'Deep down in their heart, they wish they could be given some incentives' : a qualitative study on the changing roles and relations of care among home-based caregivers in Zambia

Cataldo, Fabian and Kielmann, Karina and Kielmann, Tara and Mburu, Gitau and Musheke, Maurice (2015) 'Deep down in their heart, they wish they could be given some incentives' : a qualitative study on the changing roles and relations of care among home-based caregivers in Zambia. BMC Health Services Research, 15 (1): 36. ISSN 1472-6963

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Background: Across Sub-Saharan Africa, the roll-out of antiretroviral treatment (ART) has contributed to shifting HIV care towards management of a chronic health condition. While the balance of professional and lay tasks in HIV care-giving has been significantly altered due to changing skills requirements and task-shifting initiatives, little attention has been given to the effects of these changes on health workers¿ motivation and existing care relations.MethodsThis paper draws on a cross-sectional, qualitative study that explored changes in home-based care (HBC) in the light of widespread ART rollout in the Lusaka and Kabwe districts of Zambia. Methods included observation of HBC daily activities, key informant interviews with programme staff from three local HBC organisations (n = 17) and ART clinic staff (n = 8), as well as in-depth interviews with home-based caregivers (n = 48) and HBC clients (n = 31).Results: Since the roll-out of ART, home-based caregivers spend less time on hands-on physical care and support in the household, and are increasingly involved in specialised tasks supporting their clients¿ access and adherence to ART. Despite their pride in gaining technical care skills, caregivers lament their lack of formal recognition through training, remuneration or mobility within the health system. Care relations within homes have also been altered as caregivers¿ newly acquired functions of monitoring their clients while on ART are met with some ambivalence. Caregivers are under pressure to meet clients and their families¿ demands, although they are no longer able to provide material support formerly associated with donor funding for HBC. Conclusions: As their responsibilities and working environments are rapidly evolving, caregivers¿ motivations are changing. It is essential to identify and address the growing tensions between an idealized rhetoric of altruistic volunteerism in home-based care, and the realities of lay worker deployment in HIV care interventions that not only shift tasks, but transform social and professional relations in ways that may profoundly influence caregivers' motivation and quality of care.

Item Type:
Journal Article
Journal or Publication Title:
BMC Health Services Research
Additional Information:
© 2015 Cataldo et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Uncontrolled Keywords:
?? hivafricazambia community health workersgeneral health professionspublic health, environmental and occupational healthinfectious diseaseshealth policycontributions to practice ??
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Deposited On:
18 Jun 2015 05:35
Last Modified:
15 Jul 2024 15:03