FINAL REPORT 
A study to determine the quality and level HBC care activities in the Kunene Region 
Prepared for Medicos del Mundo 
Prepared by Jerry Mameja 
March, 2007 


Table of Contents 

Acknowledgement -------------------------------------------------------------------i 

Abbreviation --------------------------------------------------------------------------ii 

Executive Summary ------------------------------------------------------------------iii 

1. Introduction ------------------------------------------------------------------1 
2. Background of Kunene Region--------------------------------------------3 
3. Design and Methodology---------------------------------------------------3 
3.1 Overview ------------------------------------------------------------3 
3.2 Field work------------------------------------------------------------4 
4. Findings ------------------------------------------------------------------------5 
4.1 Caregiver----------------------------------------------------------------5 
4.1.1 Age of caregivers------------------------------------------------------6 
4.1.2 Education of caregivers-----------------------------------------------6 
4.1.3 Training of caregivers-------------------------------------------------6 
4.1.4 Selection of caregivers------------------------------------------------7 
4.1.5 Incentives----------------------------------------------------------------7 
4.1.6 Hours spend on caregiving-------------------------------------------8 
4.1.7 Understanding of roles of caregivers-------------------------------8 
4.1.8 Volunteerism------------------------------------------------------------9 
4.2 Clients 
4.2.1 Educational background of clients---------------------------------10 
4.2.2 Age of clients----------------------------------------------------------10 
4.2.3 Gender and marital status of clients------------------------------11 
4.2.4 PLWHAs Among Those On Home Based Care----------------12 
4.2.5 Dependants of Clients-----------------------------------------------12 
4.2.6 Coverage of CHBC services---------------------------------------14 
4.2.7 Availability of HBC kits for use by care givers------------------14 
4.2.8 Skills of care givers to monitor CHBC services----------------14 
4.3 Coordination and networking----------------------------------------15 
5. Conclusion and Recommendations--------------------------------------------17 
ANNEXES: 

1. FGD-Caregivers 2. LLKI-Caregivers 
3. LLKI-Coordinator 4. LLKI-Patients 
5. FGD-Patients 6. Fieldwork Plan 

Abbreviations 

AIDS Acquired Immune Deficiency Syndrome 
AFM Apostolic Faith Mission 
ARV Anti-retrovirals 
DACOC District AIDS Coordinating Committee 
DHS Demographic and Health Survey 
CHBC Community Home Based Care 
ELCAP Evangelical Lutheran Church AIDS Programme 
IGP Income Generation Projects 
HIV Human Immunodeficiency Virus 
M&E Monitoring and Evaluation 
MdM Mιdicos del Mundo 
MoHSS Ministry of Health and Social Services 
MoU Memorandum of understanding 
MIPA Meaningful Involvement of People Living with AIDS 
MTP Medium Term Plan 
NGOs Non Governmental Organizations 
OVC Orphans and Vulnerable Children 
PLWAs People Living with HIV and AIDS 
NRCS Namibia Red Cross Society 
RACOC Regional AIDS Coordinating Committee 
TOR Terms of Reference 
UNAIDS United Nations Joint Programme on HIV/ AIDS 
VCT Voluntary Counseling and Testing 


ACKNOWLEDGEMENT 

I would like to thank all of those who generously took time from their busy schedules to 
participate in this assessment, to be interviewed, to answer questions, to share their 
views and, in many other ways, to make certain that we had the crucial information 
required to complete this study. In particular it is imperative for us to acknowledge the 
Home Based Care Clients, and the Secondary Caregivers of the Community Home 
Based Care Services in all the communities of Opuwo, Epupa, Sesfontein, Khorixas, 
Kamanjab and Outjo constituencies. I am particularly grateful to the Secondary 
Caregivers and Clients who took the time to participate in focus group discussions. It 
would have been impossible to complete this study without their participation. 

Amaia Unzueta of Medicos del Mundo deserves special recognition for her willingness to 
work late and give up her weekends to ensure that this study was completed on time. 
My special thanks goes to Sister Pujo Mbaumba and Doctor Ebong Akpabio who 
provided as much detail of the Kunene CHBC Programme and the Regional AIDS 
Coordinator, Mr. Charles Uarije, who traveled with us to the communities and paved 
the way for the interviews. We are especially aware that several staff of MdM and their 
key stakeholders from The Ministry of Health and Social Services, The Constituency 
AIDS Committee, Namibia Red Cross Society and Evangelical Lutheran Church AIDS 
Programme, who set aside time from the important business of preventing HIV and 
mitigating the impact of HIV/AIDS in the Kunene Region, to be interviewed as key 
informants. 

I hope I have adequately reflected the information collected in the field and that the 
research findings and recommendations contained in this report will contribute to a 
clearer road map for the Kunene CHBC programme in developing strategies and 
interventions to mitigate the negative effects of AIDS related illness, to an improved and 
increased understanding concerning the challenges experienced by CHBC clients, 
primary and secondary caregivers, their immediate families and communities at large. 

Jerry Mameja 
May 2007 


ii 
EXECUTIVE SUMMARY 
The Namibian government has long recognized the need to strengthen Community 
Home Based Care (CHBC) efforts to ease the congestion and costs of institutional 
hospital care for chronically ill PLWHAs. In order to improve the quality of life of 
PLWHAs, lessen the burden of care on families and the community, the government has 
instituted several policies and guidelines to provide access to CHBC, manage and 
mitigate the negative effects of HIV and AIDS. These policies include; 
. Integrated Training Manual of Community Home Based Care Volunteers 
. Handbook on Community Based Care 
. Guidelines for Home Based Care 
. The National AIDS Policy 
. Community Based Health Care Programme Policy (currently underway) 
In recognition to Community Home Based Care being internationally recognized as the 
backbone of assisting governments to cope in alleviating congestion within institutional 
care, Medico del Mundo (MdM) decided to undertake a baseline study before assisting 
CHBC implementing partners in the Kunene Region. Specifically the study was 
undertaken; 
. To assist MdM to understand the challenges faced by clients, primary and 
secondary caregivers of Community Home Based Care Services with the aim to 
assist implementing partners to design a programme that will appropriately 
address some of these challenges and meet the needs of clients. 
Results from the study show that clients and caregivers face various challenges in 
receiving and implementing Community Home Based Care Services. The lack of proper 
infrastructure in the Kunene Region currently has negative effects on the client as access 
to treatment and nutrition have become limited and caregivers lack basic materials and 
skills to lessen the pain of the client. CHBC in a mature epidemic has become even 
more complex as both primary and secondary caregivers are being asked to do more in 
terms of the services they are providing, which go far beyond the client’s basic needs, 
but encompass the material and psychosocial needs of the children and other members 
of the family. 
Key findings of the study are; 
. Women and children continue to bear a disproportionate burden of HIV in 
terms of prevalence rates and also care, with 76% of women in the 6 study areas 
accounting as carers; 
. Male involvement in CHBC in the region is very limited; 
. Nutritional support of clients is questionable since no concerted effort is made 
to provide patients with balanced diet, except for the e-pap provided for by 

iii 
partners such as MdM. There is also no systematic approach to the provision of 
nutritional support; 
. The bulk of clients on CHBC face challenges that are likely to hinder their 
recovery such as lack of food, nursing care, medical care (treatment) and 
financial support; 
. More than 90% of secondary caregivers did not feel empowered to meet the 
basic needs of their clients with a significant number stating they could not meet 
nutritional, medical fees and basic care and support services; 
. Although, generally caregivers are provided with HBC kits, these are not readily 
replenished; 
. Many lacked skills to meet the psychosocial and material needs of the client’s 
children, knowledge on will writing and comprehensive counseling skills to add 
value to their work; 
. A majority of the clients on CHBC were aware of their HIV status, signifying the 
importance of Counseling and Testing as a significant entry point to primary care 
and support; 
. A majority of the secondary caregivers had received Community Home Based 
Care training. However, the training was not consistent in terms of refresher 
courses to allow them to deal with emerging client issues; 
. The CHBC programme in the region has limited resources and programme 
expansion may become a challenge to meet the basic needs of clients, mainly 
those related to food and nutritional support. 
Partners such as NRCS have basic selection criteria of caregivers and monitoring and 
evaluation systems to track the programme’s achievements, but these needs to be 
further enhanced and shared with others in the region. 
Several recommendations are outlined in this report. The five key foundations for 
CHBC responses relate to: 
. Resource Mobilization to meet the basic needs of CHBC clients who have 
limited to no access to ARV treatment or basic clinical care; 
. Greater coordination among CHBC implementers to effectively respond to 
clients needs; 
. Encouraging male involvement and responsibility to promote care as a normal 
human development lessening the current burden of care on women. Care must 
be recognised as a priority human need and the community must encourage the 
commitment of both men and women to caring work; 
. Structured and consistent training of secondary and primary caregivers to offer 
a holistic menu to clients ranging from HIV prevention, psychosocial care, 
information of treatment preparedness, counseling and testing, psychosocial 
support for children, general disease management and control; and 
. Mobilizing communities to promote and sustain CHBC to alleviate the burden 
of care on the primary caregiver and the family is essential. Many of the 
traditional informal care structures are already overwhelmed and liable to break 

down if they are not given support and these valuable resources need to be 
nurtured, protected and strengthened. 

Taken together, these five approaches will assist MdM to contribute to improving the 
CHBC services and alleviating the negative impacts of AIDS directly on the client and 
lessening the burden of care on the secondary and primary care givers, the majority of 
whom are young women and children. 


