The objective of this research is to reveal the implications of the choice of home- and community-based care as opposed to other policy choices and, using a gendered lens, to find a plausible way of assessing the social and economic effects of this care policy for households, families, and centrally for women. Women’s paid and unpaid work, the continuum of paid and unpaid health/care work, care work, the care economy and community care are reviewed, as well as household structure, unemployment and the provision of health and welfare services in South Africa. The costs of unpaid care provision, methods for and issues to do with measuring time-use, and approaches to valuing unpaid care work are also considered. Time-use and financial cost information obtained as part of the 2004 KwaZulu-Natal Income Dynamics Study qualitative study from 19 family caregivers of 17 terminally ill people in 16 households, is the central source of data. The qualitative study employed a modified extended case study method. The psychological, emotional, social and physical costs of unpaid care work are not counted. Instead, caregivers’ labour time spent in unpaid care work is counted and valued using four methods (average earnings, opportunity cost, generalist, specialist), and financial costs to households of unpaid care provision are also counted. In this way unpaid care work is assigned various costs, a necessary step if this work is to be included in policy making processes. The findings are not representative but make possible some speculation about home-based care in KwaZulu-Natal. Findings on financial costs suggest that the welfare grant to the poorest elderly is subsidising the health services. On average 10 hours are spent by household caregivers in unpaid care work per ill person per day, and women are accounting for the bulk of this time. Moreover, in terms of valuing, most appropriate to the poor in KwaZulu-Natal is the generalist method using the proportionate approach and median earnings rates. If family caregivers were paid for the time spent in unpaid care work and households were reimbursed for their financial costs, for 2004/5 using the low estimate it would cost approximately R585 per month per ill person for unpaid care provision that takes place seven days a week and 10 hours per day (R7,619 per month using the high estimate). When multiplied by the number of AIDS-sick people in KwaZulu-Natal, this spending on costed unpaid care provision exceeds the monthly health and welfare spending on home-based care in KwaZulu-Natal for 2004/5 of approximately R2 million by R104,025,512 million if the low estimate is used. These costs are compared to the costs of a selection of similar public and private interventions in South Africa. Without fail the costs of unpaid care provision do not exceed 26 percent of the costs of alternatives. The findings show that the home- and community-based care guidelines have inequality-creating effects: wealthier families may be able to buy in care if necessary, while poorer families have to provide this care themselves. Moreover, government is saving substantially on the health budget by limiting the provision of public inpatient care. Because of the high costs of operation of both high- and low-cost inpatient centres, as well as home-based care as delivered by NGOs/FBOs/CBOs, the potential for these interventions to deliver to all of those in need of such care, when compared with unpaid care provision, is not great from the perspective of a government seeking to cut costs. The findings show that home-based care is cost-effective for government but not for family caregivers who carry the bulk of care costs. Policy options such as payment for caregiving, the basic income grant and expansion of the expanded public works programme are presented. Since family caregivers are meeting a minimum standard of productive participation, it is argued that a citizen based model of social protection be adopted. Finally, what worked and did not work with regard to the study is used to inform recommendations for improved future research on unpaid care work in South Africa. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

The Home and Community Based Care (HCBC) and Support programme has been established as a cost effective response for communities to tackle HIV and AIDS and many other chronic conditions and vulnerabilities which are faced by individuals, families and communities. In terms of the Framework for Home and Community Based Care and Support Programme (2012: 4) HCBCs create an enabling platform for “individuals, families and communities to have access to holistic and comprehensive services nearest to home, which encourages participations by people, responds to the needs of the people, encourages traditional community life and strengthens mutual support opportunity and social responsibility”. Victor Khanye Local Municipality, IDP (2010-2011: 116) states that VKLM is faced with: a high incidence of HIV and AIDS due to poverty, ignorance and a lack of proper entertainment facilities; shortage of clinics and professional staff members, which makes it difficult for patients to access treatment and maximum care and support; and an increase in the number of OVCs which results in a lack of parental care and guidance, poverty, illiteracy, lack of access to medical care, school drop-outs and ultimately an increase in criminal activity and the further spread of HIV and AIDS. The research will assess the effectiveness of Home Community Based Care programmes (HCBCs) on orphaned and vulnerable children with specific reference to the Victor Khanye sub-district in Nkangala District, Mpumalanga Province. The research was conducted in Delmas and its surrounding farming areas. Victor Khanye sub-District has nine wards, most of which are predominantly farming rural areas. The field research took place during June and August 2013 and represents observations recorded at the field interviews, the local AIDS committee and one-on-one interviews with beneficiaries The study is concluded with conclusions drawn from the field study and recommendations.

