HIV/aids related home based care practices among primary health care workers in Ogun state, Nigeria

Living and dying with incurable illness in poverty and pain is all too common in sub-Saharan Africa [1, 2]. With minimal resources and huge shortages of health workers, national health systems in a number of African countries have focussed primarily on preventive, curative and maternal health services thus responding to a set of immediate health problems [1]. In many countries, minimal resources have been dedicated to supportive or palliative care [3]. However, the severity of the HIV and AIDS pandemic has triggered donor interest in palliative and home based care in Africa, an interest which has never been greater, as evidenced by multiple small projects [3, 4] and promotion by various national and pan-African initiatives [5, 6].

There is ample evidence that home based care services and practice is prominent especially among informal health care workers such as traditional birth attendants [TBAs], Voluntary health care workers etc. in Nigeria though the practice among the formal health care workers is rare [7–10]. This is done in spite of a relatively easy access to institutional maternity services in urban areas. Previous studies about home health care in urban and peri-urban areas have reported that the utilization of home based services is more closely related to the needs of caregivers than the care needs level of the users [2]. It is usually determined by multidimensional services indicators and care needs such as poor education, multiparity, and low socioeconomic status in rural areas in Africa [4, 11–13]. Although there have been a few number of studies that focused on care at home, more information is needed about the range and severity of problems encountered by primary care professionals and the barriers that prevent optimal care in order to identify the educational and training needs of primary care teams.

The World Health Assembly in 2005 even declared supportive or palliative care as an urgent humanitarian responsibility [14]. Despite various palliative care programmes which have been developed, it is still only available to less than 5% of those in Africa who need it [14]. Assessment of the perception and practice of home based care by health care workers is vital to understanding the extent of practice among the study population and also to determine the factors that encourage its practice in an African population. This study was therefore designed to determine the perception and practice of health care workers on HIV/AIDS related home based care in the health facilities in Ogun state, Nigeria.

The study shows that the prevalence of practice of home based care among these public health workers was low [16.6%]. The fact that home based care practices among health care workers was low has been widely reported by several studies especially in low socioeconomic settlements [7,11-13]. The practice of home based care among the study population was significantly associated with perception of its relevance in the management of HIV/AIDS. The study shows the need for community-based interventions to promote improved home based care practices in urban and rural areas. Implementation of an effective program for promotion of home based care practices requires understanding of the community and household traditional care practices. Such information will enable the development of programs to promote culturally sensitive and acceptable changes in practices.

The effectiveness of home care services on recipients is still controversial. It has been difficult to assure the quality of care research [16], and consequently there is inconsistent evidence in support of the effectiveness of home care services [17]. As a result, some studies have reported positive effects of home care services including reductions in functional decline [18–22], mortality rates [23–27], institutionalization rates [28–30] and costs of care [31]. Other studies, however, have reported that home care services are ineffective in reducing functional decline [20], mortality rates [17, 19] and institutionalization rates [31, 32] in community-dwelling elderly persons.

Only those that practice home based care believed that its practice is feasible while others believed that it is either an expensive venture or a cumbersome practice. This indicates that the practice of home based care is greatly influenced by cost. Several studies have reported similar findings [9, 10] on issues pertaining to the development of home treatment services and on macro-level outcomes such as cost-effectiveness and admission rates, which have political, economic, and practical implications. However, there is a paucity of research regarding the structures and processes in actual operations over time, as well as a lack of research of service-user experiences and satisfaction on key areas of service provision [20, 24, 33]. Establishing performance indicators for assessing home based care is essential in identifying the effect of home care services and would contribute to standardization and improvement in the quality of home care services. This may be one strategy for addressing the shortage of resources and encouraging health care workers to practice quality home based care [1, 3].

The study implies that neither the adequate knowledge of home based care nor its training significantly influenced its practice but those from the facilities that had support group were about 5 times more likely to practice home based care for people living with HIV/AIDS. This shows that practical Information about the reasons for home based care is more important than theoretical knowledge. This may indicate a need for health care planners to design appropriate health care services especially in management of chronic diseases. Several studies have reported similar findings [24–26]. More information is needed about the range and severity of problems encountered by primary care professionals and the barriers that prevent optimal care in order to identify the educational and training needs of primary care teams.

Our study has certain limitations. The study findings are limited in terms of overall generalization and impact since the study might also have been faced with recall bias and it is not all health workers in Abeokuta south local government area that was recruited into the study. Despite these limitations, we believe that our data provide useful information for the assessment and implementation of home based care services in Nigeria and will also inform policy decision in Nigeria and other low income countries.

The study concludes that the practice of home based care for people living with HIV/AIDS among the study population is low and it is greatly influenced by cost and perception of its effectiveness and relevance. The study recommends that the health care workers should be adequately trained on the practice of home based care and its implementation in order to enhance its practice.