1. Introduction 
Namibia is in the unenviable position of belonging to one of the most severely HIVaffected 
countries in the world and in Southern Africa. Although there has been 
considerable progress in understanding the many facets and determinants of HIV 
infection, the likely course of the pandemic and the depth of its impact are still 
unknown in many countries. Resource-limited countries with high rates of infection 
face the biggest challenges, as government and NGO infrastructures are often 
undeveloped and slow to shift their focus away from nation-building and other 
perceived priorities in order to scale up their response to HIV/AIDS. This has been 
the case in Namibia. 

The steep rise in HIV-infection rates came just a few years after its independence in 
1990. Although only 4 cases of HIV were diagnosed by 1986, by 2002 22.3% of all 
pregnant women in Namibia were estimated to be HIV-positive (Ministry of Health 
and Social Services, 2001). Today HIV prevalence is 19.7%. The decline in prevalence 
rates is not indicative of the number of people in need of care and support. It is 
estimated that at least 260,000 Namibians are living with the virus; out of that 
population at least 31,596 are in need of Home Care Service but only 40% are 
receiving home care services. A mature epidemic such as the one being experienced 
in Namibia, more people are succumbing to AIDS and are in need of treatment. 
Although Namibia is at an advanced stage with regard to the provision of care 
through the public and private health services with nearly 50% receiving care, a 
significant number are receiving care at home through the CHBC programmes. 

For nearly three decades community-based engagement and collaborations have 
dominated the efforts from researchers, academicians, and programme managers to 
improve community decision-making and action for health promotion, health 
protection, and disease prevention. As a result of this concerted undertaking, 
community-based organizations (CBOs) have seen enormous increase of individual 
household and community volunteers working collaboratively with or through 
groups of people affiliated by geographical proximity, special interests or similar 
situation to address issues affecting the well-being of their people. 

The devastation of HIV/AIDS, Malaria and Tuberculosis, on communities has 
prompted the Government to call for individuals, households and communities to 
rise up to the challenge of fighting these diseases. The answer to this call is 
evidenced through the increased number of household/community-based 
programmes. One such intervention is an increased activity around community and 
home based care of terminally ill patients as a result of HIV/AIDS. Due to the AIDS 
epidemic, the increase in non-communicable disease, the implications thereof and an 
ageing population’s impending impact on communities, it became necessary to 
consider how best to provide care for healthy people, those with disease and their 
families. Evidently, as more people become ill, most will not be able to stay in 
hospitals, hospices and institutions of care. Home and Community care is a 
formidable tool to provide health services by formal and informal caregivers in the 
home in order to promote, restore and maintain a person’s maximum level of 
comfort, function and health including care towards a dignified death. 


2 
Community Home Based Care has received wider attention in Namibia from the 
Namibian government for its ability to provide continuum of care for the chronically 
ill and PLWHAs in their home environment. It provides services in a cost effective, 
sustainable and comprehensive manner, in a complementary approach to institutional 
care. CHBC programmes by organizations such Namibia Red Cross Society and 
Catholic AIDS Action have therefore been hailed by the MOHSS as an effective 
approach for reducing congestion in hospitals, thereby reducing health/hospital 
expenditures in the face of increasing number of chronically ill (PLWHA, malaria, TB 
patients and other incurable illnesses). Apart from providing care and support to 
clients/patients, the CHBC programmes also seek to enhance or build the capacity of 
clients’ families to offer affordable, quality care for their relatives. 
In order to improve the quality of life of PLWHAs, lessen the burden of care on 
families and the community, the government has instituted several policies and 
guidelines to provide access to CHBC, manage and mitigate the negative effects of 
HIV and AIDS. These policies include: 
. Integrated Training Manual on Community Home Based Care 
. Handbook on Community Based Care 
. Guidelines for Home Based Care 
. The National AIDS Policy 
. Community Based Health Care Programme Policy (currently under way) 
Although the Kunene region is the least affected in terms of HIV prevalence, a 
number of entities providing CHBC have emerged. However, this emergence of 
community based programmes has not been uniform both geographically and in 
operations. This implies that approaches to sustaining them are also varied. 
Collaborative effort is fundamental to success and ensures that care in the 
community becomes care by the community. It is thus fundamentally crucial to gain 
an understanding of the operations of the various service providers and identify 
areas of technical support and greater collaboration. Hence the rapid assessment of 
the effectiveness and quality of the Home Based Care services being offered in the 
region by the various service providers and gather information on areas that need 
improvement in the network system, capacity building need for caregivers and 
identify need for support to the grass root level. The specific objectives of the 
assessment are to: 
. Ascertain the challenges being faced by the care givers, health personnel, 
stakeholders and the community in their efforts to provide quality HBC 
services 
. Provide advise on best practices and weaknesses 
. Identify training and other needs of the clients, community and HBC givers 
. Identify opportunities for collaboration among partners offering HBC services 
and other HIV/AIDS service providers 
. Identify opportunities for collaboration among caregivers of different NGOs 
operating in the same communities 
. Provide advise on the best methods of monitoring HBC services using 
common guidelines in the region 

3 
. Gather and analyse information on common incentives, such as HBC kits, and 
its agreed content 
2. Background of Kunene Region 
The population of Kunene region is currently estimated at 74,110 and 75% of this is 
rural based. The region has the lowest literacy rate in the country at 57%, but 72% 
of the population has access to a radio for the purpose of IEC. According to the 
2004 sentinel sero-survey, the HIV/AIDS prevalence in Kunene was the lowest in the 
country at nine percent and the only region with prevalence below 10%. The region 
is sparsely populated with a density of 0.6 persons per square kilometer and many of 
the roads are not tarred. This creates challenges in delivering social and health 
services to the inhabitants and requires commitments, perseverance and 
resourcefulness on the part of the health workers and public health managers. The 
shortage of critical health care professionals, such as doctors, nurses and social 
workers plagues the region and hampers the provision of quality service delivery. 
This vast region is divided into six constituencies (Opuwo, Epupa, Sesfontein, 
Khorixas, Kamanjab, and Outjo). The administrative functions of the region are 
performed at Opuwo. 
Currently, there are three major HBC players in the region as outlined on the table 
below. The NRCS has the most volunteers (103), followed by MoHSS (69) and 
ELCAP (53). AFM is the latest addition with 5 volunteers and operates in one town 
in the Khorixas constituency. 
Table 1: Trained Home Based Caregivers by different Organisations 
Organisation Constituency 
Outjo Opuwo Khorixas Sesfontein Kamanjab Epupa 
NRCS 26 8 57 - 12 - 
ELCAP 25 7 - 15 5 - 
MoHSS 12 46 11 - - 3 
AFM - - 5 - - - 
TOTAL 75 61 73 15 5 3 
3. Design and Methodology 
3.1 Overview 
Four main approaches were incorporated to collect information on HBC activities in 
the Kunene region namely, a desk review of the existing literature, a questionnaire, 
in-depth interviews, key informant interviews with stakeholders, supervisors, 
national managers, regional coordinators, caregivers and patients and focus group 
discussions with clients and caregivers. 

The main reason why multiple-methods were opted is that we are cognizant of the 
fact that no single research method would capture all of the changing features of the 
social phenomena being studied. Thus, the benefits and shortcomings of the various 
methodologies were considered and an integrated approach was used which 
combined elements of both qualitative and quantitative data, enabling triangulation. 

3.2 Field work 
The fieldwork was carried out over a period of one week, starting 28 January until 
03 February. The research team visited the following constituencies: 1) Opuwo, 2) 
Kamanjab, 3) Sesfontein, 4) Epupa, 5) Khorixas, and 6) Outjo 


4. Findings 
4.1 Caregivers 
Table 2: Number of caregivers interviewed 
Constituency Male Female 
Outjo 2 7 
Opuwo 2 6 
Khorixas 0 11 
Sesfontein 4 6 
Kamanjab 3 6 
Epupa 1 2 
TOTAL 12 38 

We interviewed 50 people, 12 male and 38 female. That means that female 
secondary caregivers constitute 76% of the caregivers. This depicts, more male 
clients are being taken care of by female care givers as male caregivers are hard to 
come by. There are various reasons of low male involvement in CHBC programmes, 
as traditionally, socially and culturally care has been the domain of women since its 
viewed as domestic work. Domestic work is viewed as low status since it is not paid 
(women’s work) and men are expected to be breadwinners and should prioritize 
income paying employment instead of voluntary work. Therefore the role of caring 
for the sick has been regarded as the full responsibility of women including the girl 
child. 

In addition, women bear a disproportionate burden in terms of HIV prevalence in 
Southern Africa. Recent estimates done by UNAIDS suggest that women account for 
over 60% of all new HIV infections in the region. The recent Namibia DHS (2000) 
corroborates the findings, where it is estimated that women bear the 
disproportionate brunt of the epedemic, with an estimated 39% of women under 30 
years being positive compared to 29% of men of the same age. In addition women 
also overwhelmingly bear the burden for the physical and emotional caring of the 
sick. In Southern Africa it is estimated that women account for 95% of carers in HIV 
and AIDS programmes. 

The table above indicates the majority of caregivers are women. In all the five 
constituencies of the study, women account for the bulk of carers of CHBC clients 
for both primary and secondary care services. The obvious dominance of women in 
the HBC programme have profound implication for the sustainability of such a 
programme, as there is a continuation of male centered power relations among men 
and women in Namibia. Until such time when we have developed and implemented 
evidenced based strategies that empower women, success and sustainability must be 
understood in the context of the contradictions and tensions of gendered 
relationships. 