Volunteer home-based caregivers are critical role players in South Africa‘s health care system and in the South African government‘s strategy to fight HIV and AIDS. In order to achieve the aims that the government seeks to attain, it is important that the care and treatment provided to patients receiving community home-based care (CHBC) be of a high quality. While the need for quality care is supported by government and civil society, research indicates that it is not clear whether quality care is indeed being provided and therefore there is a need for research into the quality of CHBC. The research aimed to undertake a critical assessment of CHBC programmes to determine the quality of care provided by volunteer caregivers using social capital theory as a theoretical framework. The study examined the quality of CHBC by analysing the context of CHBC, by investigating the support that volunteer caregivers and their clients receive and by discussing the support that volunteer caregivers and their clients still need. The study used one-on-one in-depth interviews and focus groups to obtain relevant data. The participants included volunteer caregivers, clients and supervisors who took part in the one-on-one interviews. The focus groups consisted of key informants and supervisors respectively. The quantitative data consisted of descriptive statistics which helped describe the participants. The qualitative data was coded and themes and sub-themes were developed. The data was also analysed by an independent coder. The results showed that poverty, and the related problems of poor living conditions and a lack of food security affects the quality CHBC. In addition, unemployment and the problem of stipends also affect quality CHBC. Certain socio-economic factors were also found to lead people to choose to become volunteer caregivers and unemployment was found to be an important driving force behind the choice to undertake volunteer caregiving. Furthermore, the volunteer caregivers in the sample received organisational support from their supervisors and their fellow caregivers or peers. They also received social support from their families and their communities. Regarding the clients of the volunteer caregivers, it was found that they received a number of types of support including psycho- iv social counselling, spiritual counselling and care of a holistic nature. In addition, the study found that there is a need for standardised quality training of volunteer caregivers, which will equip them with multiple skills. It was also found that volunteer caregivers require mentoring and quality supervision in order to be able to provide quality CHBC to their clients. Government has the ability to put the necessary systems and structures in place, such as a scope of practice for volunteers, standardised training and monitoring and evaluation, to enable CHBC and its relevant role players to operate at optimum levels. It also has the authority to make the changes and to enforce rules. Furthermore, it has the ability to unite CHBC organisations and can create the necessary conditions that can lead to increased social capital. Furthermore, the study recommends that two additional dimensions of quality care be added to existing dimensions of quality in health care. The first is the holistic approach to caregiving and the second is social support systems, namely supervisor/mentor and peer support and family and community support. This second dimension is also closely linked to social capital and the networks that make up CHBC.

Institute for Rural Development / PhDRDV

MSCPNT / Department of Nutrition

MPM / Oliver Tambo Institute of Governance and Policy Studies / See the attached abstract below

MPH / Department of Public Health / See the attached abstract below

In South Africa prior to 1994, community-based care and support services were established for whites only. The majority of older African (black) persons received informal support from their adult children and relatives. This has waned over the years due to the social and economic changes that have put into doubt the continued viability of such support. The Older Persons Act of 2006 requires social workers to establish community-based care and support services for older persons. Hence, the study was conducted to understand the factors that influence social workers in establishing CBCSS for older persons in Bloemfontein in the Free State Province. A qualitative research method was undertaken to accomplish the goal of the study. Purposive and snowball sampling techniques were used to identify suitable participants. Face-to-face semi-structured interviews were conducted with fifteen social workers who provide services to older persons. The data was analysed through Tesch’s (cited by Creswell, 2009:186) eight steps of qualitative analysis and data verification was conducted following Guba’s (Kreftling, 1991) model. The major finding is that there is a need for social workers to specialise in older persons programmes (gerontology). For the programmes to be a success, it is recommended that the Department of Social Development (DSD) strive to retain social workers who are knowledgeable and experienced in older persons programmes. / Social Work / M.A. (Social Science)

In South Africa prior to 1994, community-based care and support services were established for whites only. The majority of older African (black) persons received informal support from their adult children and relatives. This has waned over the years due to the social and economic changes that have put into doubt the continued viability of such support. The Older Persons Act of 2006 requires social workers to establish community-based care and support services for older persons. Hence, the study was conducted to understand the factors that influence social workers in establishing CBCSS for older persons in Bloemfontein in the Free State Province. A qualitative research method was undertaken to accomplish the goal of the study. Purposive and snowball sampling techniques were used to identify suitable participants. Face-to-face semi-structured interviews were conducted with fifteen social workers who provide services to older persons. The data was analysed through Tesch’s (cited by Creswell, 2009:186) eight steps of qualitative analysis and data verification was conducted following Guba’s (Kreftling, 1991) model. The major finding is that there is a need for social workers to specialise in older persons programmes (gerontology). For the programmes to be a success, it is recommended that the Department of Social Development (DSD) strive to retain social workers who are knowledgeable and experienced in older persons programmes. / Social Work / M.A. (Social Science)

MPM / Oliver Tambo Institute of Governance and Policy Studies