Scaling-up HIV/AIDS and TB home-based care: lessons from Zambia

Home-based care coverage in Africa is currently very low and likely to reduce drastically in the near future. This paper investigates the low coverage of home-based care programmes in Africa and uses two home-based care projects in Zambia as case studies. The very limited involvement of governments in the provision of home-based care services appears to be one of the main reasons behind the low coverage of home-based care in Africa. Governments therefore should provide some form of basic home-based care services and/or strengthen support to other institutions providing home-based care. In order to facilitate governments' involvement in home-based care activities, an analysis of tasks performed by community nurses and volunteers is used to identify tasks that government, missionary or NGO employed nurses may be able to provide without, or with very limited, donor assistance. However, further research and development is needed to develop affordable, feasible and sustainable home care programmes that can be implemented by staff working in government, NGO and missionary health facilities. In addition, innovative strategies are required to establish effective partnerships between the NGO, missionary and government health facilities.