Water, sanitation and hygiene in community based care: implications for wellbeing for people living with HIV/AIDS/TB in Durban, South Africa

Abstract

Majority of the HIV/AIDS patients in South Africa receive health care services at home. How-ever, limited studies have been conducted to examine the water, sanitation and hygiene (WASH) situation in the homes of the care receivers and its impact on community-based care. The main objective of this study was to explore community health workers (CHW) perceptions on WASH in home-based care and the implications on people living with HIV/AIDS/TB, their family mem-bers and the CHW. Participants for this qualitative study were drawn from four community home-based care organizations in four marginalized communities in Durban providing care to HIV/AIDS/TB clients. Data was collected using participant observation of care-giving activities; semi-structured interviews with five home-based care project managers from the organizations and five focus group discussions with a total of 49 CHW. The study revealed that CHW had lim-ited access to protective materials such as gloves and aprons and therefore tended to avoid carry-ing out activities that could help maintain proper hygiene in the homes for fear of infection. There was limited and unreliable access to water supply. CHW had to fetch water from immedi-ate neighbours or surrounding areas and this created a time burden for caregivers taking away the time spent with patients. Inadequate access to water influences sanitation and hygiene, and this affects the work of CHW. Government needs to respond promptly to the water and sanitation needs of marginalized communities with limited resources. The findings of the study had impli-cations for policy on WASH and community-based care in low in-come communities. INTRODUCTION Unsafe and insufficient water, poor sanitation and hygiene are some of the factors contribut-ing to poor health in low and middle-income countries (World Health Organization [WHO],