African Home-Based Caregivers Alliance: Women Collectively Organize for Healthier, Mutually Supportive Communities

                                                              

African Home-Based Caregivers Alliance: Women Collectively Organize for Healthier, Mutually Supportive Communities

Huairou Commission
Solution proposed by: 
Initially GROOTS Kenya, +the Uganda Community Based Association for Child Welfare& Intl Women's Comm. Ctr in Nigeria
In a Nutshell: 
The Home-Based Care Alliance (HBCA) is a network of grassroots women leaders and groups from 11 African countries who serve as caregivers for their community members dealing with HIV/AIDS. The first responders to help people living with HIV, orphans and widows when the disease first came to their communities, HBCA members today work to insure ARV access and adherence and community responsive health and social services. Organized for recognition and resources, Home Based Care Alliance members are pressing local officials for budget mechanisms to finance their collective care and support work.
Where and When: 
Since 2003, the HBCA has grown from an initial base of 2,300 caregivers in Kenya to over 44,000 caregivers organized into multi-district federations in 11 African countries (Benin, Cameroon, Ethiopia, Ghana, Kenya, Malawi, Nigeria, South Africa, Uganda, Zambia, Zimbabwe). The Alliance’s growth and scale is directly linked to the interlocutor role caregivers continued to play--linking communities to hospitals, clinics, social protection services and local development processes, roles that have expanded and changed over time.
Challenges: 
The Home-Based Caregivers Alliance (HBCA) was designed 10+years ago to build recognition in Africa and around the world that community based caregiving work was 1) essential to the fight against AIDS (alongside treatment access and prevention) and 2) being led by grassroots women's groups working collectively (not one grandmother or volunteer at a time). Designed as an organizing and networking platform, the HBCA focused on linking grassroots group's across cities, towns and countries so they could share their local work to: improve care and support for community members affected and infected, persuade government officials and agencies to support community and caregiver priorities and position organized caregivers as a key, community based/cso constituency in the fight against and response to HIV/AIDS locally to globally.
Innovation: 
The Home-Based Caregiver's Alliance (HBCA) is an innovative approach to addressing urban challenges associated with The HBCA is an innovative grassroots approach to addressing urban challenges associated with providing effective health & social services and quality care & support to residents of poor communities who are infected and affected by HIV-AIDs, esp. those in (peri) & urban informal settlement areas (e.g. Mathare and Kwempe). HBCA members--women leaders of local self help groups primarily—champion accessible health care and psycho social support and also collective approaches that insure asset protection, nutritional and food security, decent housing and sanitation, etc. for people living positively, widows, orphans+ at risk youth. Women’s public leadership increases as a result.
Concept: 
This Home Based Caregiver's Alliance, linking community based women's groups in 11 African countries, is modeling a development framework meant to value, recognize and enumerate women’s contributions to health and community development. The development framework championed by the HBCA clusters in three mutually reinforcing elements. Primarily, the framework calls for caregivers to drive the demand for accountable and effective governance through increasing their participation in planning and decision-making at all levels. Secondly, the framework calls to protect and economically empower women as caregivers to improve their own well-being. Finally, the framework calls for full acknowledgment of the contributions women make as caregivers to health and community development through strengthening and integrating the health and caregiver-led community systems. All three of these elements are rooted in context specific, women-initiated good practices for bringing quality healthcare, psycho-social and basic service support to those communities most impacted by HIV/AIDS . The organizing efforts of the HBCA network demonstrate the centrality of grassroots women's leadership in rebuilding the social support structure of communities devastated by the AIDS pandemic; underscoring why mutual self help relationships and grassroots women's collective empowerment must be recognized and rewarded in order to promote equitable and resilient development in African cities and towns.
Description: 
In the past 13 years, especially due to the introduction of lifesaving ARVs, the work of caregivers has shifted dramatically--from palliative care to supporting people living positively to access essential basic services and medication. Testing and ARV adherence is a key focus of caregivers and they have developed strong formal referral systems with health facilities, sometimes working out of hospitals and clinics. Caregivers also continue to organize support groups--for people living with HIV, orphans and grandmothers. They have moved into other community health areas (e.g. pregnancy care, immunizations, early childhood). As their experience base grew, organized caregivers advocated for representation on local decision-making bodies such as the District AIDS Control Councils to influence the distribution of resources and roll out of programs in their communities. Seeing the need for addressing the root causes of poverty and vulnerability in their communities, caregivers became very involved in community development issues. As the deaths of male household heads escalated, they led local efforts to stop and support widows and orphans from being disinherited. They formed watchdog groups and forced local legal and administrative agencies to protect women and children. To address the higher caloric intakes required with ARV treatment (and the nutritional deficits that were arising), caregivers planted kitchen gardens and cultivated collective farms. Leaders also tackled water management, soil degradation, climate change adaptation, drainage and sanitation, climate change adaptation to improve living conditions and food security. The hardest part of their work—has been to gain public recognition and resouces to support the work they perform. To sustain their work, HBCA members commonly operate savings and credit schemes and income generating projects to underwrite women’s participation. They also collectively sell produce and products and create new markets. The most advanced groups have succeeded in negotiating with government officials and agencies for grants and stipends to finance their work.
Impacts: 
Per its inspiration, the 11 country HBCA put caregiving at the center of the fight against AIDS. The HBCA advocacy, locally to globally, demonstrated how local women's groups improve the quality and scope of healthcare and psycho-social support and organized and advocated to establish community-responsive relationships with local authorities and health care and other agencies. As importantly, the HBCA put and keeps the public spotlight on women's caregiving roles and contributions--requiring cities to publicly recognize and compensate women's groups for leading this work. Thus the African HBCA has created a key plank in advancing SDG 5/Women's Empowerment & Gender Equality--compensating the unpaid care work of women) .