6 
The challenge for the Kunene CHBC programme design is to develop and implement 
strategies that will involve more men in CHBC services but continue to motivate 
women who are already doing the bulk of caring. 
Therefore, it is recommended that MdM plays a role to: 
. Assist the CHBC programme to devise strategies for male involvement and 
motivation, such as regular male workhops/conferences and specific activities 
targeted at men etc.; and 
. Work with its partners to look at their recruitment criteria to cater not just 
for male involvement and motivation, but to promote care for it to be 
recognized as a priority human need and that society must encourage the 
commitment of both men and women to caring work. 
4.1.1 Age of caregivers 
The average age of volunteers is 27 years, while that of the clients is 40 years. The 
age group of the Caregivers is essential in determining the training needs and 
resources required for effective care of CHBC clients by the age groups. It is also 
essential to note the age of the youngest primary caregiver, who is likely to be an 
out of school girl. This fact was more evident in Sesfontein where the majority of 
caregivers are young boys and girls whose primary motivation to join the 
programme is to improve their Curriculum Vitae, thus increasing prospects for 
empoyment. 
The greatest challenge faced by such young caregivers is the exposure to cross 
infections as well as compromising their ability to perform their duties, mainly when 
they are not properly trained. It will be critical for the programme design to enhance 
appropriate training geared towards these younger caregivers. 
4.1.2 Education of caregivers 
Namibia’s literacy levels are relatively low compared to its neighbours, estimated at 
65%, with the Kunene Region at 57%. The study included the level of education of 
caregivers. This was deemed essential for the Kunene CHBC programme to 
develop or re-package training materials and information to enhance skills, 
understanding and knowledge of Caregivers implementing CHBC services. Enhancing 
the skills and understanding of Caregivers is likely to improve the quality of care 
offered to CHBC clients. Most volunteers (90%) can read and write and over 70% 
have reached Grade 10. 
The programme design will need to re-package information and training materials to 
enhance skills to improve the quality of care being provided to CHBC clients by 
caregivers. Subsequenty, the strategies will need to take cognizant of the educational 
levels of both CHBC clients and care givers (primary and secondary) and must take 
care not to exclude caregivers who cannot read, regardless of their small 
proportion, but develop pictorial materials that will encourage their understanding 

7 
4.1.3 Training of caregivers 
Table 3: Training conducted by HBC implementing partners 
It is important that training be provided to all caregivers to enable efficient delivery 
of care and also acts as prevention tool against cross infection, stress and burnout. 
The National Home Based Care guidelines clearly articulate the following topical 
issues to be covered in the CHBC training; communication skills, basic facts about 
STIs, HIV and AIDS, basic nursing, infection control, counselling, home visits etc. 
About 90% of the Secondary Caregivers responded they had received training at one 
point on the aforementioned topics. The topics that have been covered in training 
include; basic counselling, child development, children’s rights, caring for the patient, 
communication skills, prevention of HIV transmission, nutritional needs of HIV and 
AIDS patients, psycho-social support, prevention of parents to child transmission, 
home visits, breast feeding, infection control, risk behaviours and prevention of bed 
sores. 
Although, over 80% of the volunteers feel that they received adequate training in 
counselling and that the training was sufficient at that point, more refresher training 
is needed due to the changing nature of the epedemic, and emerging issues such as 
ARVs, natural remedies, nutrition, and OVC care. It is obvious from the above 
table that almost all of the Caregivers recieved a once-off training in 2005. This is a 
worrisome fact considering the changing nature of the HIV/AIDS pandemic. In 
addition, volunteers would need more and continuous trainings that covers basic 
communication, will writing, and infection control. Primary caregivers should be 
given similar trainings. 
It is recommended that MdM work with stakeholders, both at the regional and 
national levels, in their efforts 
. To speed up refresher trainings; 
. To coordinate trainings and develop a standarized training manual and 
ranslate it into the local languages and 
. To increase the numbers of trained caregivers in constituencies, such as 
Sesfontein, Epupa and Kamanjab 
Organisation Training conducted Number of 
people 
trained 
Constituencies Year 
Conducted 
MoHSS Opuwo, Epupa, 
Khorixas, Outjjo 
1999, 2001, 2003, 
2004, 2005 
72 
NRCS Opuwo, 
Kamanjab, 
Khorixas, Outjo 
2005 103 
ELCAP Opuwo, 
Kamanjab, 
Sesfontein, 
Outjo 
2005 52 

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4.1.4 Selection of caregivers 
All informants were asked how they became volunteers or how volunteers in their 
respective communities or organisations are selected. Generally people become 
volunteers by their own initiative, or through a selection by either internal 
mechanisms at community level or through outside initiatives by individuals, 
government or non-governmental organisations. The approaches are varied, as 
indicated in the table below. 
Table 4: Selection criteria of caregives 
Organisation Selection Crietria of volunteers 
Namibia Red 
Cross Society 
. Community announcements 
. Selection based on set criterias, i.e education, social 
engagement, age etc. 
ELCAP . Church announcements 
. No set criteria (based on willingness) 
MoHSS . Selection by nurse/s based in hospital 
The selection approach for volunteers is a very critical factor in volunteer attrition. 
When volunteers are selected by community structures within their environment, 
these structures are more likely to provide support and morale to them, thus 
reducing the chances of them discontinuing with volunteering. Some defined 
selection criteria that includes “minimum age” and “prior social engagement” must 
be considered. In addition, the Regional HBC Committee should take steps to 
standardise the selection criteria. 
4.1.5 Incentives 
Motivation and retention of volunteers remains a problem. As the number of clients 
in HBC has increased, it has become increasingly difficult to motivate and retain 
volunteers. 
Many of the volunteers we spoke to are rewarded materially or monetary for the 
services they deliver. Generally, CHBC volunteers feel that they should be rewarded 
for the services they render, because they too must meet their needs of transport, 
food and clothing. Volunteers expect that if resources allow, they should be given 
bicycles, pay school fees for their children, free medication, washing soap, access to 
government food and input schemes. 
Much has been said about whether the provision of incentives by donors or external 
organizations to community volunteers destroys existing mechanisms or could 
influence the work of volunteers positively or negatively. According to CHBC 
volunteers, although they understand that the concept of outside organisations giving 
volunteer incentives may not be sustainable once funding comes to an end, it is still 
imperative to consider the circumstances under which they operate. Additionally, 
the government should standardise or put in place volunteer incentives. Volunteer 
turnover creates major problems where incentives are not standardised. For 

instance, the NRCS provide incentives of up to N$ 200 a month for their facilitators 
and N$ 500 for supervisors, whereas ELCAP provides as little as N$ 20 a month. 
To ensure sustainability of this concept, communities should work closely with 
implementing organisations to find ways of skills transfer. Furthermore, communities 
should get involved in income generating projects such as gardening, farming and 
poultry to help sustain the volunteering concept. 

Some also propose that the government should take steps to internalise volunteer 
incentives to ensure that once donor fatigue sets in, these vital activities are 
maintained. Importantly is that government services are enhanced by the use of 
volunteers and therefore should facilitate the development and implementation of a 
minimum standard of volunteer tools and materials that include risk-compensation. 

4.1.6 Hours Spend on Caregiving 
The epidemic is taking an enormous toll on the country’s economy and health 
services. Life expectancy declined to 42 years in 2001, from over 50 year in 1997. 
Furthermore, recent studies suggest that AIDS patients occupy up to 50 percent of 
hospital beds and experience multiple severe illnesses, requiring increasing days care 
with the majority of care happening at the community/ family. 

Table 6 below summarises the number of times in a month that caregivers see home 
based care clients. 

Table 5: Number of times Caregivers see CHBC clients 

Measure Number of times per month 
Minimum 1 
Maximum 30 
Average 6 

A wide variation exists in terms of the reported number of days/hours volunteered 
by the secondary caregivers. The number of days per week volunteers work depend 
entirely on the condition/state of the CHBC client and the distance to the client. On 
average caregivers visit CHBC clients six times a month and each visit takes an 
average of 45 minutes. This means that on average, caregivers spend 4.5 hours on 
caregiving per month on client. Whilst this number of hours is acceptable due to the 
number of clients and distances each care giver is likely to cover, in the absence of 
support at the family level, this greatly compromises the quality of care. In addition, 
75% of the time was devoted to travel and 25% to clients. Almost no time is spent by 
volunteers training family carers who provide continuous care. The quality of the care 
provided to clients would improve tremendously were more time set aside to train 
family care givers to do the bulk of the caregiving. This would also enable the care 
givers to significantly scale up the coverage of the programme in their catchment 
areas. 

The implication of the HBC programme design will be to devise strategies that 
increase quality for the improvement of a clients’ health. This may mean reducing the 
number of clients per caregiver and enhancing the skills of the primary caregiver. 


Therefore, it is importnat to enhance and promote caregiver strategies that improve 
the quality of services at client level. 

