| dc.description.abstract | BACKGROUND:
Care for HIV/AIDS is optimized by the integration of family and community (WHO, 2002). The home based care strategy of HIV/AIDS service delivery was launched by the AIDS support organisation (TASO) in the year 2003 with the objective of supporting home caregivers to cope with the management of the very ill who are not able to access institutional health care. Volunteer community nurses are key to this strategy. However, their performance has not been assessed despite the fact that they are a key link between TASO and the community in providing medical care to PLWHAs. Assessment of their performance will therefore help identify gaps so as to improve the strategy.
OBJECTIVES:
To establish the availability of community nurses to clients, to assess their performance in this home based care model and to identify the factors that motivate them to offer care.
METHODOLOGY:
A Cross sectional study was conducted within the TASO Mbale service centre coverage site. All the community nurses and health unit in charges in the sub county where the nurses work were studied. Systematic sampling was used to select 422 clients receiving services from the nurses. Data were collected using questionnaires, observation checklists and key informant interview guides. Analysis was conducted by univariate, bivariate and multivariate techniques. The latter was done using stepwise logistic regression. Thematic analysis was used to identify factors that motivate them to offer care.
RESULTS:
Most (90%) clients were aware of the community nurse in their sub county. Those clients who were aware of the nurses in their community were more likely to seek for her care than those who were not (p<0.0001). Most (71.8%) of the clients who sought for the nurse’s care accessed her. However, the nurse was accessed in most cases (49% and 35.5%) with help from other community members including ACWs. On most occasions (67.2%), the community nurse provided the required care. The majority of clients received a required service within 2 days (195, 67.2%) of request. It took between 0.4 days for a nurse to get a client. Half of the nurses (50%, 6/12) had good performance as measured by a score greater than 75%. Knowledge attitudes towards their roles {OR 3.462, 95%C1:1.75-6.859}} and duration of time to access a service {OR-6.576, 95% C1:1.387-31.184} were associated with performance. The nurses are motivated by facilitation with equipment and supplies as well as improved allowances.
CONCLUSIONS:
The community nurses are available to most clients. Their performance is mainly associated with their knowledge of care, attitude towards their roles and their duration of time it takes to deliver a service. The area of coverage and facilitation also contribute to their performance. They are motivated to perform by non-financial as well as financial incentives.
RECOMMENDATIONS:
The presence and activities of community health workers like community nurses should be publicized to increase their availability. Numbers of community health workers need to be increased in an area to improve coverage. Facilitation with non-monetary incentives like better transport means may improve performance. The quality of care as well as the effectiveness of community nurses requires ongoing evaluation. | en_US |
