Community participation in health: Home/community-based care as an alternative strategy to institutional care – a case study of Dunoon home-based caregivers
In South Africa, since 2000, an increase of awareness in community involvement has become apparent, owing to the response from people to the need to be more engaged in decisions pertaining to their community. This positive move echoes an increasing acknowledgement by those in authority that community participation is essential to the main demands of renewing democracy, expanding service provision and constructing robust communities. The development of innovative patterns of participation development means that local communities should be empowered to participate in decision making, whilst government establishments need to have the determination and ability to respond to various community needs. The Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) pandemic has placed an enormous responsibility on public health services, such as South African hospitals, which are already functioning with limited resources. This has shifted the load of nursing to family members and communities as public health services are often stretched beyond their limits. Several community or home-based care programmes and facilities have materialised in reply to this necessity. In the context of participation of communities, the duty of community involvement in health plays a vital role in the future of public health in South Africa. Accordingly, this research was conducted to explore the nature and extent of community participation within the HIV/AIDS context in the Dunoon suburb in the Western Cape. An empirical research design, which consisted of qualitative methods, was used in this exploratory study to investigate the nature and extent of home-based care as an alternative strategy to institutional care. The research population was comprised of community members at the Dunoon informal settlement, the home-based workers employed at Heavenly Promise NGO, as well as staff and management of the Caltex/Chevron Refinery, members of Project Management 4 Africa (PM4A) and representatives of the Department of Social Development (DSD), which together constitute the partnership that is dedicated to combating the spread of HIV/AIDS in Dunoon. In general, the research findings demonstrate that home-based caregivers displayed strong levels of participation right from the outset of the project. The findings also established that participation among the community members was a combination of passive, weak and non-participatory, whereas home-based carers displayed a level of active participation. Furthermore, home-based care staff played a key role in decision making, while carers essentially undertook the work in the community. Hence, home-based care and communities participating in health matters are considered to be substantial as home care focuses primarily on palliative care of the patient at home, with the support of the family and the immediate community. Consequently, it is hoped that this research will prove significant and will enhance the existing knowledge of the potential benefits of home-based care as an alternative strategy to institutional care.