CHEC HOME BASED CARE PROJECT EVALUATION

CHECHOME BASED CARE PROJECTEVALUATION BUSIKU NDUNA and the Evaluation Team

The evaluation objectives are; • To assess the extent to which project activities and approaches areaddressing the needs of PLHIV/AIDS patients and OVC in target area of 3 provinces • To assess the extent to which home care and support activities andapproaches have led to improve performance of Home Based Careservices • To assess the extent to which the implementation of HBC activities ismaking the best way to provide direct support to PLHIV/AIDS patients and OVCs • To evaluate the overall effect (positive and negative) of the projecton the provision of care and support to PLWHA/OVC • To assess the extent to which the results achieved will continuewithout support

Evaluation outline The final evaluation will consist of the following components; • Executive summary of process, outcome and impact , • Purpose, scope and methodology • Evaluation of the process, outcome and impact of project activities • Analysis, finding and recommendation against each objective • Key recommendations on project activities and approaches to help achieve or revise project targets • Confirmation of necessity, appropriateness, time scale and feasibility of continuation of the project & • Appendices

Methodology • Review project documents and other relevant publications which include Baseline Survey, Post Training Evaluation, Appraisal Reports • Develop evaluation tool(s) and pre-test them • develop and finalizing a detailed evaluation plan. • Conduct in-depth qualitative interviews of a series of key informants including Cambodian government officials at all levels, donor representatives, partner NGOs, and CHEC HBC team members • Conduct focus group discussions with project participants including beneficiaries PLWHAs and Care givers and HBC team members

Methodology continued • Conduct quantitative surveys and with PLWHA’s and Care givers • Make observations during field visits to Kampong Tralach, Sa Ang, and Preah Sdach • Conduct Site visits to verify the completion of project achievements • Conduct SWOT and include in analysis of evaluation and preparation of first draft of evaluation report • Participate in a half-day review meeting with HBC team members to discuss the draft evaluation report • Finalize report incorporating comments and corrections from the review meeting

Data collection/Evaluation design • Incorporate Observational studies, utilise project records and Interviews with key informants, Conduct; • Surveys of PLHIV/AIDS patients and care givers • In-depth Interviews of PLHIV/AIDS patients and their care givers, • in-depth interviews with key informants, • Observational methods without control groups or comparison groups to assess HBC project success in delivering services,

Data collection/Evaluation design continued • Not claiming “cause and effect,” • verbal methods of data collection to include low-literacy stakeholders • supervisory observations with HBC Team members • In-depth interviews with community leaders and various stakeholders and • Utilise project reports by Home Based Care team members

Quantitative Data collected highlights • Concerns of PLHIV/AIDS patients interviewed to include: • Project phase out by HBC project • Phase out by HBC project partners such as WFP • Fears of Poor or deteriorating health • Lack of employment opportunities during health peaks and willingness to work • Lack of substantial capital to realize innovative ideas and to improve economic status

Quantitative Data collected highlights Continued • reduced but not eradicated discrimination in communities. • Lack of employment opportunities during health peaks and willingness to work • Lack of substantial capital to realize innovative ideas and to improve economic status • reduced but not eradicated discrimination in communities.

Quantitative Data collected highlights Continued • 100% of PLHIV/AIDS patients and care givers interviewed do not feel prepared for the HBC project to phase out instead they recommend that the project extends its capacity into the provision of skills and financial capital in turn insuring the maintenance of the current improved health quality of PLHIV/AIDS patients • 100% of care givers (including grandmothers) and other PLHIV/AIDS patients have to supplement their financial resources to add on to transport cost to VCCT services, health centers, referral hospitals, and self help group meeting • 100% of PLHIV/AIDS patients and Care givers consent that Home based care teams are important because they provide emotional and mental support to PLHIV/AIDS patients especially when other family member have to work to supplement the household economic capabilities

Quantitative Data collected highlights Continued • 100% of PLHIV/AIDS patients continue to experience emotional burden related to feelings of guilt about the constant care they require from their loved ones or care givers, • 100% of PLHIV/AIDS patients elaborated that at times when their health greatly improves they are inclined to acquire a means to contribute financially, this can also mean relocating to urban areas in order to help with improving family financial status, • The greatest concern for grandmothers taking care of (OVC) is the welfare of the grandchildren if something were to happen to them as care givers.

