COMMUNITY HEALTH V

DIPLOMA IN CLINICAL MEDICINE & SURGERY

KMTC

3RD YEARS [YEAR 3 SEMESTER 2]

MODULE 58: Community Health V

Code: CHE 323; Hours - 30; Credits – 03

Pre-requisite(s): Community Health IV
1
Module Competence

 Implement family health care and

universal health care

2
 Module Outcomes
 By the end of this module the learner
should: -
1. Demonstrate understanding of fundamental
Concepts of family health care
2. Demonstrate understanding of universal
health care
3. Provide home based care

3
Module Units
Unit Name Hours
Theory Practical
1. Family Health care 10 4
2. Universal Health Coverage 6 4
3. Home Based Care 4 2

4
 Module Content
1. Family health care: definition, family, objectives,
principles, approaches (family as the context, family
as he client, family as a system, family as a component
of society), merits, demerits, range, role of a clinical
officer, family assessment, health appraisal, health
beliefs, communication, identifying families at risk for
health problem.
2. Universal health care: definition, objectives,
components (health care financing, health service
delivery, health workforce, health facilities, quality
assurance mechanisms, information systems), benefits.
Risk sharing in health (insurances).
3. Home Based Care: Introduction to HBC, objectives,
components, rationale, principles, infection control in
the community, diseases covered in HBC. Advantages
and disadvantages.
5
Teaching Strategies
1. Interactive lecture
2. Small groups discussions
3. Power point presentation
4. E-learning
5. Problem based learning
6. Study guides

6
 Reference
1. Huss J. etal. (2006) Start your own
medical practice
2. Dahle M. J. (2014) The white coat investor
3. Hacker et al (2010). The medical
entrepreneur: pearls, pitfalls and
practical business advice for doctors.
4. Saleemi N. A. (2011). Entrepreneurship
simplified East African Edition printing
services Ltd., Nairobi, Kenya.
7
 Content Delivery
Week Dates Unit
From To
Week 1: Family health care; definition, family, objectives, principles.
Week 2: approaches (family as the context, family as he client, family as a
system, family as a component of society)
Week 3 merits, demerits, range, role of a clinical officer, family assessment
Week 4 Health appraisal, health beliefs, communication, identifying
families at risk for health problem.
Week 5: FIELD TRIPS
Week 6: Universal health care; definition, objectives, components
Week 7: health care financing, health service delivery, health workforce.
Week 8: health facilities, quality assurance mechanisms, information
systems
Week 9: CATS
Week 10: Benefits of UHC. Risk sharing in health (insurances).
Week 11 Home based care; introduction to HBC, objectives, components,
rationale,
Week 12: principles, infection control in the community, diseases covered in
HBC. Advantages and disadvantages.
Week 13: Field trips
Week 14: fields
Week 15: Field trips
Week 16: revision
Week 17: Study week
Week 18: End of Semester Examinations 8
FAMILY HEALTH CARE

9
Definition:
❑ Family health care is a holistic approach to the
achievement of wholesome health for the family.
❑ Family Health: “a state of positive interaction between
family members which enables each members of the
family to enjoy optimum physical, mental, social and
spiritual well being.”
❑ “The health status of the family as a unit including the
impact of the health of one member of the family on the
family as a unit and on individual family members; also,
the impact of family organization or disorganization on the
health status of its members.” Online medical dictionary.
❑ Family health Is part of community health. Is more than
the sum of personal health of individual. Is a unit of health
care.

10
Concept of Family Health Care
❑ Family health care is a holistic approach to the achievement of
wholesome health for the family.
❑ Family health is a part and component of community health
❑ “Family health is more than the sum of the personal health of
individuals (including father) who form the family since it also takes in
to consideration-interaction in terms of health (physical and
psychological) between members of the family-relationships between
the family and its social environment-at all stages of family life in its
different structural types’’. Family should be distinguished as: A unit of
health and unit for care.
❑ Family health is a state in which the family is a resource for the day-
to-day living and health of its members. A family provides its individual
members with key resources for healthful living, including food,
clothing, shelter, a sense of self-worth, and access to medical care.
Further, family health is a socioeconomic process whereby the health
of family members is mentioned.
❑ Family health care means health care provided to a family members by
a Resource Family in accordance with the written instructions of the
health professional.
❑ The family is the interface between societal and individual health, and
the economic interface between the family and society determines
what resources are available for a family's health.
11
Aims of Family Health Care:
❑ Identifying and appraising health problems of the
family
❑ Providing health education for the promotion of health
and prevention of diseases
❑ Providing clinical services according to the needs of
the family
❑ Helping the family to develop competence at assessing
their health problems and at carrying out remedial
health action.
❑ Contributing needed materials for personal and social
development of family members
❑ Helping and encouraging the family members to utilise
available resources to maintain all aspects of the
health of the family
❑ Sharing health information with the family to enable
members to understand and accept health problems
12
Principles of Family Health Care
❑ Establish a good working relationship with the
family
❑ Plan relevant health education and sharing of
clear health messages, which will guide them on
how to take care of themselves
❑ Gather relevant information about the family
which will enable them to identify health
problems and set priorities
❑ Provide need-based support and services to the
family regardless of sex, age, income, and
religion, in order to improve their health status
❑ Work in collaboration with other health service
agencies to avoid duplicating family health care.
❑ Use the clinical process in the care of families
13
THE PROCESS OF FAMILY HEALTH CARE:
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation

Assessment
❑ This involves collecting data using interviews, observation,
subjective appraisal and reviewing available records and
reports.
Diagnosis
❑ Identify (diagnose) the family health problems, needs and
resources.
Planning
❑ Plan for health action by choosing effective and affordable
alternatives and setting priorities after considering the
available internal and external resources. You should work
hand-in-hand with the family members at all stages of
planning 14
Implementation:
❑ You should implement the interventions or health actions
agreed with the family members.
❑ Increase the family’s ability to function effectively and
removing barriers to health
Evaluation
❑ This involves evaluating or measuring whether the
expected outcome has been achieved.
❑ If no achievements have been made, find out what factors
interfered and change your approach accordingly.

15
Determinants of family health
❑ Living and working conditions
❑ Physical environment,
❑ Psycho-social environment
❑ Education and economic factors
❑ health practices
❑ Cultural factors
❑ Gender etc.

