developing countries, increasing the already heavy burden on health care facilities. As a result, donors, implementing partners and communities are beginning to create home-based care programmes to provide care for persons with HIV/AIDS. This paper recommends reorienting this home care provision as a service founded in, and coming from, the community rather than the health system. A methodology, in the form of an assessment matrix, is provided to facilitate the assessment of a community's capacity to provide care for people with AIDS. The focus is on rapid assessment methods using, where possible, readily available information to clearly and systematically define current circumstances. The matrix created for a specific community is then used in the development of an action plan with interventions prioritized and tailored to local needs. A case study from a hypothetical developing country, where HIV/AIDS is a significant problem, is used to illustrate the process.
PIP: Any AIDS program should strive to strengthen the capacity of the home and community to care for people with AIDS by building on traditional family structures which support all chronically ill people. A rapid assessment tool has been developed to resolve potential conflicts and to facilitate the design of an AIDS program tailored to local needs. It was designed with developing countries in mind. It uses an assessment matrix for systematic community evaluation of the problems and resources with current home care. The 3 levels are individual, household, and community. The key categories are HIV prevalence and awareness, perceived needs, community capability, and health and social system. For example, community capability and its operation are examined at the individual, household, and community level. Each country or program must come up with its own process and outcome indicators. They should choose indicators based on data that will always be available and permit measurement of progress towards selected goals/objectives (e.g., percentage of HIV seropositive TB patients). After completion and review of the matrix, the strengths, weaknesses, and barriers (which will become apparent) are used to develop an action plan. There are general guidelines for data analysis and the development of the action plan. Every program should be area-specific and community-based. Neither donors nor implementers should misjudge the obstacles to care within the community. Incremental steps will result in improved capacity of the community to cope with people with AIDS. All people who are involved in home care (e.g., prostitutes) must be included in the team to evaluate home care. Outside help (e.g., donors) must not undermine community initiatives to care for members with AIDS. The information and conclusions should be presented to the community and key informants for verification before implementing any interventions.