According to the study which focused on Botswana, providing
caregivers with financial and material support is an urgently required public
The study revealed that providing caregivers of people
living with HIV and AIDS with financial and material support will ensure that
caregivers are not demoralized in rendering care services to their clients as
well as attract more people into caregiving.
Though the Botswana government provides caregivers with
financial support amounting to US15,26 this far lower than what caregivers
spend to look after clients, says the study. Results from the study showed that
the cost of providing care per client per month to caregivers was approximately
US 184,17. Yet, in spite of this gigantic gap between what they obtain from
government and what they expend, caregivers soldier to provide care to people
living with HIV and AIDS, relying on their own meager resources.
"Providing incentives, such as mealie-meal and food baskets
and loans for income-generating activities, and lending a sympathetic ear to
their plight will help boost the morale of caregivers and attract others to
caregiving," states the report.
In Botswana, as in many southern African countries,
community home based care (CHBC) has emerged as a critical vanguard in the
provision of care to people living with HIV and AIDS but at a serious cost to
the lives and livelihoods of caregivers, mainly poor and marginalized women and
girls. The offloading of patients to the community in many parts of the region
has been necessitated by public health systems facing a myriad of challenges,
including limited financial and logistical support, ongoing brain drain,
competing national priorities and diseases such as AIDS, TB and malaria.
"While CHBC may be seen as a cheap alternative mode of
health care delivery, it is certainly not affordable for families and
caregivers," says the study. "It is important for government to consider how
best costs of providing care can be shared between them and those who provide
According to the study, the overall costs of increasing
monthly allowances to caregivers and support provided for the families of
clients would be quite low for the government of Botswana compared with the
huge sum of money budgeted each year for healthcare and for HIV and AIDS.
Suffice to state, caregivers are largely invisible in the
global AIDS infrastructure despite the fact that they are at the frontline of
the response to the epidemic in many countries across the world. They have to
make do with little to no resources, face poverty, and incur huge costs in the
provision of care to clients. Often, they are also unable to adequately voice
their needs, to seek redress against injustice and influence policies that
ultimately will shape their lives.
The findings from the study in Botswana showed that
caregivers are compelled to provide their clients with supplies, such as food
and washing soap, transport them to hospitals or clinics to collect their
drugs, and cover costs of caring for clients. According to the study, community
home based care is not a cheap endeavour and the cost of caregiving has shifted
from the government to families and caregivers, who now incur enormous
expenditure in care giving activities.
There is no doubt that, in Botswana, as in many parts of sub
Saharan Africa, an over-reliance on caregivers to support people living with
HIV is not only unsustainable but also promotes poverty and inequality. For
women and girls, the burden of caregiving constitutes an additional layer that
promotes gender inequality.
In view of this, governments in the region need to put in
place policy and legal frameworks as well as budgetary mechanisms that protect
the lives and livelihoods of caregivers. International donors also need to
seriously consider increasing the financial support targeted directly at
Indeed, in Botswana, as in many parts of Southern Africa,
the absence of financial incentives constitutes a serious drawback to the
effectiveness of care programmes for people living with HIV and AIDS. It is
critical for governments in the region to develop policy and legal frameworks
as well as budgetary mechanisms that empower caregivers to properly cater for
clients. International donors also need to seriously consider increasing the
financial support targeted directly at making caregivers do their work better
and not at the expense of their own lives.
Contributed by: Bobby Ramakant