16
Scope and components of family health
1. Problems faced by family:
❑ Broken homes, drug abuse, juvenile delinquency, disability
and rehabilitation, unmarried mothers, teenage pregnancy
2. Reproductive health
❑ Safe motherhood, ANC, delivery care, PNC, Family
planning, Nutritional deficiencies, LBW
❑ STIs/RTIs/HIV/AIDS, legal abortion, infertility services,
❑ Adolescent health (suicide, depression, STIs)
3. Child health Child bearing, rearing,
❑ Child health services: nutrition, immunization, Growth
monitoring
❑ Mortality and mortality of children
❑ Social problems of children:
o Child abuse
o Abandoned or street children
o Child labour
o Juvenile delinquency
o battered baby syndrome
17
4. Gender issues in family:
❑ Girls trafficking, Gender mainstreaming, Female Genital
Mutilation (FGM), female feticide (sex-selective abortion),
5. Aging:
❑ Problems of ageing, active ageing
6. Mental health:
❑ situation of mental health, its causes and prevention,
National mental health policy

18
Family:
❑ A group of two or more persons, who share emotional
bonds and material things, usually live in the same
household, are related by blood, marriage or adoption,
and sexual relationship is socially approved for the
parents.
❑ A basic social group united through bonds of kinship or
marriage, present in all societies.
❑ Family can be defined as any social group of people who
are united together by ties of marriage, ancestry or
adoption, having the responsibility for rearing children.
❑ Family is the basic unit of a community
❑ It is the building block of any society.
❑ It is so important to individuals and society because it
responds to some of the fundamental human needs

19
❑ A family is a group of persons united by the ties of
marriage, blood or adoption constituting a single
household, interacting and intercommunicating, with each
other in the respective social role of husband and wife,
father and mother, son and daughter, brother and sister,
holding and maintaining a common culture.
❑ It can be considered as a social system comprising of
persons who co-exist within the context of expectations of
reciprocal affection, mutual responsibility and temporal
duration
❑ Family dynamics keep on changing from setting to setting
and this has made it difficult to define what a true family
is
❑ Economic resources is the single most important factor
affecting the family
❑ Poverty is linked with a wide range of problems such as
homelessness, inadequate parenting
20
❑ The traditional family structure as is known today has
been affected by many factors such as war ,
industrialisation and time
❑ Family structure has changed in response to major social,
economic and political changes
❑ Women who the home were their reserve have been
hounded out in search of employments
❑ Women started demanding their rights including the right
to vote, and right to shape the social forces
❑ The dawning of the information age has brought about
global awareness of family mores and alternatives
❑ Marriage is now one of the many options which include
living alone, cohabitation, maintaining a sexual
relationship while staying apart and marrying after getting
pregnant.
❑ With this in mind, many families are questioning and
redefining their role in the contemporary society.
21
❑ This has a very strong implication for all health care
professional who may attempt to guide them
❑ The demographic changes affecting a family include a
divorce remarrying, inheritance, illicit relationships,
reduced children etc.
❑ Couples are not morally and legally bound to hold on to
marriage making this institution unstable
❑ Complex Family is a generic term for any family structure
involving more than two adults. e.g. Group marriage,
polygamy and polyandry
❑ A dysfunctional family is a family in which conflict,
misbehavior and even abuse on the part of individual
members of the family occur continually, leading other
members to accommodate such actions. experiences.

Views on family
❑ Biologist view -
❑ Psychologist view -
❑ Economics views -
❑ Sociologist views - 22
Traditional family:
Major premises related to traditional families
❑ Romantic love forms the basis for a successful
marriage
❑ Sexual activity should be confined to marital
relationship
❑ A person should have only one partner of the
opposite sex
❑ Masculine and feminine sex roles shall be clearly
defined
❑ Children should be raised in a nuclear family
setting
❑ The nuclear family is the most effective unit for
family living and social functioning
23
Traits of a healthy family
There are several common features of healthy,
happy families that include:
❑ Cohesiveness
❑ Open communication
❑ Parents leading by example
❑ Conflict management, and
❑ Setting clear expectations and limits.
❑ Healthy families stick together.
❑ Support;
❑ Love and caring for other family members;
❑ Providing security and a sense of belonging;
❑ Making each person within the family feel
important, valued, respected and esteemed.
24
Types of Family:
1. On the basis of marriage:
❑ Polygamous or polygynous family – one man many wives.
❑ Polyandrous family- One woman many husbands.
❑ Monogamous family- one man one wife.

2. On the basis of the nature of residence

❑ Family of matrilocal residence
❑ Family of patrilocal residence
❑ Family of changing residence

25
3. On the basis of ancestry or descent family
❑ Matrilineal family
❑ Patrilineal family

4. On the basis of size/structure /depth of generations.

❑ Nuclear or the single unit family - father, mother and
children
❑ Joint family/extended/ three generation/ Consanguineal. –
father, mother, children, uncles, aunts, grand ma, grand
parents, cousins
❑ Singe family - father and children or mother and children
❑ Blended family - husband and wife bring into the new
marriage unrelated children from their previous marriages
❑ Binuclear family- A family where parents have divorced but
continue to share responsibility of bringing up children. - a
woman brings her children and a man bring his children
together to make a family
26
5. On the basis of the nature of relations among the family
members
❑ The conjugal family which consists of adult members
among whom exists sex relationship.
❑ Consanguine family which consists of members among
whom there exists blood relationship - brother and sister,
father and son etc.

27
List of the types of families
❑ Nuclear family
❑ Single parent families
❑ Separated family
❑ Dyad family
❑ Step-parent family
❑ Blended or reconstituted family
❑ Single adult living alone
❑ Generational family
❑ Cohabiting
❑ Compound
❑ Gay
❑ Group marriage
❑ Commune
❑ Care giving families

28
Characteristics of a family:
❑ Universality: There is no human society in which some form of
the family does not appear.
❑ Emotional basis: The family is grounded in emotions
❑ Limited size: As a primary group its size is necessarily limited.
It is a smallest social unit.
❑ Formative influence: The family welds an environment which
surrounds trains and educates the child. It shapes the
personality and moulds the character of its members.
❑ Have functions: all families perform certain function.
❑ Nuclear position in the social structure: The family is the
nucleus of all other social organizations. The whole social
structure is built of family units.
❑ Responsibility of the members: The members of the family has
certain responsibilities, duties and obligations.
❑ Social regulation: The family is guarded both by social taboos
and by legal regulations. The society takes precaution to
safeguard this organization from any possible breakdown.
❑ Structure: all families have a structure
❑ Life cycle: All families go through a life cycle 29
Functions of the Family:
❑ Bringing about a sense of community togetherness and a
balance between individual and shared (mutual) action by
each family member; nurturance and trust, stability and
integrity of the group, interdependence and the ability to
meet demands on survival and development.
❑ Providing basic needs for the members
❑ Nurturing young ones
❑ Legal functions- gives members nationality
❑ Inducing its members to its religious faith and teaching
respect and tolerance for religious differences
❑ Sharing leisure and recreation together (companionship)
❑ Providing security and refuge for its members in times of
need
❑ Providing a socially sanctioned environment for sexual
expression amongst married adults
❑ Seeking health care for its sick members and providing
nursing care for its sick, disabled or dependent members
❑ Maintaining a healthy home environment conducive to the
development of its members 30
❑ Teaching respect for individual members and their
property
❑ Teaching tolerance, fairness and a sense of right or wrong
among it’s members and others.
❑ Caring for it’s members and developing a sense of trust
between and among it’s members
❑ Providing an environment for learning and internalizing
individual and gender roles and responsibilities
❑ Socialization; it is essential to the personality, emotional,
social and intellectual development of children It is the
process by which newborn children are trained in the
society’s values, norms, standards of behaviors action,
etc.. Without proper socialization, children would end up
being mere biological beings, or they would develop anti-
societal attitudes and behaviors. Socialising its members
into the larger community.
❑ Providing social support, psychological comfort and
physical care and protection for the young, the sick, the
disabled and the aged.
31
Roles of a family
❑ Child socialization
❑ Child care
❑ Provider’s role
❑ House keeper role
❑ Kinship’s role
❑ Therapeutic role
❑ Recreational role