4.1.7 Understanding of roles of Caregivers 
Most secondary caregivers in the six constituencies studied are unemployed (77.5%). 
On averaged, many of the volunteers have been in service for about three years. 
Secondary caregivers do so for various reasons such as to assist the community, help 
others in difficult situations, volunteer out of compassion, want to take care of 
OVCs and also that some of them have a relative with the same problem hence the 
need to help others. Others felt that, they might need the same help at some point 
in their lives as this has become everyone’s problem. Furthermore, the study shows 
that if secondary caregivers had a family member with HIV and AIDS they would 
definitely recommend him/her to a CHBC programme, showing appreciation and 
acceptance offered by CHBC services. 

Worrisome is the consistent response in all the constituencies of caregivers who 
actually indicated that they became volunteers because they did not have anything 
else to do. Although this is an inevitable truth, it is worth investing in the training of 
these volunteers to ultimately enable them to regard their role of caregiving as 
pivotal to enhance the well-being of their societies. Hence, the need to develop 
comprehensive information strategies in order to enhance the understanding around 
issues of care. Primarily, strategies that include counselling for primary caregivers is 
important to reduce this risk. 

4.1.8 Volunteerism 
Secondary Caregivers were asked to describe what volunteerism means to 
determine their understanding of Volunteerism in the context of CHBC 
programmmes. 

The sixth edition of the Oxford Dictionary describes a volunteer as a person who 
does a job without being paid for it, a person who offers to do something without 
being forced to do it. Informants from CHBC volunteer describe a volunteer as 
someone who is mature, merciful, loving and committed to look after orphans, the 
sick and their children without being paid. The volunteers further presented the 
characteristics of a volunteer as someone who is; dedicated, patient, soft hearted, 
sociable, mature and can read and write. 

The study revealed that in general women are more likely than any other group 
within the community to volunteer their services. The catergory of female 
volunteers includes young women, single and widowed women, and a few men who 
are not employed. 

The types of volunteer groups that exist in the Kunene communiies were said to be 
churches, political groups, local leaders, village community leaders, peer educators 
and teachers. These volunteer groups were chosen by villagers or the community. 


11 
4.2 Clients 
Table 6: Number of clients interviewed 
Constituency Male Female 
Outjo 0 3 
Opuwo 1 6 
Khorixas 1 8 
Sesfontein 0 0 
Kamanjab 3 5 
Epupa 1 2 
TOTAL 6 24 
The data clearly corraborates earlier statements of the disproportionate burden of 
HIV/AIDS on women and that risk and vulnerability to HIV/AIDS are substantially 
different for men and women as is most evident in the marked age and sex 
differentiated HIV prevalence rates in the country. Women are also more willing to 
come forward and seek HBC services than their male counterparts. 
4.2.1 Educational background of clients 
The highest level of education for the majority of clients is primary school with less 
than 30% reaching high school. Seventeen percent of the clients have never gone to 
school. The implication of the Kunene programme is to develop strategies for 
educating clients about disease management and control at the client level. This will 
empower clients to manage their own illness since the greatest challenge faced by 
clients is lack of and access to appropriate information. 
4.2.2 Age of clients 
The average age of a client is 40 years, compared to the average of caregivers which 
is 27 years, meaning that an increasing number of older clients are cared for by 
younger caregivers. The findings also show that the youngest age of the CHBC client 
is 2 years. Namibian Estimates put the number of children under 18 yeras living with 
the virus at 10% showing more children are surviving beyond the 3years old 
stipulated age of an HIV infected child. Although Namibia is doing well compared to 
its neighbours, a lot still needs to be done to enable children to access ART. Proper 
care for children is still limited and the numbers of children on treatment is minimal 
due to; 
. Lack of convenient paediatric formulations for ARVs; 
. Lack of skills for counselling children with HIV and AIDS; and 
. Lack of adequate skills to provide ART services by Health workers. 
The implications for the programme design is how to meet the needs of these 
youngest clients with appropriate information and reassurance for the children to 
cope with their illness. Therefore, there is need for the programme design to 
develop strategies that will cater for the needs of both older and youngest clients of 
CHBC programmes. Secondly, strategies will need to improve the skills of younger 

caregivers, who lack the skills and the protection of cross infection during caring and 
lastly training for both primary and secondary caregivers will need to take cognizant 
of the age groups. 

4.2.3 Gender and marital status of clients 
Caring for the sick has traditionally been the responsibility of women, due to their 
low social and economic status in the region. Generally in the Kunene region, men 
are expected to be breadwinners and therefore should highly prioritize incomepaying 
jobs instead of voluntary work. Therefore, the role of caring for the sick has 
been viewed as the responsibility of women, including the girl child and as the table 
below illustrates, the burden of care falls on women. 

Table 7: Marital status of clients 

Constituency Married Unmarried Widow TOTAL 
Male Female Male Female Male Female 
Outjo 0 0 0 3 0 0 3 
Opuwo 0 0 1 5 0 1 7 
Khorixas 0 0 1 8 0 0 9 
Sesfontein 0 0 0 0 0 0 0 
Kamanjab 1 0 1 6 0 0 8 
Epupa 1 1 1 0 0 0 3 
TOTAL 2 1 4 22 0 1 30 

The study included the relationship between CHBC clients and their caregivers and 
also marital status. The major reason for this inclusion was to determine who is 
taking care of the client. In all countries implementing home based care services, 
families have always been, and remain the major providers of long term care. This is 
true for the care of both the elderly and people with chronic illnesses due to AIDS 
related illnessnes such as TB. However, it is increasingly recognised that families 
cannot continue to increasingly shoulder such heavy burdens alone. 

As shown on the above table, most community home based care clients are young 
women who are not married. The burden of care giving is borne primarily by 
women, who generally have very little access to, or in control of the resources 
needed to assume this responsibility. Thus, while the need for home care is growing, 
there is a very real and increasing danger that families who have neither the means 
nor the knowledge required for such an important task will be left to their own 
devices to shoulder care giving responsibilities. The implication for the Kunene 
CHBC programme is to device strategies that are supportive to reduce the burden 
of care at the family level, especially on women. Due to economic factors, family 
resources to provide quality care are reducing, hence the need to develop support 
mechanisms which take cognisance that families still provide the majority of care for 
the terminally and chronically ill. 


4.2.4 PLWHAs among those on Home Based Care 
Very little is documented on how PLWHAs are actively contributing to CHBC 
programmes rather than just as receipients of services, even though it is well known 
that many of caregivers themselves are HIV positive or have nursed a spouse or 
relative with AIDS related illnesses. UNAIDS has documented1 the merits of 
meanifully involving PLWHAs in all HIV and AIDS programmes firstly to reduce 
stigma and discrimination and secondly to tap on their vast experiences. 

Greater and meaningful involvement of PLWHAs is of paramount importance to the 
success of CHBC programmes like the one being embarked upon by partners in the 
Kunene region, especially as the majority of CHBC programmes are geared towards 
PLWHAs. The survey shows that PLWHAs constitute the majority (86%) of those 
clients receiving CHBC services and 14% of the clients do not know their status. On 
the other hand, only a small fraction of the CHBC caregivers knew thier status. 

However, though it was not the objective of this study to find out if any of the care 
givers are PLWHAs, it is hoped the programme design will incorporate the 
involvement of PLWHAs as caregivers, due to their vast experience, resilience and 
coping mechanisms as role models. Involving PLWHAs makes strategic sense, 
empowers PLWHAs, reduces stigma and discrimination and raises self esteem. Some 
of the CHBC clients felt powerless to play their role in decision making processess 
in the family due to their status. 

Development of strategies that include and involve PLWHAs and the chronically ill in 
decsion making processes is crucial to ensuring sustainability of the programme. It 
has been documented that those receiving CHBC services identify with others like 
them. The establishment of post test support clubs and groups of people living 
openly with the disease, in the communities to provide an entry point to CHBC 
service is key. This will increase the meaningful involvement of PLWAs (MIPA) in 
MdM’s programmes thus increasing its learning agenda around assisting initiatives 
that involve infected persons. 

4.2.5 Dependants of Clients 
Namibia has been at the forefront of promoting family planning, but this has been a 
challegge in some regions, like the Kunene as the results from the study indicate 
CHBC clients do have a sizeable number of children who require care when a parent 
is ill or the other parent is deceased. When a parent falls ill, the needs of children 
are likely to suffer as resources are diverted to taking care of that ill parent, 
especially if it is the bread winner. 

The study results reveal that, the CHBC clients have had an average of 5 children or 
dependants. These children according to the Government of Namibia’s National 
Action Plan on Orphans are classified as living in difficult circumstances and will 
require care and support. 

