Government-funded programmes and services for vulnerable - Unicef

Government-funded programmes and services for vulnerable children in SA
departments of social development are sufficient, as a best-case scenario, to cover only
49 per cent of the statutory services and interventions required by the Children’s Act
(Budlender & Proudlock 2010: 40).
HCBC services and programmes
Insufficient funding
The provision of HCBC services and programmes is dependent on government funding.
Many of the organisations providing these services struggle to access government funding.
When they do manage to access funding, it is in the form of a subsidy rather than full
funding based on the cost of the service provided. This means that the organisations have
to look for additional donor funding. The lack of adequate and consistent funding raises
questions about the consistency of the availability of these services and their long-term
sustainability (Giese 2008).
A significant barrier impacting on the levels of service delivery through these structures
is the over-reliance on unpaid volunteers. As pointed out by Mathambo et al. (2009), the
mostly female volunteers are exposed to stress in the care and support that they provide
to people affected by HIV/AIDS, and there is little or no support for them in turn.
Low literacy levels and insufficient training
The generally low literacy levels of volunteers and the limited organisational capacity
within the HCBC structures often result in low levels of training, which impact on the
quality of care that is provided through these services (Mathambo et al. 2009).
Duplication of services
Within the departments of Health and Social Development, there has been a duplication
and fragmentation of HCBC programmes falling under different programme headings within
different departmental directorates. Up until now, there has been no clear linking of the
different programmes or an understanding of how they fit together (if at all) (Streak 2005).
Insufficient internal and cross-departmental coordination has seen the proliferation of
many HCBC programmes that are in essence the same in terms of targeted beneficiaries,
mode of operation and services provided. ‘This fragmented approach to service delivery
remained despite it being a cost multiplier and its constraint on system responsiveness to
new disease and social challenge…An example from health could see a household have
as many as five lay cadres targeting it, and not necessarily in a coordinated manner’ (DoH
& DoSD 2009: 11).
There has, however, been national recognition and response to the duplication,
fragmentation and related concerns about the capacity of HCBCs and the quality
of services provided. Attention has also been paid to the exploitation of workers
who have been engaged to do very important work, but have not benefited from
legislative protection such as that provided to other workers in terms of South African
labour law. This recognition has been captured in two draft policies, currently under
development by the departments of Health and Social Development jointly – they are
the South African National Policy Framework for Home and Community Based Care and
Support Programme (Revised draft, November 2009) and the Community Care Worker
Management Policy Framework (DoH & DoSD 2009).
These two draft policy documents respond to the current challenges to HCBC
programmes by creating a common framework within which to synergise HCBC and
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