32
Role of the family in health:
❑ Prevention of ill health
❑ Identification of deviation from normal
❑ Decision making on seeking medical help and
where to seek it.
❑ Act as a referral i.e. gives details about the
patient problems
❑ Visits the patient, pays bills etc. incase of
admission
❑ Provides home based and rehabilitative care for
the member after discharge.
❑ Ascribes the sick role to the sick member
❑ Provides basic needs such as food and shelter to
members.
33
Factors that affect health of a family
EXTERNAL FACTORS
❑ Family locality
❑ Terrain
❑ Climate
❑ Water supply
❑ Air
❑ Biological environment (insects, rodents, etc.)
❑ Housing and residence

INTERNAL FACTORS
❑ Family size
❑ Structure
❑ Type, members
❑ Relationship
❑ Biological characteristics and values
34
Family values
❑ It comprises of ideas, attitudes and beliefs
which guide the development of family
norms or rules
❑ Family values are composite of societal
values and culturally determined cultural
systems which individuals bring to the
family from the family of origin
❑ Family values include such things as
productivity and achievement, materialism,
work ethics, education, equality and
tolerance of diversity
35
STAGES OF FAMILY DEVELOPMENT:
1. Independence stage. This is the stage from when an
individual begin to separate emotionally from his/her
family. At this stage, one strives to become independent
emotionally, financially, physically and socially. In
addition, intimacy with opposite sex is developed.
2. Coupling. This is the stage when one develops a new
family system. The main task is to develop
interdependency and the ability to cope with a new way
of life.
3. Decision to have a baby. The decision to have a baby or
not is made. This can be stressful especially to the woman
who may have fears of pregnancy associated problems.
Also the male may fear to verbalize fears of anticipated
increased responsibility and this may result in health
problems.

36
4. A family with a young child. There is a
transition from being a member of a couple to
being a parent. The main task is creation of a
loving, safe and organised environment for the
upbringing of the children.
5. A family with an adolescent. This is when the
eldest child has reached adolescence. The main
task is to provide a balanced atmosphere in
which the teenagers have a sense of support and
safety. One should be flexible as the teenagers
have varied ideas and encourage them to be
independent and creative.
6. Launching adult children. This begins when the
first child becomes independent. The main task
is to support the children to enable them to
become independent.
37
7. Retirement or senior stage. At this stage
the other children becomes independent
until all of them leave the family. It is also
at this stage that one retires if they had
been on employment.
8. Family in later life. At this stage the
family review their life and they either
have a sense of accomplishment or
bitterness. The focus changes form the
individual family to middle level
generation and support them. The family
also deals with death of a spouse, sibling
and other peers as well as preparation of
one’s death.
38
 Family Life Cycle:
Introduction:
THE FAMILY LIFECYCLE:
❑ A source of roles, responsibilities and challenges for
families!
❑ Families experience predictable stages.
❑ Stages are influenced by Socioeconomic status (SES),
ethnicity, culture.
❑ The transitions between stages are stressful.
❑ Individual lifespan stages & family stages interact.
❑ Families can be health allies or interrupters.
❑ Family physicians are well-positioned to notice family
stress and to offer guidance.
❑ To be successful: members need to adapt to family
changes to ensure family survival.
❑ In each stage, challenges in family life cause you to
build / gain new skills.
❑ Not everyone passes through these stages smoothly. 39
Definitions:
❑ A family lifecycle is a series of stages families go
through as the structure of the family changes.
❑ However, not every family follows the life cycle in
order or description because each family is unique.
❑ Understanding the stages in the lifecycle of a family
can help prepare parents and other family members
for the challenges and demands each stage brings.
❑ Family life cycle – Set of predictable steps or patterns
and developmental tasks families experience over
time.
❑ The family life cycle concept facilitates studying the
family from beginning to end.
❑ Family stage – A time period in the life of a family
that has a unique structure.
❑ Transition – The shift from one family stage to
another
40
Assumptions:
❑ Age does not matter… people enter the stages at different
points, i.e. having a baby at 18 versus having a baby at 23
or 41.
❑ Development of group of interacting individuals is more
important than of the individual.
❑ Developmental processes are inevitable and important in
understanding families.
❑ Growth is going to happen.
❑ Families and individuals change over a period of time. 41
Why study the family life cycle?
❑ Mastering the skills and milestones allows you to
move from one stage of development to the next.
❑ If you don't master the skills: more likely to have
difficulty with relationships and future transitions.
❑ Family life cycle theory suggests: successful
transitioning may also help to prevent disease and
emotional or stress-related disorders.
❑ Your experiences through the family life cycle will
affect who you are and who you become.
Objective of studying Family Life Cycle as a
physician
❑ Understand the tasks of family stages.
❑ Become familiar with stage stressors.
❑ Anticipate potential problems in families.
❑ Be alert to abnormal family development.
❑ Know when to offer education/counseling. 42
What can disrupt the cycle?
❑ Severe illness, stress, financial problems, or death
can have an effect on how well you pass through
the stages.
❑ If you miss skills in one stage, you can learn them
in later stages.

Family Medicine Requirements: Family

❑ Structure
❑ Development
❑ Stages of stress
❑ Epidemiology of illness
❑ Role in illness care
❑ Child rearing and education
❑ Counseling and education
❑ [Family violence, neglect, abuse]
43
Role of Physician / clinician
As with an individual lifecycle stages:
❑ Anticipate typical problems
❑ Advise, educate, counsel
❑ Empathize
❑ Support

What is family life cycle theory?

❑ An approach to studying families.
❑ Dates back to the 1930s
❑ Family developmental theory includes two basic
concepts
1. The life cycle
❑ Emotional and intellectual stages from childhood to
retirement as a member of a family.
2. The developmental task.
❑ Growth responsibilities that arise at certain stages in
the life of the family. 44
Family Development:
❑ Predictable stages
❑ Affected by socioeconomic status (SES)
o “Quickened timing of life” for lower SES
❑ Affected by culture, ethnicity, religion etc.
o Timing, roles, tasks, demands
❑ Affected by age of each member at each
stage
o May create stress when out of synch, off cycle
o e.g. first parenthood at very early age
❑ It suggests that families go through stages of stability
different from adjacent stages .
❑ At each stage , certain tasks and functions are expected to
be achieved to meet biological requirements, cultural
imperative, aspirations and values. 45
Family Life cycle Stages (Family Stages)
❑ STAGE 1: Beginning Family
❑ STAGE 2: Expanding Family / Childbearing Family
❑ STAGE 3: Developing Family / Preschoolers Family
❑ STAGE 4: Family with School Children
❑ STAGE 5: Family with Teenagers
❑ STAGE 6: Launching Family / Launching Centre
❑ STAGE 7: Empty Nest
❑ STAGE 8: Aging Stage / Aging Family