1 From Principle to Practice: Greater Involvement of People Living with or Affected by HIV/AIDS (GIPA): 
UNAIDS Best Practice Collection (2004) 


14 
There is no doubt that HIV and AIDS is having a devastating impact on children with 
more than 14 million having lost one or both parents in East and Southern Africa. In 
Namibia, the increasing death rates as a result of HIV/AIDS have left in their wake a 
growing number of orphaned children currently estimated at 162,000 children in 
need of care and support. It is estimated that in a single year, some 800,000 infants 
are infected with HIV (600,000 through mother-to-child transmission), and some 
580,000 children have died of AIDS (East and Southern Africa). If the 1980s was the 
decade of HIV infection and the 1990s was the decade of AIDS, the 2000s are an era 
of orphan-hood in the East and Southern Africa regions. The declining HIV 
prevalence rates in Namibia are not indicative of a declining orphan population. In 
fact the orphan population is estimated at 162,175 by 2006/7 up from 131,130 in 
2004/5. CHBC are viewed as a significant entry point for identifying and supporting 
vulnerable children before the death of their parents. However, various studies have 
shown that despite the efforts being done by CHBC caregivers at the client level, the 
needs of children are very rarely met and most interventions only start after the 
parent has died. The results from the study show that the children’s needs of CHBC 
clients are met by a small number of secondary caregivers, leaving both the sick 
parent anxious of what is going to happen to their children. 
CHBC Secondary Caregivers are not meeting the needs of CHBC clients’ children as 
they are not trained in OVCs but trained mainly to meet the needs of the client. 
However, the study results show that the Secondary Caregivers are cognizant that i) 
they are not meeting the children’s needs; ii) the clients worry about the children 
and iii) the care givers are not sure how to support the children. The study results 
concluded that clients want the following children’s needs addressed; school fees, 
food, uniforms, stationery and clothes and most importantly psycho-social support. 
The implication of the Kunene CHBC programme is the need to develop strategies 
to integrate OVC care into the CHBC programme. 
It is therefore recommended that MdM assist partners to: 
. Develop strategies for OVC integration into CHBC programme; 
. Train CHBC Care givers (both primary and secondary) on how to cope and 
meet the needs of children during parental illness, such as psychosocial 
support, bereavement trainings and other trainings that will enhance care and 
support for CHBC clients children; 
. Develop and implement referal systems of support for CHBC clients children 
and train the caregivers of those referals; 
. Ensure follow up mechanisms to make sure referal systems are in place and 
followed up to lessen the burden on secondary caregivers as currently they 
feel it is their duty to meet those needs; 
. Assist the primary caregivers to fully understand the role and limitations of 
the secondary caregivers especially in providing material support. 

4.2.6 Coverage of CHBC services 
Graph 1: Clients requiring CHBC service 
0 
20 
40 
60 
80 
100 
120 
% 
Outjo Opuwo Khorixas Sesfontein Kamanjab Epupa 
Requiring Care 
Receiving Care 
A total of 162 clients are enrolled in the CHBC programme in the Kunene region, of 
which 160 are with the NRCS programme and only two with ELCAP. Obviously, the 
existing responses in the region have limited coverage, that is, few people needing 
CHBC services, actually receive it. The total enrollment of 162 represents only 41% of 
the estimated numbers of people requiring care in the region. Moreover, attention 
should be provided to the Sesfontein constituency where no client receives support. 

4.2.7 Availability of HBC kits for use by care givers 
While caregivers are willing to volunteer, the lack of and late replenishment of 
CHBC kits hampers their work to improvement of services. This is a worry to 
caregivers who feel they are not meeting the adequate care needs of their clients, 
especially those who are bed-ridden. It is also important that partners agree to a 
standard CHBC kit using MoHSS guidelines. 

Discussions around home remedies must be openned and caregivers advised 
appropriately. The proposed CHBC coordinating committee could add value to the 
programme by initiating a review of which medicinal plants are used by different 
groups in the region as home remedies for specific symptoms. The committee could 
start discussions with the MoHSS on pharmacological effectiveness testing of some 
of these plants. The results can be used to advise CHBC givers and could ultimately 
form part of the kits. This may enhance sustainability of the HBC programme. 

4.2.8 Skills of care givers to monitor CHBC services 
Monitoring and evaluation systems that produce limited data to inform programming 
in the region is weak. The NRCS is the only service provider with some sort of a 
monitoring system, where caregivers are expected to provide periodic reports, 
which are linked to the monthly allowance of the facilitators and supervisors. While 
this is commendable, it is noted that lack of transport, distance to be traveled and 


weak supervision of secondary caregivers render the system ineffective. In addition, 
these reports are collected merely as a mandatory exercise and requirement from 
donors other than to advice programme intervention at the local level. We have 
not found any evidence of an explicit monitoring system with the other major 
players in the region. 

Therefore, the coordinating mechanisms, as described below, become crucial to 
develop monitoring tools for all CHBC activities to enable it to effectively evaluate 
the impact of the programme at the regional level. 

4.3 Coordination and networking 
Another objective of the study was to determine the extent to which CHBC 
implementing partners’ activities are coordinatred. Namibia is increasingly identified 
as a ‘success’ in terms of its national response to HIV/AIDS. Explicit political 
commitment from government, understanding of the multi-sectoral dimensions of 
the epidemic, attention to issues of discrimination, and work at the community level, 
are all cited as important ingredients of this success. In short, critical elements of an 
enabling environment exist in this country. The potential of a well-coordinated 
response to form a critical part of local, national and regional responses to the 
epidemic was recognized as early as during the development of the First Medium 
Plan on HIV/AIDS (MTPI), in part because sustained and effective multi-sectoral 
responses to HIV/AIDS depend just as much on personal and society-wide 
commitment as on interventions that external observers may view as necessary. 
Therefore, providing an enabling environment became a key area in the fight against 
HIV/AIDS with a broad range (both thematic and geographic) partners. 

CHBC programmes in the Kunene region are still fragmented and coordination is 
weak. This might contribute to duplication and competition among CHBC providers, 
as well as weak CHBC programming, largely due to poor networking and 
information systems. The study revealed that no formal structure exists, other than a 
recently established committee, consisting of members of the NRCS, MoHSS and 
ELCAP with the support of MdM. The committee is not yet effective but it is 
envisaged that its main role would be to oversee the activities conducted by the 
various partners, because of the realization that this could not possibly function 
effectively within such a loosely defined structure. It is of critical importance that 
this committee be properly instituted as a body that will manage and administer 
CHBC activities in the region, with well defined terms of reference, membership, 
and responsibilities to provide the required leadership and authority and to 
strengthen the management of the activities up to the local level. The implementing 
partners will need to be made responsible and accountable for achieving the results 
to which they commit themselves. The committee would also strengthen 
mechanisms for continuous learning through performance monitoring and reporting 
(PMR). Because of its role as the coordinator of civil society and government 
activities at the regional level, it is imperative that the committee be endorsed by 
The Regional AIDS Co-ordinating Committee (RACOC), most preferably as a subcommittee 
within RACOC, and through the same mechanisms filter down to the 
Districts AIDS Co-ordinating Committees (DACOCs). 


Furthermore, areas that need further strengthening and development include: 
securing more direct participation by PLWHAs, greater investment in the capacity of 
partner members to participate in working towards the overall objectives, 
participatory development of a focused agenda and a more effective managed 
structure at the constituency level. Constituency level coordination mechanisms, 
such as DACOCs need strengthening to provide support and linkages to other 
health services and community-based initiatives on palliative care. 

Another dimension to the strengthening of coordination is community involvement, 
were communities could be empowered to take ownership of the concept of 
volunteerism through mobilising the community by making use of local leaders and 
other gate keepers, the establishment of IGPs, and encouraging a unity of purpose. 
Efforts must be made to provide communities with more workshops on 
volunteerism so that the concept is further enhanced. 


18 
5. Conclusion and Recommendations 
The study reveals that, the bulk of clients on community home based care face 
numerous challenges which include; lack of food, nursing care, medical care and 
financial advisement; Very few clients face challenges such as lack of legal assistance, 
gloves and infection controls, dressing/bandages and condoms. What is of paramount 
importance is that nutrition should be the back bone of a CHBC client. For 
PLWHAs good nutrition is significant to improve their health, quality of life and 
leads to their recovery. When good nutrition is absent, their decline in health is 
inevitable, as access to food in the era of treatment is of utmost importance. 
Although the study did not go into details of meals per day of clients, it is crucial to 
note that access and ability for continued food generation will be paramount to 
clients prolonged good health. Both clients and caregivers in the study cited food as 
a challenge. Therefore, we recommend the following to be done: 
. Develop strategies to incooperate nutritional support in CHBC programme; 
. Establishing or reviving nutritional gardens for access to food generation; 
. Enhance the capacity of primary, secondary caregivers and their clients and 
clients families to establish and run IGPs; 
. Consistent provision of Kits to Caregivers to enhance their services to 
CHBC clients; 
. Distribute food and strengthen referal support for food packs. 
Major challenges facing CHBC caregivers when offering services to their clients are 
numerous and relates to lack of resources to meet the needs of the clients and their 
children, knowledge on writing wills and infection control and balanced food for the 
client. These challenges also represent the priority areas for CHBC primary care 
givers. In addition, the appropriate training of caregivers and the provision and 
replenishment of CHBC kits are two critical elements to the improvement of 
services offered by CHBC caregivers. The absence of kits is a worry to caregivers 
who feel they are not meeting the adequate care needs of their clients. Caregivers 
feel they require information and more training to assist them to meet these needs. 
Developing appropriate strategies and responses to enhance CHBC is critical to any 
efforts by MdM to prevent HIV transmission, improve care and support for PLWHAs 
and their families, and mitigate the negative impacts of HIV and AIDS pandemic in the 
Kunene. MdM’s main comparative advantage is being currently grounded in the 
community, has built relations with the community leadership and the community in 
general, thus in this respect MdM’s visibility in the community is readily felt. 
There are critical factors—all interconnected—that place CHBC services at the core 
of improving the quality of care offered which must be addressed by MdM and it’s 
CHBC implementing partners in the 6 constituencies systematically if the CHBC 
programme is to achieve its objectives. These are: 
. The impact of HIV and AIDS differs markedly along gender lines in regards to 
the provision of CHBC services, reflecting men and women’s different roles 
and responsibilities in the household and marked activities- this has 
implications for care, support and programmes. The strategies to be 

