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HARARE, - Zimbabwe's sinking economy and reduced donor support are threatening home-based care (HBC) programmes for people living with HIV and AIDS, according to a new report.

The survey, jointly produced by the Southern Africa HIV and AIDS Information Dissemination Service (SAfAIDS) and the Health Development Network (HDN), noted the impact of runaway inflation - officially pegged at more than 6,000 percent - on HBC schemes once considered models of their kind.

"One of the challenges is that we don't always have the capacity to give clients everything they need; drugs are in short supply, and the basic issue of money in their households is often a challenge," Red Cross care facilitator Majulie Nyamhunga told IRIN/PlusNews.

Home-based care had its genesis in the mid-1990s as public health services, facing cost-cuts demanded by economic reforms, struggled to absorb the swelling number of AIDS patients. The end of free medical care hit the poorest households hardest, reducing their access to health services, triggering interventions by church and civic groups.

The extended family has traditionally been the first line of support but, when it is unable to cope, community-centred HBC programmes staffed mainly by volunteers have played a vital role in helping those in need. Caregivers provide basic first aid and counselling, travelling long distances, usually on foot, to reach affected households.

But Zimbabwe's economy has been in a steep nose-dive since 2000, with acute shortages of foreign currency, basic commodities, fuel and water, and unemployment hitting at least 70 percent. The public health system has been crippled, unable to replace ageing hospital equipment or fleeing medical staff.

Under these conditions, the need for an effective HBC system becomes all the more apparent, but rocketing inflation has made it difficult to supply even soap and gloves to caregivers who, even more critically, have become exhausted by their caseloads in a country where almost one in five adults is HIV positive.

"When you see a client, and you see she is very sick, it is very difficult to quickly forget," care facilitator Gamuchirai Guvamombe explained.

"Community home-based caregivers have always been known to volunteer their services. However, due to the harsh economic environment, caregivers have suffered from burnout and some HBC programmes had to introduce incentives to guarantee their retention," the SAfAIDS/HDN report noted.

Deteriorating conditions

Caregivers, especially men, have begun to drop out in increasing numbers; the report recommended providing allowances, along with protective clothing, uniforms and bicycles to stem the loss.

Zimbabwe's prevailing food insecurity, a consequence of drought and foreign exchange shortages, has also hit HBC programmes, the survey pointed out. Community caregivers have become preoccupied with fending for themselves and their families before undertaking community activities.

As a consequence, some HBC programmes have been forced to scale back, reducing their areas of coverage, said the report. To try and keep going in such a difficult environment, care-providers have pooled resources or undertaken joint fundraising with donors; dire shortages have sometimes led to the substitution of orthodox medicine with herbal remedies in an attempt to offer relief to ailing patients.

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