Other version (compressed) family life cycle stage:

❑ STAGE 1: Beginning Family
❑ STAGE 2: Expanding Family
❑ STAGE 3: Developing Family – combines stage 3, 4 & 5
(STAGE 3: Developing Family, STAGE 4: Family with School
Children and STAGE 5: Family with Teenagers)
❑ STAGE 4: Launching Family
❑ STAGE 5: Aging Family - combines stage 7 & 8 (STAGE 7:
Empty Nest and STAGE 8: Aging Family)
46
Other version family life cycle stage: more
elaborated (explained using the previous
version)
1. Couple Commitment: exclusive relationship
2. Learning to live as a unit: dividing the labor
3. Parenting first child: negotiating the roles
4. Adolescent child: re-adjusting boundaries
5. Launching children: empty nest, exits,
entries of new members, mid-life crisis(?)
6. Retirement: new lifestyle, roles
7. Old age: social, physical and health losses

47
Other version family life cycle stage: more
elaborated (explained using the previous version)
1. Couple Commitment: exclusive relationship -
(Beginning Family)
2. Learning to live as a unit: dividing the labor
3. Parenting first child: negotiating the roles -
(Expanding Family)
4. Adolescent child: re-adjusting boundaries -
(Family with Teenagers)
5. Launching children: empty nest, exits, entries of
new members, mid-life crisis(?) – (Launching
Family / Launching Centre / Empty Nest)
6. Retirement: new lifestyle, roles
7. Old age: social, physical and health losses -
(Aging Family)
48
.
i. Stage 1: Beginning Families- Stage Of Marriage

ii. Stage 2: Early Child Bearing - Parenthood

iii. Stage3; Family With Preschool Children

iv. Stage 4: Families With School Children

v. Stage 5: Families With Teenagers

vi. Stage6: Launching Centre Families- Encouraging

Children To Marry

vii. Stage 7: Parents Of Middle Years- Post Parental Stage

[Link] 8: Families In Retirement And Old Age

Family lifecycle Stages:

STAGE 1: Beginning Family

❑ In this stage, two people form a family unit separate from
each one’s original family unit
❑ There are no children in this stage of the life cycle
❑ Married couple establish home but no children
❑ Developmental Tasks: Establishing a satisfying home and
marriage relationship and preparing for childbirth
Challenges:
❑ What challenges face the beginning family as they prepare
for the parenting process?
❑ What roles may be assumed by the family members in this
stage?

STAGE 2: Expanding Family / Childbearing Family

❑ During this stage, children are added to the family
50
❑ From birth of 1st child until that child is 2 ½ years old
❑ Developmental Task: Adjusting to increased family size
and providing a positive developmental environment
Challenges:
❑ What challenges face the expanding family as they
begin the parenting process?
❑ How will roles change in the family when the first
child is born?

STAGE 3: Developing Family / Family with Preschoolers

❑ This stage begins when the last child starts school
❑ Oldest child is between 2 ½ and 6
❑ Developmental tasks (DT): coping with demands on
energy and attention with less privacy at home.
Challenges
❑ What challenges face the developing family with children
from ages 6-20 years?
❑ Will these challenges affect family roles? 51
Stage 4: Family with School Children
❑ When oldest child is between ages of 6 and 13
❑ DT: Promoting educational achievement and fitting in with
the community of families with school-age children
Stage 5: Family with Teenagers
❑ Oldest child is between ages of 13 and 20
❑ DT: Allowing and helping children to become more
independent

STAGE 6: Launching Family / Launching Centre

❑ This stage begins with the departure of the oldest child
and ends with the departure of the youngest child from
the family unit.
❑ When oldest child leaves family until the youngest leaves
home
❑ DT: Releasing young adults and accepting new ways of
relating to them; maintaining a supportive home base
52
Challenges
❑ This stage holds many challenges for families. What are
some of them?
Stage 7: Empty Nest
❑ From time children are gone till couple retires
❑ DT: Renewing and redefining marriage relationship;
preparing for retirement years

STAGE 8: Aging Stage / Aging Family

❑ This stage is sometimes called the “empty nest” stage,
because the children have left the original family unit.
This stage has parents with children who are now
independent and living on their own.
❑ From retirement till death of the marriage partner
❑ DT: Adjusting to retirement; coping with death and living
alone.
Challenges
❑ What challenges would face parents in the empty nest
stage?
❑ How do roles change for family members in this stage of
the cycle? 53
Family Life Cycle Questions
❑ Do all families go through these stages?
❑ Are all families “nuclear” (two parents with children)?
❑ Do all families face the same challenges?
❑ How do roles change as the family moves through different
stages?
❑ Is the structure of the Family Life Cycle Changing?
❑ If so, what is changing / impacting it?
For Example:
❑ What happens to parents’ roles when an older member of
the family needs care?
❑ What happens to children’s roles as each sibling moves out
to live independently?
❑ What happens when a child moves back in because of
economic or emotional reason?
Remember….
❑ The family life cycle is one way to look at the roles and
responsibilities of parenting.
❑ In ‘real life’, the life cycle may be a combination of
several stages at one time! 54
Stages and Stress
❑ Transitional stress
o Predictable problems
o Family struggles to adjust
❑ Normal part of family life cycle
o Can become a full-blown crisis
o Complicated by other issues
o Can cause damage to the family
Other Types of Family Stress
❑ Disasters, serious illness, financial, caretaking
❑ Stages out of sequence
❑ Increasingly common family stressors
o Divorce
o Single parenting
o Blended families
o Sandwich generation
o Boomerang kids
o Parenting grandchildren 55
Family Stress and Health
❑ Kids are more susceptible to physical and emotional
problems when family is stressed.
❑ Young child: colds, stomachaches
❑ Older child: social withdrawal, school problems
❑ Teens: acting out
❑ Conversely: “Satisfying human relationships are the most
healing medicine of all.”
❑ “Perception of parental love and caring may have
important effects on biological and psychological health
and illness throughout life.”
❑ Men Illness and recovery can be directly associated with
patient’s perception of wife’s love and support.

56
Family Conference:
❑ Consider a family conference for serious, chronic, or
recurring illness/problems.
❑ Clinical “red flags”: Non-responsive conditions
o Migraine
o Depression
o Anxiety
o Chronic fatigue
o Pedi problems
o Insomnia
Family Conference: Goals
❑ Obtain information
o Current family issues
o Family functioning
❑ Provide information
o Address their questions.
o Educate family about diagnosis.
❑ Elicit family support for treatment plan.
o Ensure treatment adherence.
o Activate and maximize support systems. 57
Family Conference: Tasks
❑ Support family during the illness crisis.
❑ Identify and address related family issues.
❑ Refer to family therapy if indicated.
❑ Assess adjustment of each family member.
❑ Refer for individual therapy if indicated.