Quantitative Data collected highlights Continued • 100% of caregivers that are grandmothers noted that they required and appreciate constant reinforcement from HBC team members as far as information updates in how to help OVC live healthy with HIV/AIDS and directions on taking ARV and OI drugs • 100% of the care givers have attended SHG meeting at least once with their loved one, noting that it was good a experience in helping them as care givers to understand the difficulties experienced by loved ones, • 100% of PLHIV/AIDS patients noted that without food supplements from CHEC and partners they would have minimal food or no food supplies in turn worsening their mental, emotional and physical health

Quantitative Data collected highlights Continued • 100% of care givers that are young adults interviewed and not attending school, noted that they have work to supplement family financial resources, • 100% of PLHIV/AIDS patients and Care givers noted that: • HBC team member at least conduct 2 visits per PLHIV/AIDS patient household per month, • the most important aspects of the HBC team home visit include emotional and mental support and healthy lifestyle counseling by HBC team members

Greatest HBC project achievements • In its capacity the Home Based Care project responds to the varied and changing needs in each affected individual’s situation or life.

Analysis • The HBC project continues to work well inline with MoH standard operating procedures • There remains a strong demand for community HIV/AIDS education and care in the communities • Skill and capital support for PLHIV/AIDS patients and OVC is especially needed as part of a move towards project initiatives towards sustainability after future project phase out • Despite an evident sprit of voluntarism in the community CAG members require some help, in relation to transport and other costs

Analysis continued • Support provided by the HBC project to PLHIV/AIDS patients and OVCs has helped to alleviate the economic burden within affected families • The Home Based Care project activities have helped to reduce stigma and discrimination toward PLHIV/AIDS patients and OVCs

Analysis continued CAG,HBC project members and initiatives to inform and educate are relevant because for example Grandmothers who are care givers: • Insist on constant reinforcement of drug prescription, and directions of use • require emotional support related to emotional and mental stress about the future of OVC if them as only surviving family member were no longer present

Project Strengths observed during field visits. Continued • consultation with PLHIV/AIDS patients, Care givers • Strong collaboration and Information Sharing With Operational District, Provincial Health Department • HBC training and capacity building including strengthening of CAG and HBC team member project capabilities.

Recommendations • HBC project continuation • In addition to Pagoda donation boxes Establish microfinance initiatives with a larger financial cumulative and shorter waiting time when in comparison to the pagoda donation box • Provision of professional skills so that the community can sustain positive changes enable by HBC project initiatives.

Recommendations continued • Improve unavailable or poor transportation resources i.e. broken or old bicycles to enable HBC team members to fulfill their responsibilities • Continue initiatives by CAG and HBC team members to inform and educate the community discrimination is never completely eradicated only reduced.

Recommendations continued • Continue Providing food support as PLHIV/AIDS patients require this support due to restricted skills and availability of economic capital and good diet is extremely important in the maintenance of good health • Expand project capacity to assist with transport and health costs as PLHIV/AIDS patients continue to face difficulties in relation to financial fees for medical check ups i.e.CD4 test costs

Recommendations continued • Expand Project capacity to offer economic opportunities as PLHIV/AIDS patients keep moving from one residential location to another to find employment due to financial restrictions, making follow up for the HBC Team difficult if not impossible • Expand HBC project capabilities as increasing numbers of PLHIV/AIDS patients are coming out with their status increasing the work load of the HBC teams.

Recommendations continued • HBC project should reconsider the pay gap between project team leader and member

THE END.

CHEC HOME BASED CARE PROJECT EVALUATION