Arm's Reach Care (ARC)
Matero, Lusaka
Arm’s Reach Care is a pioneering community care project focused on strengthening care provided in the home and creating a network of community health workers and nurses to provide enrollees a wider range of high quality, lower cost care at home. The central philosophy of Arm’s Reach Care, “Everyone A Caregiver,” emphasizes providing maximum care at or as close to home as possible.
Advances in care and treatment have made HIV/AIDS a manageable disease. With proper nutrition, treatment of opportunistic infections, and adherence to drug regimens, people can live for years, raising their families and contributing to their communities. Arm’s Reach Care will enable people to live with HIV/AIDS.
Power of Love has launched Arm’s Reach Care in Matero, a low-income community in northern Lusaka, Zambia’s capital. In addition to decreased episodes of sickness and greater reach of available health care workers, the program has also reported high levels of HIV testing for enrollees and their Family Care Givers (FCGs), the first step to preventing the spread of the disease.
Structure
Arm’s Reach Care consists of three levels of care service that identify children infected with HIV and help them and their families live with HIV.
Each level, from Family Care Givers to Project Nurse, is more skilled medically. Care providers at each level are trained to provide medical care within their capabilities and to quickly recognize situations that require referral to the next level of care providers. The Matero Care Center provides outpatient service for more critical patients needing professional observation and intervention.
Family Care Givers (FCGs) are members of the patients’ household trained in basic home nursing. Initially, FCGs take part in a 5-day workshop. Continued education is provided in bi-monthly daylong refresher sessions. In addition to HIV/AIDS education, FCGs are taught simple, yet effective responses to common opportunistic infections such as chronic diarrhea, fever, and cough, and maintenance of good hygiene. They are also taught care-giving specific to patients in the clinical AIDS stage, such as bathing and nurturing. Monthly support meetings for the FCGs provide ongoing opportunities to teach about HIV/AIDS, to promote Voluntary Counseling and Testing, and to reduce the stigma surrounding AIDS.
Community Care Assistants (CCAs) are trained in medical care-giving specific to HIV/AIDS, particularly in the identification and treatment of opportunistic infections. CCAs are trained in an intensive 8-week workshop, followed by monthly daylong refresher sessions. The refresher sessions allow the CCAs to reinforce their existing skills, reflect on and address challenges encountered in the community, and acquire knowledge on new areas relevant to their practice. CCAs supervise up to 25 patients each. They provide each household with one to five home visits every week, during which they supervise care provided by FCGs, oversee treatment adherence, and counsel the patient and the FCG.
Project Nurses are fully trained, certified nurses. They meet regularly with CCAs to review patient records and visit each patient monthly. Project Nurses make final diagnoses and referrals, and prescribe treatment courses, as per Zambian regulations for community-based healthcare. S/he can dispense medication for common opportunistic infections and transport urgent cases to the local clinic for further treatment.
Key Benefits
The Arm’s Reach Care Model is different from existing home-based care projects because it relocates ownership and responsibility for care of persons living with HIV/AIDSback into the home. The FCG program gives the FCG a deeper understanding of the components of care for her patient and of her essential role in providing that care.
By training FCGs and CCAs, the Arm’s Reach Care model creates a broad base of trained caregivers in the community, facilitating the management of AIDS-related infections. With the assistance of CCAs, the Project Nurse is able to focus on the more serious cases requiring his/her advanced skills, and to make decisions on referrals to government clinics. Arm’s Reach Care offers a solution to both the shortage of trained health professionals and to the over-burdening of government clinics. Additionally, the model will implement a data capturing and management tool, CHART, to support the CCAs and Nurses and further increase their efficiency.
With its unique philosophy and structure, Arm’s Reach Care constitutes a radical shift from present models by engaging more community members in care-giving, significantly increasing the range of care provided at home, and increasing the output and impact of individual caregivers and of the overall system.
Implementation
Power of Love has launched Arm’s Reach Care in Matero, a community in Lusaka, Zambia. In the last year, we have trained a 150 FCG's and provided for 150 children. As a direct result of the FCG training and ongoing counseling during home visits, all patients have been tested for HIV. Furthermore, patients at a more advanced stage of disease progression have been placed on ARVs (provided by the government clinic). The nutritional supplements we provided to all patients have also played an indisputable role in supporting patients’ recovery from opportunistic infections and improving their overall condition.
Results of Arm’s Reach Care are undeniable: patients who were previously unable to attend school due to debilitating chronic diarrhea or serious fungal infections are now able to resume their studies and have dreams of an adult life. FCGs who were previously kept away from work by long waits at the clinic and children in need of intensive care at home can now return to earning money to support these children and the rest of their families.
As a testament to the success of the program, we have lost only 2 children out of a total of 140 children over the last 2 years. Since the life expectancy at birth for a HIV positive child is 5 years, statistically we should have lost many more children each year. However, this was not the case. Additionally, as care givers (grandmothers/grandaunts/mothers) see for themselves the positive effect that quality care has on the children, they themselves have come forward for testing (which, as you know, is critical in preventing the further spread of HIV).
The Matero ARC implementation has been hugely successful and the lessons acquired to date are informing both further development of the model and expansion of the existing project in Matero.
Project Manager: Melissa Edoh
Melissa Edoh is a graduate from MIT and the winner of the prestigious Fulbright Award in 2005. She is currently pursuing graduate studies at Harvard School of Public Health.