Family Support Systems

❑ Assess support systems available to family
❑ Family support services are community-based services that
assist and support parents in their role as caregivers.
❑ Such services can take many different forms depending on
the strengths and needs of the family, but their
overarching goal is to help parents enhance skills and
resolve problems to promote optimal child development.
All families can benefit from support in some way; the
principles of family support should be incorporated into
casework across the child welfare service continuum. 58
Non-Traditional Families
❑ Respect each family’s
o Priorities, values, choices, routines
o (What if choices are unhealthy?)
❑ Recognize their efforts and sacrifices
❑ No family should ever be made to feel
o Dysfunctional or deviant
o And especially not when they are in a crisis.
NB: FINAL SUGGESTIONS
❑ During clinic visits
❑ Inquire about family situation.
❑ B.A.T.H.E. (Stuart and Lieberman 2002): BATHE is an acronym
for Background, Affect, Trouble, Handling, and Empathy and
refers to specific questions or comments incorporated into a
standard medical interview. Is an interview approach that can be
applied in the out-patient setting whereby questions belonging
to each of the 5 categories are asked in the above order.
❑ Consider how family status is affecting patient.
❑ Convey acceptance and support.
59
HOME VISITING:
Purpose
❑ It allows you to follow up individual families at home to
find out why some health problems persist.
❑ It keeps you aware of what is going on in your catchments
area

Process of home visiting

1. Entry/ initiation phase
❑ The clinicians shares information with the patient on the
reason and purposes for home visits.
❑ Set the date for the visit.
2. Pre-visit activities
❑ Gather information regarding the patient and the family;
bio data, location of the house, distance from your health
facility and the physical address.
❑ Investigate the community resources
❑ Assemble supplies 60
3. Activities phase
❑ This is the working phase during which you put into
action your planned health activities. To include
assessment, setting goals, planning the action,
carrying out the action and evaluation.
4. Termination phase
❑ This occurs when the health oriented goals have been
met. Termination of home visits can occur due to any
of the following reasons:
o The patients’ health has been restored and the
patient can function without the nurse
o The patient has changed their residence
o The clinician has transferred the patients’ care to
another clinicians or agency
5. Post visit activities
❑ Post-visit activities include recording and reporting
important events of the home visits, and sharing the
reports with the appropriate authorities and
individuals about the patient family.
61
Skills in home visiting
❑ Good technical skills and knowledge of
preventive and therapeutic measures
❑ Good communication skills and teaching ability
❑ Good leadership skills and rational thinking to
make sound judgments
❑ Good counselling skills and an understanding of
human relations

NB:
❑ During home visits you act on your own, making
decisions on the spot and carrying them out
❑ You need to be prepared.
❑ When planning and implementing home visits, you
should be guided by some basic principles in order to
make a success of it.
62
Principles of home visiting:
Home visits should be:-
❑ Planned and of benefit to the patient
❑ Purposeful, clear and meet the patient‘s needs
❑ Regular and flexible according to the needs of the
patient
❑ Educative to the patient.
❑ Home visits provide an excellent opportunity for
health education
❑ Used to demonstrate principles of health
❑ Convenient and acceptable to the patient
❑ Respectful of the patient‘s right to refuse care
❑ Recorded in the appropriate case file

63
Advantages of Home Visiting:
❑ Home visiting gives a more accurate assessment of the
family structure and behaviour in their natural
environment.
❑ Home visits provide an opportunity to observe the physical
environment of the home and identify barriers to, and
resources for achieving family health.
❑ Allows the clinicians to work with the patient first hand
information to implement health action using realistic
resources.
❑ It enhances the family’s sense of control and active
participation in meeting its health needs.
❑ It provides an excellent opportunity to implement planned
health care.
❑ It provides an opportunity to learn about the home and
family situation.
❑ It provides an opportunity to clarify the doubts and
misconceptions raised by family members.
❑ It provides an opportunity to observe and appreciate
family practices and progress of care given by the nurse
and others
64
NB. Home visiting provides an excellent opportunity to
implement health care which was planned or was started in
the hospital.

Disadvantages of Home Visiting:

❑ Home visits consume a lot the clinician's time and energy
as well as transport fuel (petrol or diesel) or bus fare.
❑ Unforeseen events may occur during home visits, which
will interfere with planned activities.
❑ The patient’s family may not accept the clinician due to
various factors such as cultural or religious differences,
personal characteristics of the clinician and the patient or
to some extent, socioeconomic status of the clinician and
the patient.
❑ Confusion of the clinic’s role in a community where there
may be a lack of knowledge and understanding of the role
of the clinician.
65
UNIVERSAL HEALTH COVERAGE

66
Introduction:
❑ Currently, at least half of the people in the world do not receive
the health services they need. About 100 million people are
pushed into extreme poverty each year because of out-of-
pocket spending on health. This must change.
❑ To make health for all a reality, we need: individuals and
communities who have access to high quality health services so
that they take care of their own health and the health of their
families; skilled health workers providing quality, people-
centred care; and policy-makers committed to investing in
universal health coverage.
❑ UHC does not mean free access to every possible health service
for every person. Every country has a different path to achieving
UHC and deciding what to cover based on the needs of their
people and the resources at hand. It does, however, emphasize
the importance of access to health services and information as a
basic human right.
❑ Universal Health Coverage, is one of the “Big Four” strategic
pillars declared by the President of Kenya which will see major
policy and administrative reforms in the medical sector, to
ensure everyone has access to quality and affordable medical
coverage by 2022. 67
Definitions:
❑ Universal health coverage means that all people have access
to the health services they need, when and where they need
them, without financial hardship.
❑ Universal Health Coverage (UHC) means that all people can
access quality essential health services, without having to
suffer financial hardship to pay for health care.
❑ UHC means that all individuals and communities receive the
health services they need without suffering financial hardship
❑ It includes the full range of essential health services, from
health promotion to prevention, treatment, rehabilitation,
and palliative care across the life course.
❑ Universal health care is a broad term that encompasses any
action that a government takes to provide health care to as
many people as possible. Some governments do this by setting
minimum standards and regulations and some by
implementing programs that cover the entire population. But
the ultimate goal is health coverage for all citizens.
❑ Universal health coverage should be based on strong, people-
centred primary health care. Good health systems are rooted
in the communities they serve. They focus not only on
preventing and treating disease and illness, but also on
helping to improve well-being and quality of life. 68
❑ Universal Health Coverage (UHC) means, “Every person,
everywhere, has access to quality health care without
suffering financial hardship’
o Who: All people including the poorest and most
vulnerable
o What: full range of essential services, of good quality
o How: reducing out of pocket expenses through cost
sharing (pre-payment and risk pooling)
❑ Universal Health Coverage – Health for all
❑ World Health Organization (WHO) defines UHC as a “Health
care system with a motive of equity in access through
promotive, preventive, curative and rehabilitative health
interventions.”