19 
employed need to take into consideration women’s contribution to CHBC, 
but not forgetting the need to include male involvement to lessen the burden 
of care especially on women and children; 
. The need to employ a community based CHBC programme that focuses on 
community commitment to care and male involvement and responsibility. 
This intervention needs to address in a robust manner issues such as 
appropriate training, information re-packaging and dissemination, addressing 
denial and stigma among CHBC clients, gender inequality in CHBC 
programmes, directly involve people living with HIV and AIDS, in order to 
achieve the CHBC objectives to improve the quality of care for CHBC 
clients; 
. The need to develop strategies that address disease progression, stigma and 
discrimination and openness. This is possible if the programme intensifies the 
use of PLWHAs as agents of openness with a disease that still carries a lot of 
stigma; 
. Evidence shows that projects are more likely to succeed if they are closely 
linked to the services they promote, services are available and participants 
can access the services that are promoted. This represents a challenge for 
the CHBC programme, which has limited resources in terms of the provision 
of CHBC kits, funds to expand IGPs standardized trainings for both primary 
and secondary caregivers, limited incentives for volunteers to access services 
being provided (school fees for their children, food packs, blankets etc), ARV 
treatment and facilities for testing and counseling. There is a need to 
strengthen the strategic partnerships with government, development partners 
and other health service providers to develop specialized services such as 
advocating to access to treatment, counseling and testing, food packs, 
appropriate training for primary and secondary caregivers and provision of 
CHBC kits. This could greatly enhance and improve the quality of services 
provided by the CHBC programme and impact positively at the client level; 
. Family caregivers are the most important human resource in CHBC. They 
usually provide the greater part of all care, yet the majority of them lack 
training in basic health care. Far too often as noted in the study their ability 
to provide for their own personal, social and financial needs is seriously 
compromised by their care giving roles. The CHBC programme must 
develop strategies that empower and are supportive at the family level, but 
also ensure this support comes from the community to enhance the supply, 
quality, and sustainability of care which is essential to the CHBC programme. 
. A multifaceted coordinating mechanism must be set up where issues of 
coordination, standardization of training and incentives, selection processes 
and criteria of volunteers, HBC kits and replenishment, etc. are discussed and 
agreed upon. This becomes the foundation for a successful approach to 
community engagement. Due to the vastness of the region, this will 
inevitably follow an approach where sub-committees are established in al or a 
few of the constituencies. 

FOCUS GROUP DISCUSSION 
CAREGIVERS 


Final 


Name of Facilitator: 
Name of Note-taker: 
Name of Assistant/Other: 
Name of Community: 
Name of Committee: 
Number of Participants: # Male: # Female: 
Start time: Finish time: Total Time: 
Note-taker self-check (Print name): 
Facilitator check (Print name): 
Other check (Print name): 

1. Region: _______________________ 
2. Date: _________________________ 
3. Level of Cooperation: ____ High ____ Medium ____ 
Low 
Greeting First 

(Introducing yourself) My name is ______________________________, and I am carrying out 
a survey for Medicos del Mundo with the aim to assessing community HBC provided by the 
various stakeholders in the Kunene Region. The purpose of the survey is to uncover the 
different approaches used in the deliverance of HBC, to enable MdM to come up with a unified 
approach in assisting the regional response to HIV/AIDS. The information you will provide will 
be kept confidential and will be used only for the above purpose. Your co-operation in this 
regard will be highly appreciated. 

A 



DEMOGRAPHIC INFORMATION 


4). 
Tell us a bit about yourselves, including the following; first name, highest education level, 
length of stay in the community, employment status, your position in this committee, 
number of children you are caring for and whether you are the head of the household you 
are currently living in. 

CARE AND SUPPORT 


5). 
What is your understanding of a caregiver? [Probe for characteristics of a caregivers, at home 
level, community level, etc.] 

6). 
In your community, who are more likely to volunteer to care and support for the ill? 

[Probe for characteristics of a person who would most likely become a caregiver e.g. age, sex, 

employment status, status in community etc.] 

7). 
What type of caregivers exist in your community and broader area? [Probe for the 

different groups such as ELCAP, RED CROSS, MoHSS etc.] 

a) How were these caregiversvolunteers identified/selected? 

b) What the roles and responsibilities of these caregivers? 

c) On average, how much time (hours) do these caregivers devote to volunteer work 

per day? 

d) On average, how many days do these caregivers work per week? 

e) Please describe the geographical coverage of these caregivers? [Probe for specific names 

of the villages/communities served, distance covered, means of transportation, etc.] 
f) Who are these caregivers? [Probe for characteristics of the caregivers; e.g. gender, age, 

employment status, etc.] 
g) How long did these caregivers serve the community(s)? 
h) How long will these caregivers be serving the community(s)? 
i) How were these caregivers established? [Probe to determine whether it was a community 

initiative or an outside initiative] 

8). 
In your opinion what motivates people to provide caregiving in any community? What do 
you/they enjoy about being a caregiver? 

9). 
In your view, what are the challenges of being a caregiver? [Probe for examples of specific 
challenges faced.] 

TRAINING 


10). Have you received any training? 
a) [If training was provided] What type of training did you receive? [Probe for duration and 
type of training]. 

11). 
Do you feel the training was adequate? [Probe for how this is monitored and evaluated]. 

B 


a) 
Do you think you have the skills and experience to be providing the services you do? 
[Probe for an explanation]. 

12). 
[Ask this question even if the volunteer received any training to establish whether additional 
training is needed, if any] What type of training (or additional training) do you need? Please 
describe in detail. 

INCENTIVES 


13). 
How are you rewarded for the services you deliver? [Probe for any other type of rewards 
and not only rewards in the form of money and materials]. 

14). 
Are you aware of volunteers doing similar work in other communities or regions who are 
provided with incentives? [Probe for the type of incentives they receive] 

CARE AND SUPPORT 


15) In total how many patients do you provide support to? (probe for each participant in the 
FG and get a sense of the age and sex differences) 
16) What material support do you receive from your organisation? 


SUSTAINABILITY 


17). In your view is the concept of outside organisations giving volunteer incentives sustainable, 
once funding comes to an end, please elaborate. 
18) (In the case where they receive incentives) If you were not receiving incentives, would 
you still care for your patients? 

CLOSURE 


19) 
Do you have any other closing comments? 

Thank you very much for your time and cooperation 


Local Level Key Informant Interview Guide 
Caregivers 
Final 


1. Region: _______________________ 
2. Date: _________________________ 
3. Community:________________________ 
4. Organisation affiliated to:___________________________ 
Greetings 

My name is ______________________________, and I am carrying out a survey for Medicos 
del Mundo with the aim to assessing community HBC provided by the various stakeholders in 
the Kunene Region. The purpose of the survey is to uncover the different approaches used in 
the deliverance of HBC, to enable MdM to come up with a unified approach in assisting the 
regional response to HIV/AIDS. The information you will provide will be kept confidential and 
will be used only for the above purpose. Your co-operation in this regard will be highly 
appreciated. 

D 



E 
A. DEMOGRAPHIC INFORMATION 
Q 
4). Sex of caregiver (do not ask; check the right box) . 1 Male . 2 Female 
5). How old are you? Age___________________ 
6). Are you currently attending school? . 1 Yes . 2 No 
7). What is your highest education 
level? 
. 1 None / pre-primary 
. 2 Primary (Gr. 1-7) 
. 3 J. Secondary (Gr. 8-10) 
. 4 S. Secondary (Gr.11-12) 
. 5 Tertiary (Univ. and 
Techni) 
. # Others 
_____________ 
8). What is your marital status? 
. 1 Married 
. 2 Divorced 
. 3 Single 
. 4 Cohabiting 
. 5 Not living with 
partner/ spouse 
9). How many dependants do you have? . 1 One 
. 3 Three 
. 5 Five and more 
. 2 Two 
. 4 Four 
10) Does your spouse/partner has any 
source of income? 
. 1 Yes . 2 No 
11) How long have you been a caregiver? Years ______________________________ 
Months ____________________________ 
12) On average, how much time (hours) 
do you devote to caregiving per day? 
. 1 One 
. 2 two 
. 3 three 
. 4 four 
. 5 five 
. 6 six or more 
13) On average, how many days do you 
devote to caregiving per week? 
. 1 One 
. 2 two 
. 3 three 
. 4 four 
. 5 five or more 
14) Before you joined this organisation 
(say name), did you work for any 
other organisation? 
. 1 Yes . 2 No 
15) Why did you leave the last 
organisation/project you volunteered 
for? 
CARE AND SUPPORT 
16. Do you have protective clothing? 
__Yes __No __Inadequate 
If inadequate, please 
explain…………………………………………………………………………. 

17. Is soap and antiseptic always available? 
__Yes __No __Occasionally 
18. What hygiene procedures are followed after the patient dies? 
……………………………………………………………………………………………… 
……………………………………………………………………………………………… 
……………………………………………………………………………………………… 
18.1 Is this adequate 
Inadequate 
__Yes __No 
19. Is there a procedure manual to guide terminal care of patient living with AIDS? 
__Yes __No 
20. If yes, is the manual followed when doing terminal care? 
__Yes __No 
Notes: 
………………………………………………………………………………………………….. 

