GUIDELINES IGNORED

Home-based care status six months after launch

Nine times cheaper than hospital care, it had high compliance until numbers swelled

In Summary

• Home based care was launched in June in Kenya to ease pressure on hospitals

• Mombasa currently has 411 patients under the HBC. But is it serving its purpose?

Kenya was the first country to implement home-based care as a way of combating the coronavirus.

Launched in June, the programme was developed by the World Health Organisation as a way to ease pressure on hospitals, which are already overwhelmed.

Under this programme, patients who are asymptomatic and have no underlying condition are expected to isolate themselves in their own homes.

This has given room for hospitals to only accommodate more serious cases or emergencies, considering most hospitals are overwhelmed, while some are suffering as a result of the health workers' strike.

By December 20, 5,834 Covid-19 patients were under home-based isolation and care, while 831 people were admitted in various hospitals

Currently, 411 patients are under HBC in Mombasa, while 1,698 patients have been under the programme since its launch in Kenya.

But how does this programme work, and is it really working?

Health workers would pop in once in a while to check on my progress and if we were adhering to the guidelines
Vinny Odour

COVID-19 SURVIVOR

Vinny Odour was among the first people to undergo the home-based care when he tested positive for Covid-19.

Oduor alongside his workmates had undergone the testing when they were about to resume work.

“I was confident I would test negative because I always followed all the protocols put in place by the Ministry of Health. I was shocked when my test came out positive,” he said.

Immediately his results were out, officials from Public Health got in touch with him and he was told to start isolating himself as he waited for further directions from the Health department.

The health workers gave him an option to choose whether he should be isolated at the hospital or at home, and he picked the latter.

But first, community health workers went to his home to assess whether Odour could remain under this programme and if his home was conducive enough to accommodate him alongside his wife and two children without the risk of infecting them.

He qualified for the home-based cared since he had no pre-existing condition, was asymptomatic and his wife was willing to be his caregiver.

“After they ensured we had a room where I would isolate myself, the long and lonely process began. Health workers would pop in once in a while to check on my progress and if we were adhering to the guidelines,” he said.

Oduor and his wife made a difficult decision to send away their children to their grandparents so as to control the risks of having them infected.

The decision was also made after other children in their neighborhood learnt that the family had a Covid-19 patient and the couple could not risk having the children undergo stigma.

Alone with his wife, the hotelier had to endure sitting, drinking, sleeping, watching TV or moving within a restricted area.

“My wife would cook and serve me in my bedroom, she had to move to another room. I could not risk leaving the room lest I infect her and other neighbours or I be caught by the health officials, who used to make impromptu visits,” he said.

Utensils, beddings and the room he isolated in used be disinfected frequently.

He said while all this happened, his fears were to infect his wife, who had in fact taken leave from her workplace so as to look after him.

After 20 days of anxiety, fears and painkillers, Rashid finally tested negative.

“The anxiety and fears are much worse than the virus itself. I sometime thought of getting worse and maybe failing to get to hospital on time or maybe missing a hospital bed and having to slowly die in an ambulance,” he said.

On November 11, Central Police traffic base commandant Luke Makamu died of what is suspected to have been Covid-19.

County commissioner Gilbert Kitiyo said Makamu had fallen sick and developed breathing complications, after previously being treated for pneumonia.

Unconfirmed reports said the officer died from coronavirus while under home-based care. It was alleged that he had failed to get a bed at one of the Covid-19 centres in Mombasa, and he was forced to go back home.

STATUS QUO

A health worker who works in one of the Covid-19 centres in Mombasa said the home-based care protocols were observed to the core when the programme was launched.

However, the situation has changed as most of the guidelines which need to be ascertained before a patient is placed under HBC are no longer followed.

“Previously, health workers had to assess living standards before they released a patient for HBC. But currently, as long as you are asymptotic, you are free to go home,” he said.

The health worker said community health workers also no longer do follow ups on the patients, and chances of patients not following protocols are very high.

He said most of the asymptomatic patients, especially those who cannot afford a meal, are having difficulties isolating themselves.

But public health communication officer Richard Chacha said the county government has dedicated community health workers and volunteers who monitor patients under the programme.

Chacha said the county’s department provides the CHW with protective gear whenever they visit patients or while doing their normal monitoring.

He said the health workers alongside volunteers are mandated with monitoring and giving feedback to the Health department of any contravention of HBC guidelines by patients.

“Because of the increasing numbers of HBC patients, our health workers might not be able to monitor each patient everyday. Therefore, there are patients who might decide to go against the given protocols,” he said.

“Adhering to the HBC guidelines is an individual responsibility. It is for the patient to know the risks he will be spreading if he decided to leave the isolation room.”

The communication official said hospitals give patients an opportunity to choose whether to remain under hospital care or undergo self-isolation.

However, the patient has to meet certain requirements before he is given the options.

Some of the requirements include the housing and its environment, the risks of infection and number of people living in the area and also the financial aspect of the patient.

The patient is only allowed to be under the programme if only he does not have pre-existing conditions or is asymptomatic.

He should also be in a position to pre-purchase any medicines and to afford at least a meal a day.

The patient is only allowed to go to hospital if his situation worsens and he will have to alert the hospital before going or during routine check-ups.

COST OF HBC

The cost of treating a patient at home is also much more affordable compared to hospitals.

Health Director General Patrick Amoth has previously said it costs Sh21,400 per day to care for a patient with mild symptoms, and Sh21,300 for asymptomatic patients, making home-based care nine times cheaper than hospital-based care.

But what happened to the much-publicised Jitenge App, which was to be used in managing and monitoring HBC patients?

The ministry had said 3,000 home-based care patients had been registered on the system and most were from Mombasa, where the programme was piloted.

Chacha said the system is yet to be rolled out in Mombasa since the health workers are yet to be trained on the App.

He said the workers are expected to undergo training in January.