69
Concept of Universal Health Coverage:
❑ The main concepts of UHC include
1) Population coverage,
2) Range of health services provided, and
3) Out-of-pocket expenditure

70
HISTORY OF Universal Health Coverage:
❑ UHC is firmly based on the WHO constitution of 1948
declaring health a fundamental human right and on the
Health for All agenda set by the Alma Ata declaration in
1978.
❑ The concept of UHC was generated in 2005 with an aim to
ensure access to the health services they require without
risk of financial ruin or impoverishment which was made as
a commitment by member countries.
❑ The commitment was reaffirmed in 2012 through a
resolution of the United Nations General promoting
universal health coverage, including comprehensive
primary health care, social protection, and sustainable
financing.
❑ Achieving UHC is one of the targets the nations of the
world set when adopting the Sustainable Development
Goals in 2015.
71
WHAT Universal Health Coverage (UHC) IS NOT?
❑ Does not mean free coverage for all interventions,
regardless of the cost, as no country can provide free
services.
❑ Is not about health financing and it encompasses all
components of health system: health service delivery
systems, the health workforce, health facilities and
communications networks, health technologies,
information systems, quality assurance mechanisms, and
governance and legislation
❑ Is not only about ensuring a minimum package of health
services, but also ensuring progressive expansion of health
services and financial protection as more resources
become available
❑ Is not about individual treatment facilities, but includes a
population based service provision.
❑ It is more than just health comprising of other factors like
equity, development priorities, social inclusion and
cohesion.
72
Dimensions of universal health coverage (UHC)
Universal health coverage (UHC) consists of three interrelated
dimensions:
1. The full spectrum of health services according to need;
2. Financial protection from direct payment for health services
when consumed; and
3. Coverage for the entire population.

Three dimensions to consider when moving towards universal

coverage Source:
73
.

74
❑ There are three main dimensions of UHC i.e. population,
services and direct costs. These dimensions allocated by
WHO provides a picture to show that the coverage is done
mainly for:
❑ Population coverage: Extend services to the population
which have not yet been addressed.
❑ Health services coverage: Include other areas where
the health facilities have not reached yet.
❑ Financial Coverage: Reduce the cost sharing and fees
while obtaining health services
❑ The WHO’s conceptual framework suggests three broad
dimensions of UHC: population coverage, service coverage,
and financial coverage. These imply three reinforcing
strategic choices for countries to advance toward UHC:
ensuring the availability of a comprehensive benefit
package, selection of priority populations, and subsidizing
the cost of care
75
The main approaches that have been done to
achieve the UHC includes:
❑ Equitable health services: Provide all population
and people with equal access and availability of
the health services.
❑ Quality health services: The services must
contain good quality to enhance and promote
services
❑ Multisectoral co-ordination: Including
collaboration with the governmental, local,
private and other sectors for effective outreach of
health services.
❑ Health system reform: There should be a central
change in the system mentioning UHC as its target
of achievement.

76
Objective of Universal Health Coverage
1. Equity to health services: For those who
need the services should be able to get
them and not just one who can pay for
them.
2. The quality of health services: The
services is good enough to improve health
of those receiving the services
3. Financial Risk protection: Ensuring that
cost of using care does not put people at
risk of financial hardship.

77
❑ All people have access to needed services without
the risk of financial ruin linked to paying for care.
❑ Coverage with needed health services (of good
quality);
❑ Coverage with financial risk protection for all
❑ Universal health coverage (UHC) aims to provide
health care and financial protection to all people
in a given country with three related objectives:
equity in access – everyone who needs health
services should get them, and not simply those
who can pay for them; quality of health services –
good enough to improve the health of those
receiving the services; and financial-risk
protection – ensuring that the cost of health care
does not put people at risk of financial hardship.
78
Guiding Principles for universal health care:
1. Universality: broader coverage all around.
2. Equity: Service for one who needs it
3. Non-exclusion and Non-discrimination.
4. Comprehensive care: Inclusion of all aspects of care.
5. Financial Protection
6. Protection of patient’s rights
7. Consolidated and strengthened public health provision
8. Accountability and transparency
9. Community participation
10. Putting health in people’s hand
------
❑ Equitable Access
❑ Efficiency
❑ Quality
❑ Inclusiveness
❑ Availability
❑ Adaptability
❑ Choice
❑ Innovation 79
IMPORTANCE / ADVANTAGES OF UHC:
❑ Promotion, prevention, treatment, rehabilitation,
palliative care
❑ Population based and personal interventions
❑ Interventions at different levels of the system:
community, primary, secondary, tertiary.
❑ Gives emphasis upon maintain quality in the services
of those who are getting it.
❑ To ensure equitable services for all who needs it and
not just ones who can pay for it.
❑ To recognize that health depends not only on having
access to medical services and a means of paying for
these services but also on understanding the links
between social factors, the environment, natural
disasters, and health.
❑ Millennium Development Goals, in alleviating poverty,
and in achieving sustainable development.
80
Importance of Universal Health Care: Continued
❑ Ensures quality, affordable health care is the foundation
for individuals to lead productive and fulfilling lives and
for countries to have strong economies.
❑ Ensures that all people can access quality health services,
to safeguard all people from public health risks, and to
protect all people from impoverishment due to illness,
whether from out-of-pocket payments for health care or
loss of income when a household member falls sick.
According to the WHO, offering universal health care:
❑ Protects countries from epidemics,
❑ Reduces poverty and the risk of hunger,
❑ Creates jobs
❑ Drives economic growth and
❑ Enhances gender equality.

81
Advantages of Universal Health Care - continued
❑ Everyone has health insurance and access to medical
services and that no one goes bankrupt from medical fees.
❑ It lowers health care costs for the national economy,
because the government controls prices for medications
and services. That streamlining trickles down to the
doctors themselves, where they are able to reduce
administrative costs and hire less staff because they’re not
forced to work with a myriad of health care companies.
❑ It equalizes service, with no doctors or hospitals being able
to target and cater to wealthier clients. That means
everyone gets the same level of care, which ultimately
leads to a healthier workforce and longer life expectancy.
❑ When a person has universal health care from birth, it can
also lead to a longer and healthier life, and reduce
societal inequality.

82
Disadvantages of Universal Health Care (Drawbacks):
❑ A common criticism of universal health care is that the
overall quality and variety of care declines.
❑ In some countries with universal health care, patients see
long wait times or even have to wait months to be seen at
all. Governments focus on providing essential and
lifesaving health care and may neglect to cover rare
diseases or elective procedures.
❑ Universal health care is expensive. If a government is
struggling with its budget, it may find that health care is
taking money away from other essential programs.

