CHALLENGES AND LESSONS LEARNT FROM COMPREHENSIVE

CARE SERVICES IN THE WORK PLACE

PRESENTER(S)

LABAN L. SIMEL

MSF – FRANCE: BLUE HOUSE MATHARE PROGRAMME

BACKGROUND

Medecins Sans Frontieres- France is a humanitarian and emergency relief organization that offers assistance to populations in distress and people living with HIV/AIDS fall in this category.

Most of its members are doctors and other health professionals who contribute to MSF-F’S smooth functioning.

It is especially challenging when the patients are also employees of the organization that is also responsible for providing their health care.

MSF-France runs a comprehensive care service facility in the Mathare slums of Nairobi known as

Blue House Clinic.

Blue House offering comprehensive care service to MSF employees:It offers the above service to a total of 9 employeesof these 4 are followed up in other health institutions.

Homabay clinic It offers comprehensive service to a total of 5 employees Of these 2 prefers private consultation

CHALLENGES AND LESSONS LEARNT FROM COMPREHENSIVE

CARE SERVICES IN THE WORK PLACE:

AIMS OF COMPREHENSIVE CARE SERVICES

To improve the quality of life and life expectancy for people living with HIV/AIDS, their families and communities

COMPONENTS OF COMPREHENSIVE CARE.

A basic package of care consists of

Testing and HIV prevention Initial and on going clinical laboratory

monitoring Diagnosis and management of acute and on

going opportunistic infections Immunizations and prophylaxis Provision of antiretroviral Nutritional assessment and support. Palliative care Counseling, Educational and psychosocial

support

THE MSF-FRANCE EXPERIENCE.

In this presentation we will discuss the challenges and lessons learnt in the following areas generally and specifically for MSF-France.

Confidentiality in the work place: Well-trained professional staff in matters affecting people

living with HIV/AIDS. Limits intervention: spouses may differ concerning

disclosure to the other spouse and children. It is difficult because the care giver is an employee as well. So when you have ethical issues to handle and still work with the patient in the same institution. The general queue with other patient is also affected.

Psychosocial support in the work place: Patient support groups Disclosure of status and its implications in the work place: Fear of disserted by partner,friends,workmates and

relatives

MSF FRANCE EXPERIENCE

CONFIDENTIALITY IN THE WORKPLACE

DISCLOSURE AND ITS IMPLICATIONS

PSYCHOSOCIAL SOCIAL SUPPORT IN THE WORKPLACE

REFERRAL AND FOLLOWUP

COST OF CARE FOR THE EMPLOYEES AND THEIR FAMILIES

SUSTAINABILITY

CONFIDENTIALITY

Lack of confidentiality causes discrimination, mistrust between the caregiver and the employee.

Requires an ethical approach for it to be successfully managed.

Coded methods of medical records storage and retrieval ensures that confidentiality.

Choose and agree whom to consult and where to seek health care.

DISCLOSURE AND ITS

IMPLICATIONS

The effect of disclosure on relationships in the workplace.

Stigma

May affect getting employment

MSF DOES NOT DISCRIMINATE AGAINST HIV POSITIVE JOB

APPLICANTS

PSYCHOSOCIAL SUPPORT IN

THE WORKPLACE

DIFFICULT TO ORGANISE SUPPORT GROUPS OR COUNSELLING WHEN

THE PROVIDERS OF CARE ARE ALSO EMPLOYEES.

REFERRAL AND FOLLOW UP

MSF IN NAIROBI HAS NO INPATIENT FACILITIES AND PATIENTS NEEDING

HOSPITALISATION HAVE TO BE REFERED TO EITHER PUBLIC OR

PRIVATE INSTITUTIONS .

COST OF CARE

MSF COVERS 100% OF THE FINANCIAL COST OF HEALTHCARE.

REPLACEMENT WORKERS – ADDITIONAL COST TO MSF

MAN HOURS LOST IN CONSULTATION AND SICK OFF TIME.

SUSTAINABILITY OF CARE IN

THE FUTURE

For those seeking care outside the regular MSF clinic it will be

financially difficult for them should MSF close its operations.

MSF- France has a medical policy for it’s staff and their dependants whereby outpatient care; is catered for at 85% by the organization and 15% by the employees. Special consideration is given by the organization for maternity cases in which it covers 100%.

For people living with HIV/AIDS the policy caters for 100% of all the medicines, consultations and any other treatment related to HIV/AIDS.

In extreme situations MSF-France replaces it’s staff who may be away due to illness with locum and this brings a double cost on the organization for the same service.

Many hours of productivity are also lost when the patient attends to their clinics for consultations and follow up.

Issues of sick-off may also arise depending on the severity of the illness.

Sick-off also for the parent or relative to be able to take care of a sick child at home- lowers the quality of work.

Sustainability of the care in the future: For those seeking care in private institution, it will be

expensive to bear the cost as individuals when no longer MSF Employees.

Lessons:

Poverty and high prevalence rate of HIV / AIDS are a major set-back in provision of comprehensive care in our general society in consideration of the Mathare slum situation in Nairobi.

Difficult but can strategies One designated HCW to provide care maintains continuity and

confidentiality. However it can be broken because people may know if you are seen by a specific health care work you must be HIV positive.

Disclosure Depends on individual employee Job security is assured in MSF – F regardless of HIV status

Cost and sustainability Is a challenge in private institutions.Care in terms of organization of counselling, medical consultations,

laboratory tests and drug availability will improve the health of those employees affected and infected.

Better information and education among the employees prevents transmission and enhances proper care of infected employees.

Medical expenses coverage for the infected employees is a major problem in view of costs involved for comprehensive care; however, need clear definition by the employer

Comprehensive care service is a long-term issue; it should not be pegged on employment period a lone. It should be considered even after employment due to advance disease or age.

Comprehensive care service a teamwork approach whereby the patient is an active role player for to be successful;

Conclusion:

We recognize that it is a big challenge to provide comprehensive care for employees living with HIV/AIDS in the work place, but with the right approach and systems in place, it can be done successfully.