21. How do you dispose of patient’s secretions and dressings? 
………………………………………………………………………………………………… 
21.1 Is this adequate 
Inadequate 
__Yes __No 
22. In total how many patients do you provide support to? (Probe for each participant in 
the FG and 
get a sense of the age and sex difference) 

……………………………………………………………………………………………… 

23. What material support do you receive from your organization? (Probe for HBC kits, 
etc) 
………………………………………………………………………………………………… 

PHYSICAL, SPIRITUAL, AND PSYCHOSOCIAL CARE 


24. Do you conduct a complete physical assessment on admission? 
__Yes __No __Don’t know 
25. Is symptomatic treatment given to patient? 
__Yes __No 
26. What do you do if the psychosocial needs of the patient are beyond the your capability? 
F 


………………………………………………………………………………………………… 

27. Is patient’s dignity and self-esteem recognized? 
__Yes __No __Not Applicable 
28. If yes, is patient’s opinion requested when (tick block if yes) 
__Preparing the menu? __Calling the pastor? 
__Visitors arrive, before taken to bedroom? __Referrals are necessary? 
29. Is patient’s privacy maintained whenever necessary? 
__Yes __No __Not Applicable 
30. Is patient informed of every procedure carried out on her/himself? 
__Yes __No 
TRAINING 


31. Have you received any relevant training? 
__Yes __No 
1.1 (If training was provided) What type of training did you receive? (Probe for duration 
and 
type of training). 
……………………………………………………………………………………………… 

32. Do you feel the training was adequate? (Probe for how this is monitored and evaluated) 
__Yes __No 
33. Do you think you have the skills and experience to be providing the services you do? 
(Probe for an explanation) 
__Yes __No 


34. (Ask this question even if the volunteer received any training to establish whether 
additional training is needed, if any) What type of training (or additional training) do you 
need? Please describe in detail. 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 

35. Before you joined this organization, did you work for any other organization as a 
caregiver? 
G 



__Yes 
__No 

36. Why did you leave the previous organization you were working for? 
………………………………………………………………………………………………… 
INCENTIVES 


37. 
How are you rewarded for the services you deliver? 
__Yes __No 
(Probe for any other type of rewards and not only rewards in the form of money and materials). 
……………………………………………………………………………………………… 

……………………………………………………………………………………………… 

38. Are you aware of volunteers doing similar work in other communities or regions who 
are provided with incentives? 
__Yes __No 
(Probe for the type of incentives they receive). 
……………………………………………………………………………………………… 
…….......................................................................................................................................................... 

NETWORKING 


39. How and where do you refer clients who need other or more specialised services? 
……………………………………………………………………………………………… 
…….......................................................................................................................................................... 
40. How often do you meet with other HBC givers from other organisation and service 
providers in you community? 
__a) Often __b) Not so often c) Never 
(Please provide details) 
…………………………………………………………………………………………… 


…….......................................................................................................................................................... 


41. Do you attend CACOC meetings and activities or does your organisation have a 
representative who attends? 
42. How often do you meet with the nurse at the health facility for HBC purposes? 
H 



__a) Often __b) Not so often c) Never 

(Please provide details) 
……………………………………………………………………………………………… 
…….......................................................................................................................................................... 

CLOSURE 


43. 
Do you have any other closing comments? 
……………………………………………………………………………………………… 
Thank you very much for your time and cooperation 


Local Level Key Informant Interview 
Coordinators 
FINAL 


1. Region: _______________________ 
2. Date: _________________________ 
3. Level of Cooperation: ____ High ____ Medium ____ 
Low 
Greetings 

My name is ______________________________, and I am carrying out a survey for Medicos 
del Mundo with the aim to assessing community HBC provided by the various stakeholders in 
the Kunene Region. The purpose of the survey is to uncover the different approaches used in 
the deliverance of HBC, to enable MdM to come up with a unified approach in assisting the 
regional response to HIV/AIDS. The information you will provide will be kept confidential and 
will be used only for the above purpose. Your co-operation in this regard will be highly 
appreciated. 

J 



BACKGROUND INFORMATION 


1. When did the HBC programme start? 
………………………………………………………………………………………………… 


2. What services do you provide? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 

3. Where does it operate? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
4. Is it part of another organization? 
………………………………………………………………………………………………… 
5. What organizations does it link to in the area? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
6. 
What categories of staff / volunteers are there and how many people are involved in 
each function? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 

………………………………………………………………………………………………… 


7. Where do you get your funding from? 
K 



……………………………………………………………………………………………… 


………………………………………………………………………………………………… 


………………………………………………………………………………………………… 


………………………………………………………………………………………………… 


………………………………………………………………………………………………… 

8. Do you have any means of generating funds for yourself? If yes, motivate. 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
9. What is the management structure? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
……………………………………………………………………………………………… 
………………………………………………………………………………………………… 
10. Who do the management account to? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
11. Is there a Board or a community or stakeholder committee? If so, provide a list of 
names and the affiliations of the organization they represent. 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 

………………………………………………………………………………………………… 


………………………………………………………………………………………………… 



………………………………………………………………………………………………… 


OVERALL APPRAISAL OF CARE 


12. What is your overall appraisal of the quality of care provided by the HBC organization? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
13. What are the strengths of its quality of care? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
14. What are the weakness of the Care domain? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
15. What has been done to strengthen identified weakness? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
16. What are the priority areas for improvement within quality of care? 
M 



………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 

17. What mechanisms of monitoring and evaluation (if any) do you have in place? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
OVERALL APPRAISAL OF MANAGEMENT 


18. What is your overall appraisal of the management of the HBC organization? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
19. What are the strengths of its management? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
20. What are the weakness in its management? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
N 



………………………………………………………………………………………………… 


21. What are the priority areas for improvement in management? 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 

17. Do you have any capacity building system in place? If yes, how often do you undergo 
training, who does the training and what is your assessment of the quality of training you 
have received? 
……………………………………………………………………………………………………… 
……………………………………………………………………………………………………… 
……………………………………………………………………………………………………… 
……………………………………………………………………………………………………… 
………………………………. 

LINKAGES WITH OTHER PROVIDERS 


22. What are the linkages with other service providers? 
……………………………………………………………………………………………………… 
……………………………………………………………………………………………………… 
……………………………………………………………………………………………………… 
……………………………………………………………………………………………………… 
23. How often do you have stakeholder workshop to determine? If ever, what do you discuss 
and the 
outcomes of such discussions. 
……………………………………………………………………………………………………… 
……………………………………………………………………………………………………… 
……………………………………………………………………………………………………… 
……………………………………………………………………………………………………… 

24. Is there a consistency of activity implementation of the various service providers? Do you 
meet to evaluate each others work, and how often? 
……………………………………………………………………………………………………… 
……………………………………………………………………………………………………… 
……………………………………………………………………………………………………… 
……………………………………………………………………………………………………… 
25. Are the areas of implementation well demarcated? How well? 
O 



……………………………………………………………………………………………………… 
……………………………………………………………………………………………………… 


CLOSURE 


26. 
Do you have any other closing comments? 
……………………………………………………………………………………………… 
Thank you very much for your time and cooperation. 

P 



Local Level Key Informant Interview Guide 


Patients 
FINAL 


1. Region: _______________________ 
2. Date: _________________________ 
3. Level of Cooperation: ____ High ____ Medium ____ 
Low 
4. Support organisation:____________________________________________________ 
Greetings 

My name is ______________________________, and I am carrying out a survey for Medicos 
del Mundo with the aim to assessing community HBC provided by the various stakeholders in 
the Kunene Region. The purpose of the survey is to uncover the different approaches used in 
the deliverance of HBC, to enable MdM to come up with a unified approach in assisting the 
regional response to HIV/AIDS. The information you will provide will be kept confidential and 
will be used only for the above purpose. Your co-operation in this regard will be highly 
appreciated. 

Q 



A. DEMOGRAPHIC INFORMATION 
18. Patient’s Occupation 
………………………………………………………. 
19. Patient’s sex 
………………………………………………………. 
20. How old are you? 
………………………………………………………. 
21. Are you currently attending school? __a) Yes 
__b) No 
22. What is your highest Education Level? 
__a) None / pre-primary __b) Primary (Gr.1-7) 
__c) Jr. Secondary (Gr. 8-10) __d) Sr. Secondary (Gr.11-12) 
__e) Tertiary (Univ. and Technicon) __f) Other 
______________________ 
23. What is your marital Status? 
__a) Married __b) Divorced 
__c) Single __d) Cohabiting 
__e) Not living with partner/spouse 
24. How many dependents do you have? 
__a) One __b) Two 
__c) Three __d) Four 
__e) Five and More 
25. Condition and mobility of patient 

__a) Critically ill (terminal, unconscious or semiconscious) 
__b) Very ill (bedridden, restricted mobility, talking with strain, assisted with feeding) 
__c) Ill (mobile, feeds independently, weak, needs minimal support) 
__d) Not so well (full blown, but completely independent) 


26. How long (in months) has the patient been on the home based care program? 
…………………… 
Notes: 
………………………………………………………………………………………………… 
………………………………………………………………………………………………… 


THE PATIENT’S ENVIRONMENT (Observation) 

10 Is the home environment neat and clean? 

R 


__a) Yes __b) Fairly __c) No 

11. Is bedroom well ventilated? 
__a) Yes __b) No 
12. Any evidence of medical hazards? 
__a) Yes __b) No 
If other, 
explain……………………………………………………………………………………… 

13. Are relevant accessories within patient’s reach? E.g. Walking aid, wheel chair, bedpan. 
__a) Yes __b) No __c) Not applicable, patient mobile 
14. Is patient’s privacy protected during relevant nursing procedures? 
__a) Yes __b) No 
Notes: 
………………………………………………………………………………………………… 

………………………………………………………………………………………………… 

PATIENT’S BASIC NEEDS (Probe who provides these services) 

15 Does the patient need to be fed or assisted during a meal? 
__a) Yes __b) No 


16. If yes, is this usually done? 
__a) Yes __b) No 
17. Is there drinking water within reach at patient’s bedside? 
__a) Yes __b) No 
18. If yes, is it usually done? 
__a) Yes __b) No 
19. What does patient normally have for 
a. Breakfast:……………………………………………………………… 
b. Lunch:…................................................................................................................. 
c. Dinner:………………………………………………………………… 
20. Would you say that the patient receives a well balanced diet daily? 
__a) Yes __b) No __c) Other 
If other, 
explain……………………………………………………………………………………… 

S 



PATIENT’S HYGIENE AND PREVENTION OF INFECTION (probe who provides 
these services) 

21. Is the patient’s bed kept neat and dry? 
__a) Yes __b) No 
If yes, is this usual? 
………………………………………………………………………………….. 

If no, please 
explain…………………………………………………………………………………. 