83
3 Types of Universal Health Care:
There are essentially three ways to provide universal health care.
❑ Socialized medicine. In this case, all hospitals would be owned by the
government and all doctors and nurses would be government
employees. The United Kingdom’s National Health Service, or NHS, is
an example of this type of system. Over time, it has proven to be one
of the most cost-effective systems. However, both doctors and patients
have less choice in the range of treatments and procedures that are
available to them.
❑ Single-payer system. The second solution is to have a single-payer
system, like Canada. Under a single-payer system, the government
provides health insurance for everyone, but doctor’s offices and
hospitals are still private businesses or nonprofits. This type of system
allows people more choice between doctors and hospitals with
different approaches to care, but it also costs more than socialized
medicine.
❑ Private insurance. The third system is to allow private insurance
companies but regulate them and mandate that everyone purchase
some type of health insurance plan. Switzerland has regulated health
insurance and the Affordable Care Act, which was passed in 2010, is an
attempt to build a mandated health insurance system in the United
States. Regulated health insurance systems allow for the most
consumer choice, but they are also the most expensive.
84
What role does health systems financing play?
Three inter-related explanations linked to health system
financing:
❑ Insufficient funds for health in some settings
❑ Too much reliance on direct out-of-pocket payments to
finance health – limited financial risk protection
❑ Inefficiency and inequity in use of resources
Financial Risk Protection
Requires:
1. Prepayment and pooling of resources - compulsory
❑ Minimizing user fees and charges – zero for the poor and
vulnerable (possibly "negative fees")
❑ Good quality services are available
❑ 2. The combination of financial risk protection with the
availability of good quality services – instrumental to
increasing health and economic wellbeing, but also valued
for its own sake
85
Six elements of universal health care
❑ A health system and its six essential building blocks:—
1. Medical products, vaccines, and technologies;
2. Health financing;
3. Leadership and governance (stewardship);
4. Health services (delivery);
5. Human resources;
6. Health information systems

86
EXPECTED OUTCOMES FOR UHC:

87
STATUS OF DEVELOPED AND DEVELOPING COUNTRIES:

88
.

89
CHALLENGES FOR DEVELOPING COUNTRIES TO
ACHIEVE UHC:
The term of UHC is getting popular among the
countries who have not yet attained it yet there are
certain challenges that creates a barrier to achieve
the UHC.
❑ Insufficient funds: In developing countries, the
external funds are the main support for universal
programs. There is a challenge to reach out to the
developing countries with financial aid to meet
the required need.
❑ Financial risk protection: Financial risk
protection is defined as access to all needed
quality health services without financial hardship.
Yet this has not been achieved due to out of
pockets payment existing among the member
countries. 90
❑ Reducing inefficiency: The challenge lies
amongst attaining efficient provision of the
services in all the sectors which is equals to
impossible because of lack of efficient
distribution of services.
❑ Reduce inequity: There is a need to
consider access to services to the poor,
marginalized and vulnerable population
which has not yet been able to be achieved
due to financial hardships.
❑ Mobilizing resources for health
❑ Use of IT for better UHC and pre-payment
systems
❑ Improvising responsiveness, equity and
quality of healthcare services 91
FACTS ON UHC:

92
FACTS ON UHC:
World Bank
❑ At least half of the world’s population still do not have full
coverage of essential health services.
❑ About 100 million people are still being pushed into
“extreme poverty” (living on 1.90 USD (1) or less a day)
because they have to pay for health care.
❑ Over 800 million people (almost 12% of the world’s
population) spent at least 10% of their household budgets
to pay for health care.
❑ All UN Member States have agreed to try to achieve
universal health coverage (UHC) by 2030, as part of the
Sustainable Development Goals.
❑ UHC does not mean free coverage for all possible health
interventions, regardless of the cost.

93
❑ UHC encompasses all components of the health system:
health service delivery systems, the health workforce,
health facilities and communications networks, health
technologies, information systems, quality assurance
mechanisms, and governance and legislation and not just
health financing.
❑ UHC is not only about ensuring a minimum package of
health services, but also about ensuring a progressive
expansion of coverage of health services and financial
protection as more resources become available.
❑ UHC is not only about individual treatment services, but
also includes population-based services such as public
health campaigns, adding fluoride to water, controlling
mosquito breeding grounds, and so on.
❑ UHC is comprised of much more than just health; taking
steps towards UHC means steps towards equity,
development priorities, and social inclusion and cohesion.
94
.

95
HOME BASED CARE

96
HOME BASED CARE (HBC):
❑ HBC is Care of persons with chronic or terminal
illnesses extended from health facility to the
patients' home through family participation and
community involvement within available
resources and in collaboration with health care
workers.

97
Why HBC?
❑ Most patients with chronic and terminal illnesses are
discharged before full recovery and therefore the
need for continuity of care.
❑ Health institutions have many limitations such as
shortage of health workers and bed capacity.
❑ Most care providers at home lack basic knowledge on
self-protection when caring for patients especially
those with HIV and other infectious infections.
❑ HBC helps reduce the stigma attached to some
chronic diseases.
❑ There is need to offer continuity of care to prolong
lives and reduce suffering of patients with
chronic/terminal illness.
98
Objectives of HBC.
1. To facilitate the continuity of the client’s care from the
health facility to the home and community.
2. To promote family and community awareness of disease
prevention and care related to chronic illnesses.
3. To empower the clients, the family and the community
with the knowledge needed to ensure long-term care and
support.
4. To raise the acceptability of terminally ill patients by the
family/community, hence reducing the stigma.
5. To streamline the patient/client referral from the
institutions into the community and from the community
to appropriate health and social facilities.
6. To facilitate quality community care.
7. To mobilize the resources necessary for sustainability of
the service.

99
PRINCIPLES OF HOME BASED CARE
1. Ensure appropriate, cost-effective access to quality
health care and support to enable persons living with
chronic illnesses to retain their self-sufficiency and
maintain quality of life.
2. Encouraging the active participation and
involvement of the patient and their family.
3. Fostering the active participation and involvement
of those most able to provide support to the
community at all levels.
4. Ensuring respect for the basic human rights.
5. Instituting measures to ensure the economic
sustainability of home and community care support.
100
6. Building and supporting referral networks/linkages and
collaboration among participating entities.
7. Building capacity at the household, community and
institutional levels.
8. Addressing the differential gender impact of the
HIV/AIDS epidemic and other chronic illnesses and care.
9. Developing the vital role of home and community based
care as the link between prevention and care.
10. Taking a multi-sector approach to care and support.
11. Addressing the reproductive health needs of persons
living with chronic illnesses.
12. Targeting social assistance to all affected families
especially children.
13. Caring for caregivers, in order to minimise the physical
and spiritual exhaustion that can come with the
prolonged care of the terminally ill (Avoid burn-out).

101
 HOME BASED CARE NEEDS
1. Physical Needs.
❑ Drugs.
❑ Clinical care such as regular check-ups.
❑ Basic needs e.g. clothing, housing, food, fuel/energy,
water, education for children and income.
❑ General nursing care - toilet needs, observation of vital
signs, care of wounds, personal and oral hygiene and
comfort.
❑ Nutritional needs.
❑ Physical therapies.
❑ Information, education and communication (IEC),
including up-to-date, accurate information on the disease,
on writing a will and on preparing for the eventuality of
death, on how to take prescribed drugs, prevention and
care of the clients’ illness.

102
2. Spiritual / Pastoral Needs.
❑ Need to repent and be forgiven.
❑ Needs to forgive others.
❑ Need reassurance that God accepts them.
❑ Needs religious groups support.
❑ Need freedom of worship according to faith.
❑ Need for sacraments and fulfilment of other religious
needs – e.g. anointing of the sick.

3. Social needs.
❑ Respect.
❑ Love and acceptance from others.
❑ Company of those around them.
103
❑ Source of income/income-generating activity.
❑ Right to own, inherit and give property.
❑ Confidentiality regarding their condition by all who
know about it.
❑ Help with the activities of daily living.

