Community/ Home Based Care for People Living with AIDS in Yeka, Gullelle, Lideta and Addis Ketema Sub-Cities of Addis Ababa Project Evaluation Report December 2008 Addis Ababa AMREF in Ethiopia Community/ Home Based Care for People Living with AIDS in Yeka, Gullelle, Lideta and Addis Ketema Sub-Cities of Addis Ababa Project Evaluation Report Principal Evaluator: Yibeltal Kiflie (MSc. in Health Monitoring and Evaluation) December 2008 Addis Ababa Executive Summary Introduction As a result of its complex nature, HIV/AIDS has brought devastating health, social and economic crisis to the world, countries, families and individuals. Patients infected with the virus require multifaceted care and support including medical, physical, social, economic, legal, psychological and spiritual support. Such comprehensive care couldn’t be provided by the health care system not only because it is not its mandate but also as a result of patient overload. Moreover, because HIV/AIDS is a chronic condition lasting for years and a person with AIDS may have frequent visits and admissions to health institutions which are already overloaded, patients usually don’t receive quality palliative care and maintain continuity of care after discharge. Therefore people living with AIDS often die neglected and denied of access to palliative care. To solve this problem, the use of the community to provide some components of care and support is a potentially effective alternative. However, most people providing or expected to provide this care in Ethiopia lack the appropriate knowledge and skills to deliver care. Project Description To contribute solve the problem in Addis Ababa where it is worse due to the high number of PLWHA, AMREF in Ethiopia implemented a project entitled “Training of Health Care Providers in Community/ Home Based Care (CHBC) for People Living with AIDS in Yeka, Gullelle, Lideta and Addis Ketema Sub-Cities of Addis Ababa” funded by AMREF Spain. Training of health workers and volunteers on CHBC, provision of home based care and palliative care were the major activities that the project have been accomplishing during its life from 05 April 2007 to its close up on 31 October 2008. Evaluation Questions This evaluation was planned to serve the information needs of project stakeholders including donors and implementers by answering evaluation questions: 1. To what extent was the project successful in implementing planned activities and achieving desired changes among beneficiaries? 2. What was the level of satisfaction of recipients of CHBC? 3. Are there evidences that community based palliative care centers can better contribute to address the comprehensive needs of PLWHA? 4. What were the strengths and weaknesses of the project? - i - Evaluation Methodology The evaluation was conducted in the project site from September to November 2008 and the specific period for data collection was from 20 to 31 of October 2008. The evaluation was process focused addressing coverage, quality and effectiveness as its dimensions. Data was collected cross-sectionally involving both qualitative and quantitative techniques through document review, expert interviews, survey of beneficiaries and focus group discussions. The expert interviews were conducted with three project staff, two experts from each of the three sub-city health offices and one from a public health center in the project site. And the focus group discussions were conducted among voluntary HBC providers, beneficiaries and project stakeholders. Quantitative data was collected on sample beneficiaries of the project. Collected data was analyzed using appropriate analysis techniques and findings were triangulated to justify conclusions and come up with appropriate recommendations. Results and Discussion The project was implemented for 19 months primarily in nine kebeles of the three sub-cities: Yeka, Gullele and Lideta. In these target sub-cities, the project was effective to provide training of trainers (ToT), training of facilitators (ToF) and training of voluntary CHBC providers for 22, 52 and 319 trainees respectively. And this was 146.7%, 86.7% and 70.9% of project targets for ToT, ToF and training of volunteers, respectively. Through these trained volunteers, it has reached 1,076 clients which was only 53.8% of the project’s target. The main reason for underachievement of the project regarding the provision of CHBC was the delayed provision of training to volunteers. The quality of care provided through these volunteers was considered as a good quality care both from providers’ and beneficiaries’ perspectives. The client satisfaction survey showed that beneficiaries rated their satisfaction level on average at 4.6 out of 5 possible points. The other major activity accomplished by the project, in collaboration with Hospice-Ethiopia, was initiation of institutional palliative care. Summary of project reports showed that the project built the capacity of Hospice by equipping and furnishing the model palliative care center, providing training to its staff and availing drugs & other medical supplies during the project’s life. During the project’s life, a total of 69 (6.9% of the project’s target) patients were admitted to the center making bed occupancy rate of 19.2%. This very low utilization of the palliative care center was primarily due to project related factors including location of the center and human - ii - resource issues. Regarding the appropriateness of expanding free standing palliative care centers, this evaluation didn’t come up with conclusive evidences that it needs further studies. Sustainability of project activities and benefits to the community was addressed through the selection of real volunteers for CHBC provision and empowering Hospice-Ethiopia for continued provision of palliative care. This was reflected by volunteers who showed determination to continue their voluntary services irrespective of the project’s status. Conclusion The community home based care project was effective in implementing its planned activities on provision of trainings on CHBC. However due to delayed initiation of project activities, inappropriate location along with shortage of staff of the palliative care center, the number of beneficiaries who received home based care and palliative care was very low as compared to both the project’s plan and the need in the community. The quality of home based care provided to project beneficiaries was very good both from the beneficiaries and providers perspective. There was no conclusive evidence on the appropriateness of free standing palliative care centers from this evaluation. The project has demonstrated accomplishment of its activities in a way that maximizes the potential sustainability of benefits to the community. Lessons Learnt Community volunteers can provide physical, psychological and social support of acceptable quality to PLWHA. This can be used to maximize the contribution of the community in the health sector. Expansion of free standing palliative care centers will have both advantages and disadvantages that need detailed study before decisions happen regarding it. Based on the findings of the evaluation, appropriate recommendations are forwarded to relevant constituents. - iii - Table of Contents Executive Summary ............................................................................................................. i Table of Contents ............................................................................................................... iv List of Abbreviations ......................................................................................................... vi 1 Introduction ................................................................................................................. 1 2 Project Description...................................................................................................... 3 2.1 Objectives of the Project ..................................................................................... 3 2.1.1 General Objective ....................................................................................... 3 2.1.2 Specific Objectives ..................................................................................... 3 2.1.3 Targeted beneficiaries of the project ........................................................... 3 2.2 Program Components/Activities ......................................................................... 4 2.3 Program Logic Model ......................................................................................... 5 3 Evaluation Questions and Objectives ......................................................................... 6 3.1 Evaluation Questions .......................................................................................... 6 3.2 General Objective ............................................................................................... 6 3.3 Specific objectives of the evaluation .................................................................. 6 4 Evaluation Methodology ............................................................................................. 7 4.1 Purpose of the Evaluation ................................................................................... 7 4.2 Study Area and Period ........................................................................................ 7 4.2.1 Study Area .................................................................................................. 7 4.2.2 Study Period