Communities make care count

By Charles Scott

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As Health systems in Southern Africa battle to cope with the HIV/AIDS epidemic, communities have become the backbone of care and support for people infected and affected by the disease. Neighboring countries South Africa and Zimbabwe face similar challenges, but while one strives to scale up treatment and care, the other struggles for survival.

Like many elderly and retired people, 70-year-old Mapatsi Tsuro spends his days in the garden tending to his crop of vegetables. But for Tsuro this is no leisurely pastime, rather it is a matter of survival. When he should be enjoying his golden years with the support of the family he raised, he now has to feed and care for eight grandchildren, following the untimely deaths of his three children.

Tsuro lives in Chicomba in eastern Zimbabwe, but his plight is common to millions of rural families in the region with the world's highest HIV infection rate and the greatest number of AIDS-related deaths. In Zimbabwe 1.7 million of the population of 13-million are infected with HIV/AIDS and Almost 900,000 of those infected are women.

Behind the alarming statistics lies human tragedy. The hardship for those infected and their families begins long before they die. Stigma, fear and despair often follow a HIV-positive diagnosis. The loss of income and support when a breadwinner or caregiver becomes ill, and the diversion of household resources to provide care increases the burden on family members, particularly children caring for terminally ill parents. Many only leave behind the trauma of bereavement and orphans.

Rural elderly care for orphans

Almost one in four children in Zimbabwe, 1.1 million, are now orphaned by AIDS. This number continues to grow as HIV and AIDS dramatically increases the vulnerability of children. The majority of the country's orphans are absorbed by the elderly in rural Zimbabwean households, a group which is barely coping with the extreme economic and social conditions in the country.

Oxfam America is supporting the Single Parents Widows Support Network (SPWSN) to improve the security of vulnerable groups by providing for their immediate nutritional needs, building sustainable livelihoods and enhancing the resilience of communities. Since 2002 Oxfam has been responding to the ongoing food security crisis in Zimbabwe through a livelihoods support program in the Seke, Mudzi, and Chikomba districts of Mashonaland East Province. The program provides seeds, fertilizers, primary health kits and on-going support to some 10,000 vulnerable households.

The supply of summer grain and legume seeds ensures that communities are able to sustain food production and build seed reserves. Over 60 community and individual nutritional gardens have also been established to grow vegetable during the winter months. The gardens ensure sufficient household food and the nutrition vital for maintaining health. Surplus crops provide some income for immediate needs such as health and education. The vulnerable groups receiving support include women-headed households, child-headed households, and households caring for orphans and the chronically ill, especially those affected by HIV/AIDS.

Critical role for community organizations

Neighboring South Africa is the site of the world's highest HIV infections, but also the country with the most people on ARV treatment. The National Strategic Plan aims to extend treatment to 80% of those with Aids by 2011. The plan also recognizes that Community Based Organizations (CBOs) and Non Governmental Organizations (NGOs) form an essential part of the integrated approach needed to address HIV/AIDS issues at community level.

Oxfam America's partner, The AIDS Consortium (AC) is one of the largest umbrella organizations in South Africa with a network of over 1000 affiliates. Members include CBOs and individuals motivated to meet the needs of the communities they live in. They offer a wide variety of services ranging from support groups for people living with aids (PLWA), job creation projects, home-based care (HBC), feeding schemes and orphan support, to national advocacy campaigns and large-scale treatment services.

Unsung heroes

"Community-based care workers are the unsung hero's of our country in the fight against AIDS and for community development," says AC executive director Denise Hunt, "with very limited resources they are forging ahead and making a huge contribution on the ground."

The AIDS Consortium represents the NGO sector on the South African National AIDS Council (SANAC). Here it is working with government and the private sector to formalize and increase the role of civil society. Hunt believes, "The only way we are going to meet the access to treatment targets are through dramatic shifts in how health care is delivered. Community care workers are in a position to play an expanded role and we are pressing SANAC to secure the finances, training and resources which will enable them enhance to their skills and contribution to service delivery."

Dr Liz Floyd, the head of Gauteng Multisectoral AIDS Unit, agrees that a more significant role for organizations is needed to meet the increasing demand for HBC and other support services.

"Government is developing a decentralized strategy for health care. It is very important to spread the resources to a network of mass-based care workers on the ground in communities in order to build community capacity to respond to and reach the people who need it," says Dr Floyd.

AC founder and Patron, Supreme Court Judge Edwin Cameron, is one of the few public figures to have openly declared his sexual orientation and positive HIV status. He points out that the epidemic is likely to be around for a long time and that community groups are vital to ensure an adequate response for PLWA. "We don't have a cure, but we do have manageable treatment," says Judge Cameron. "The public sector program is good but it is not reaching enough people. Community-based workers can bridge the gap between where we are now and where we need to be."