4. Psychological Needs.
❑ Love.
❑ Encouragement.
❑ Warmth and appreciation.
❑ Reassurance and help in coping with the disease.

104
 HBC COMPONENTS.
1. Clinical care.
2. Nursing Care.
3. Counseling and psycho spiritual care.
4. Social support.

Components 1: Clinical Care.

It is a continuation of medical care in the home.
- Early diagnosis
- Rational and targeted treatment
- Planning for the care.

105
Clinical care activities
❑ Ensuring early detection, treatment of opportunistic
infections and other complications.
❑ Reducing the suffering
❑ Protecting the client against further infections.
❑ Preventing transmission of HIV or other opportunistic
infections
❑ Ensuring that drugs prescribed to the client by the
clinician are administered at home according to the
regimen of intake.

106
Component 2: Nursing Care.
This aims to promote and maintain:
❑ Good health.
❑ Hygiene.
❑ Nutrition.
❑ Training family and community members to give care
to those that require it.
Nursing care activities.
❑ Activities to ensure good personal hygiene; bed
bathing, assisted bathing, oral care, care of the nails
and hair etc.
❑ Care for the client’s environment.
❑ Preventing the transmission of pathogenic micro-
organism.
107
❑ Physical therapy.
❑ Maintenance of skin integrity through care of pressure
areas and pressure sores.
❑ Wound care.
❑ Pain management.
❑ Administering drugs as per prescription to ensure
compliance and relieve symptoms.
❑ Maintaining the nutritional status of the client.
❑ Observing of clients to detect problems like
dehydration, dyspnoea (shortage of breath),
dysphagia (difficult in swallowing), oedema or fever.

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Related conditions that need attention include:
❑ Diarrhoea and vomiting, which may easily lead to
dehydration.
❑ Pain and discomfort.
❑ Chest problems like chronic coughs, colds and
infections.
❑ Skin conditions.
❑ Bed sores.
❑ Nausea, mouth and throat infections.
NB: It is important to;
❑ Take the patient/client to the hospital or health
facility when need arises.
❑ Reassure the client at all times.
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Component 3: Counselling and Psycho-spiritual Care.
❑ This will prolong their life and make it bearable by;
❑ Positive living and making decisions on the basis of
informed choice.
❑ Reducing stress and anxiety for both the patients
and their families.
❑ Helps people to understand and deal with their
problems and communicate better with those around
them.
❑ Helps clients to cope with their feelings.

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Component 4: Social Support.
❑ Information and referral to support groups such as
church organisations, youth groups and other social
organisations.
❑ Clients need assurance and acceptance by their
families and the community.
❑ They should get involved in family/community
activities depending on their capabilities.
❑ They should be provided with legal advice and
material assistance.
❑ Should be given opportunities to write their own
wills.

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ADVANTAGES OF HBC
Patient.
❑ The patient is cared for in a familiar environment hence less
stress and more ability to bear the illness.
❑ When people are in their homes, they continue to participate in
family matters.
❑ When one is at home close to family members, friends and
relatives, there is a sense of belonging.
❑ one is in close contact with familiar people they are likely to
accept their conditions and illnesses.
Family and community.
❑ Caring for sick people at home prevents separation and holds
family members together.
❑ Less expensive.
❑ Helps them to understand these diseases better and accept the
patients.
❑ Community cohesiveness is maintained.
Health institutions.
❑ less cost and pressure on resources.
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PLAYERS IN HBC.
1. Patient-Identifies care giver, gives consent, participates
in care.
2. Family Members and Caregiver.
3. Health care Team.
4. Health facility.
5. Community.
6. Government.
Resources Needed for Home-based Care.
1. Money.
2. Materials.
3. Time.
4. Manpower.
Networking for Home-based Care.
Network- is a group of individuals or organisations that work
together, undertake joint activities, or exchange information
in order to strengthen and extend their individual capacities.
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Reasons for referring a patient
1. When services or resources within reach are not able to
meet the patients’ immediate needs.
2. In cases where the acute phase of the disease has been
dealt with, and it is considered safe to transfer care to
other caring services/organisations within the
community.
3. When the caregiver experiences burnout and has no
access to counselling services for personal growth.
4. When the caregiver has limitations in meeting certain
needs of the patient, for example, based on religious
beliefs.
5. For better, more competent management in the next
stage of referral.
6. For specialized care in a hospital setting, especially if
the patient is deteriorating.

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Referral constraints
1. Competition among various organisations, so that they do
not disclose what they are doing and which services are
offered. They prefer to work in isolation.
2. Lack of evenly distributed community HCBC programmes,
with the result that some areas lack services and some
are overcrowded.
3. Lack of resources needed for patients to travel from one
point to another.
4. Lack of referral and networking guidelines as well as
standardized referral procedures.
5. Ignorance among family members about HCBC due to
lack of awareness and proper guidance.
6. Fear of breach of confidentiality.
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 COMMUNITY MOBILIZATION
❑ The process of getting the community incorporated to
fully participate in the programmes for the purpose of
ownership and sustainability. The community must
participate and get involved in the decision making
process, planning, organisation, and implementation
and monitoring of activities associated with HBC.

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The importance of Community Mobilization
1. Prepare the community for participatory action.
2. Create awareness about their health problems,
causes, prevention and care required.
3. Identify problems together with the community and
seek means of solving them.
4. Gather information about the community’s beliefs’,
feelings, myths and misconception of their
problems.
5. Identify available resource and how the resources
can be used to solve the problems.
6. Establish relationships within the community.
7. Ownership and sustainability of the programme.
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Factors that can hinder Community Mobilization:
1. Lack of involvement in problem identification.
2. Lack of appropriate information.
3. Lack or mismanagement of resources.
4. Insecurity.
5. Lack of social structures.
6. Communication barriers.
7. Poor health.
8. Lack of ownership.
9. Lack of interest.
10. Poor infrastructure.
11. Lack of knowledge of other partners.
12. Social differences (religious, education, cultural,
economic, political, tribal, etc).
13. Poor leadership.
14. Man-made or natural disasters.
15. Poor timing.
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Mobilizers
1. Local administrative officers and leaders such as chiefs,
assistant chiefs, councillors and area members of
parliament.
2. Leaders of various programmes, for example, district
AIDS control committee.
3. Religious leaders.
4. Organised groups, for example, religious groups
(women’s guild), youth groups, women groups (the
Maendeleo ya Wanawake organisation).
5. Community based health workers.
6. Community Own Resource Persons (CORPs), for example,
traditional birth attendants and traditional healers.
7. Other ministries workers like social workers, school
teachers, etc.
8. Patients themselves.

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Ways of mobilizing the community:
1. Meeting at specific prefixed times, e.g. community
barrazas.
2. Existing committees, such as the village
3. development committee.
4. Home visits to groups and individuals.
5. Announcements at church, mosque, temple, and
school.
6. Use of mass media electronic/print.
Process of Mobilization.
1. Planning and organizing.
2. Community entry.
3. Conducting community mobilization sessions.
4. Evaluation and reinforcement.
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END

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