22. Does patient receive a full bed bath daily? 
__a) Yes __b) No 
If no, please 
explain…………………………………………………………………………………. 

23. Is mouth and oral care given after every meal? 
__a) Yes __b) No 
If no, please 
explain…………………………………………………………………………………. 

24. Is exercise and movement in bed encouraged? 
__a) Yes __b) No 
If no, please 
explain……………………………………………………………………………….. 

25. If bed ridden, is care to back and pressure parts given? 
__a) Yes __b) No __c) Not bedridden 
26. Is patient assisted in and out of bed if necessary? 
__a) Yes __c) No __Not necessary, patient able 
If no, please 

explain………………………………………………………………………………….. 

OTHER SUPPORT MECHANISMS 


27. Do you belong to any support groups? 
__a) Yes __b) No 
If yes, provide 
details…………………………………………………………………………………. 

28. Do you belong to any other group/club etc.? 
__a) Yes __b) No 
29. Do you receive any food support? 
T 



__a) Yes 
__b) No 

If yes, provide 
details…………………………………………………………………………………. 

30. Do you receive psychosocial support from caregivers? 
__a) Yes __b) No 
If yes, provide 
details…………………………………………………………………………………. 

30a) Are you satisfied with the support? 
__a) Yes __b) No 

If no, provide 
details…………………………………………………………………………………. 

31. 
As a client of HBC services what kind of services would you like to receive that are not 
being offered now? 
Please provide 
details…………………………………………………………………………………. 

CLOSURE 


32. Overall, are you satisfied with the support you receive from caregivers? 
__a) Yes __b) No 
If no, provide 
details…………………………………………………………………………………. 


33. Do you have any other closing comments? 
……………………………………………………………………………………………………… 
Thank you very much for your time and cooperation 

U 



FOCUS GROUP DISCUSSION 
PATIENTS 


Final 


Name of Facilitator: 
Name of Note-taker: 
Name of Assistant/Other: 
Name of Community: 
Name of Committee: 
Number of Participants: # Male: # Female: 
Start time: Finish time: Total Time: 
Note-taker self-check (Print name): 
Facilitator check (Print name): 
Other check (Print name): 

1. Community: _______________________ 
2. Date: _________________________ 
3. Level of Cooperation: ____ High ____ Medium __ Low 
Greeting First 

(Introducing yourself) My name is ______________________________, and I am carrying out 
a survey for Medicos del Mundo with the aim to assessing community HBC provided by the 
various stakeholders in the Kunene Region. The purpose of the survey is to uncover the 
different approaches used in the deliverance of HBC, to enable MdM to come up with a unified 
approach in assisting the regional response to HIV/AIDS. The information you will provide will 
be kept confidential and will be used only for the above purpose. Your co-operation in this 
regard will be highly appreciated. 

V 



DEMOGRAPHIC INFORMATION 


4). 
Tell us a bit about yourselves, including the following; highest education level, length of 
stay in the community, employment status, your position in this committee, number of 
children you are caring for and whether you are the head of the household you are 
currently living in. 

GENERAL INFORMATION 


5) Which HBC groups do you belong to? (probe for NRCS, ELCAP, MoHSS) 
6) When did you become a member of the HBC group? 
7) How did you become a client of the HBC programme? 
8). Do you belong to any support groups? 
9). Do you belong to any other group/club etc.? 
10) Do you have children and how many? (probe for support of their children) 
11) How many of you are on the ART programme? 


CARE AND SUPPORT 


12) Please describe in detail the kind of support you receive as a HBC client. (Probe for food 
and nutritional support, psychological, material etc.) 

13) Are you satisfied with the support? 

14. As a client of HBC services what kind of services would you like to receive that are not 
being offered now? 
CLOSURE 


15. Overall, are you satisfied with the support you receive from caregivers? 
16. Do you have any other closing comments? 
W 



Fieldwork Plan 

DATE AND 
CONSTITUE 
NCY 
TIME ACTIVITY VENUE 
28 January, 
Sunday 
Arrival at Opuwo 
29 January, 
Monday 
08:00 -Dr. Akpabio – Acting Director MOHSS-
Opuwo 
OPUWO 
08:30-09:00 -HBC Regional Committee Hospital 
09:30-11:30 -MOHSS: 
-Ms. Mbaumba-HBC Regional Coordinator 
-Ms. Karutjaiva-Primary Health Care Supervisor (Opuwo Health 
District) 
-Mr. Tjituri-Regional Social Worker 
12:00 – 
13:00 -Red Cross: Ms. Mutambo-Regional Head and HBC responsible person 
for Opuwo 
Lunch break 
14:00-15:00 
-Red Cross Supervisors 
15:15-17:00 
-Focus Group-HBC clients 
30 January, 
Tuesday 
Travel to Okangwati at 08:00 ( 1 hour and a half) Constituency 
Office09:
30 – -Focus Group-HBC givers (from MOHSS) Okangwati 
EPUPAOKANGWAT 
10:30 
-Focus Group-HBC clients (from MOHSS) 
I 10:30 – 
12:00 Travel back to Opuwo 
-Opuwo: Focus Group-HBC givers Opuwo 
Hospital 
15:00-17:00 
31 January, 
Wednesday 
Travel to Sesfontein at 07:00 ( 3 hours) TBC 
10:00 – -ELCAP: Pastor Tjakuapi-Regional Head and HBC responsible 
SESFONTEIN 11:00 person for Opuwo and Sesfontein 
-Focus Group-HBC givers (from ELCAP) 
11:00-13:00 
Lunch break 
-Focus Group-HBC clients (from ELCAP) 
14:00-16:00 
Travel to Khorixas (3 hours and a half) 
1 February, 08:00 – -Red Cross: Mr. Boois-HBC Coordinator for Khorixas Red Cross 
Thursday 08:45 
-Red Cross: HBC Supervisors (2 persons) 
KHORIXAS 09:00 – 

X 



09:45 -Red Cross: HBC facilitators (5 persons) 
10:00 – -Red Cross: Focus group -HBC clients (10 persons) 
10:45 
Lunch break 
11:00 – 
13:00 -Red Cross: Focus group-HBC clients (10 persons) 
Travel to Kamanjab (1 hour and a half) 
14:00-16:00 
2 February, Kamanjab Kamanjab 
Friday 
KAMANJAB 
08:00-08:30 -MOHSS: HBC Supervisor-Clinic nurse clinic 
AND 
OUTJO 
08:30-10:30 -Focus Group-HBC clients 
10:45-12:30 -Focus group-HBC givers 
Travel to Outjo (1 hour and a half) 
14:30-15:30 -MOHSS: HBC Supervisor-Sister Aibes and Community Counsellor-
Ms. Tekla 
Outjo 
Hospital 
15:30-16:30 
-ELCAP: HBC Supervisor-Pastor T. Katjiveri 
16:30-17:30 
-Red Cross: Ms. Jassana – HBC Coordinator for Outjo and Kamanjab 
3 February , 
Saturday 
08:00-09:00 -Red Cross: HBC Supervisors TBC-
Constituency 
09:00 – -Focus Group -HBC clients Office 
11:00 
-Focus Group-HBC givers 
11:00-13:00 
Back to Windhoek and Opuwo 

Feed back from Mιdicos del Mundo of the HBC Survey Report 2007-Kunene
Region 


Here there are some comments that Amaia, Geraldine and me think are
important to be introduced in the HBC Survey Report if possible. 


-More specific and detail introduction about the beginning and
situation of the program by partners, as well as the workshops
that have been done, when, by who, where.
To have a clear idea about what has been done until now. 


-Introduce some recommendations about how and where start new 
workshops and if it is better to start training new volunteers or
focus on refreshing trainings. 


Y 



-Practical recommendations. (Amaia lo ha escrito en su mail pero
creo que no se le puede decir asν. Quizαs es despreciar su
trabajo…. 


-Mention that the Red Cross is working together with the Ministry
of Health and that is working in different constituencies. 


-Mention the sustainability of the program related to the role
that MdM and other NGOs must play. Maybe mention that an NGO as
MdM cannot assume the management functions of a program that must
be assumed by the Ministry. 


-Some strategies and methods to apply the recommendations. Just
the most important ones. For example, how to involve men in the
HBC. 


Z