ANALYSIS O F FINDINGS
5.2 UNDERLYING PRINCIPLES IN CHBC
Community care is the best place for quality care
Despite the tremendous challenges posed by HIV and AIDS, it is claimed that the community seems to be the best place where patients could be afforded quality care.
Hospitals do not have the personnel and resources to cope with the huge demands that HIV and AIDS make on them, and they are too expensive. CHBC is therefore seen as the most empowering tool for both PLWHAs and their caregivers working in the community.
However, as shown in the previous chapter, the findings clearly indicated that the demands placed on voluntary caregivers are too formidable to cope with because most of them work in poverty-stricken communities. Graham (1991 cited in Williams,
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1997) observes that women are principal caregivers in CHBC, however, the majority of voluntary caregivers are poor themselves. Consequently, a number of authors in the literature review cautioned against the assumption that communities, particularly women caregivers, are willing and committed to provide care, because as noted in Barnett & Whiteside (2002) such commitment can become overshadowed by poverty and related socio-economic difficulties.
Moreover, the environment is not conducive to community care, as the study indicated a high level of stigma and a lack of access to technical and professional support. Using Tallis & Cavanagh (2005) for my analysis on the issue of power, I argue that it is an illusion to assume that CHBC empowers voluntary caregivers since the findings have demonstrated a lack of access to power and resources. Added to this, is the fact that the CHBC curriculum is silent on the needs of voluntary caregivers.
A cost-effective model of care: who benefits?
The National Guideline on Community Home-based Care (2001: 8) acknowledges that it is poor families and poor communities that are hardest hit by the impact of HIV and AIDS. The guidelines still maintain that the rationale for CHBC includes involving communities in care so as "to reduce costs" associated with institutionalized care; reduce the pressure on hospital beds and other resources at different levels of service; and prevent the need for expensive institutional care. However, listening to the plight of volunteer caregivers, it was evident that they do not benefit much from such arrangements. The question that needs to be explored further therefore, is who benefits from these savings?
The study has shown that most caregivers work in isolation in private homes; thus, the impact of caregiving is concealed. The provision and practice of CHBC perceived in this way, supports the ideas of privatization, where the burden of care has been shifted to poor communities. To elaborate the link between privatization and CHBC, it needs to be recognized that privatization is the outcome of globalization, which according to Barnett & Whiteside, (2002: 352) puts "the market as the arbiter of welfare". In this context, it calls for a minimization of the role of the state, because the concern is on
economic growth at the expense of growing inequality. In simple terms, privatization helps a few rich people to become even richer, while the majority needs of the poor are ignored and overlooked. As it stands, the burden of care has been shifted to poor communities, and no platform has been created for the caregivers to articulate their needs.
The government needs to revisit and rethink its macro-economic policy, which encourages a cut in public expenditure on social services such as health (The NUMSA Shopsteward Publication, 2002). Privatization, which is the result of such interventions, continues to widen the gap between poor and rich people - between the have's and the have not's - and leaves poor people vulnerable to diseases such as HIV and AIDS which thrive in poor countries and within poor communities. While wealthier people have options, that is, they can choose to be treated in private hospitals and die in the care of professional staff if they want to, 'poor'53 people do not have choices. So, is community home-based care a specific option for the poor?
Do communities and families themselves perceive CHBC as a benefit as reflected in CHBC model, or as a liability to accommodate those who have been chased away from the hospitals? The literature review given suggests that staying in hospital nowadays is a privilege for the 'rich', while the 'poor' can die at home. At this stage, it is befitting to consider Freire's ideas on the importance of acquiring a critical consciousness about the contradictions in society. I argue that there is a need to link CHBC training with training in consciousness-raising, that is, while learning new information on care for the terminally ill, such information could be linked to the socioeconomic context, thus generating awareness about social, economic, and political contradictions in participants' lives. Radical and popular education practitioners maintain that the goal of adult education programmes should not be to fit participants into the needs of capitalist societies, as the government's macroeconomic policies such as the Growth, Employment and Redistribution (GEAR)54 suggest, but
" Poverty means different things to different people. In this particular context, the term 'poor' refers to people who lack access to basic social services such as electricity, water, food, and proper sanitation.
54 A market-driven government strategy, with the government having a limited role in driving the reconstruction of the country. It is committed to a reduced expenditure on social services and new infrastructure, and set about privatizing state assets (Marie, 2004: 77)
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to help participants develop the skills needed to control their own lives, make informed decisions and to work for social change.