What makes SALT home visits effective?

[Rituu B. Nanda]

NGOs often undertake various community based awareness, peer education activities and home visits as part of ongoing care and support effort for people living with HIV.

I wondered if home visits worked. I had no experience of doing  home visits for community engagement and mobilization. The thought of turning up at someone's front door unannounced or for the matter someone even at my door did not go well with me. There were other things to fuel my anxiety like the uncertainty of what you're going to find on the other side of the door. 

I got an insight into home visits when I was part of the Glocon Team with Ian and Alison in India (Mizoram and West Bengal) in February this year. The plan was that we would divide into 3-4 teams and go to different homes. After the visit, the team congregated at a common place in the village, sometimes joined by local community members, we would reflect on our home visits. 

A key lesson was that you don’t just drop in someone’s home. Home visit is done by invitation and time suitable to the family members. I found that we were usually welcomed by the family and even offered drinks and refreshments. Also we always had a person known to the family in our team. Alison Campbell underlines the most important factor “I think the key is in the way home visits are done. SALT approach is key.  Lots of home visits are done in a different attitude, more provider or teacher than alongside.” 

Local Salvation Army team, CHAN in Mizoram has set a fine example of home visits. CHAN has fostered positive relationships with local community members through home visits. Realizing that the community is too huge to be covered by the Salvation Army team, it has encouraged formation of volunteer youth groups within the community which do regular home visits. Over last six years, local neighborhoodsin Dinthar have determined their own response to HIV through home visits, community-led change and youth response. 

“ Willingness to meet is developed by the home visits, because people share more openly and privately at home. The concerns are gradually shared, until the community is ready to meet together.” – Alison . What happens in home settings is through community conversation a personal connection is build with the family. This is community counseling in nature where community members reflect on theirsituations and see the issue in their own context. Home visits also act as stimulation for the visiting SALT team and growth of dignity for those visited.  ''Accompaniment in the home and neighborhood environment a source of self confidence development” observes Onesmus, an experienced facilitator from Kenya. 

Another critical lesson I learned about home visits was from Nagaland. To focus on selected homes can be stigmatizing. Therefore, selecting a group of homes in the neighbourhood is done.  I recall a peer educator working on PPTCT project in Nagaland shared with me . “I used to go for home visits alone under PPTCT programme…people used to shun me away as I visited only homes of potential clients…Now after SALT programme I go with village youth teams and visit homes in the neighbourhood without targeting any particular house. We have moved away from information providers to facilitating conversation about HIV in the family. Referrals to the hospital for HIV testing have shot up. Now women come to me to take them for testing”

In the context of HIV and associated risk factors such as injecting drug use, the experience of personal stigma within local neighborhoods grows. Ian Campbell shares how home visits can lead to acceptance and openness.”The expansion of HIV related community response is noticed through home care with one person and relatives, that 'infects' neighbours with a realisation of shared concern, and the possibility of reaching for a better future” .To illustrate, here is a stoey from village leader in Dinthar, “I myself did a home visit to the home of a positive person who had passed away. I am the one who prepared his body for funeral and by touching his body demonstrated that HIV cannot be transmitted by touching”. 

Ian during Glocon Kenya found the communities  continue to respond to their issues without external stimulation or support for nearly two decades. Moreover this has been transferred to several other communities. “We see accumulated effect – it is alive, because neighborhood groups take ownership. Ownership is facilitated by home visits, don’t forget. Both home and group/neighborhood processes are needed. The team is still working because it is beyond the boundaries of any one institution. Always think beyond institutions, to the Spirit of God, and the human connection. " comments Ian.

The question is how many NGOs are exposed to the concept of home and neighbourhood life. Experience shows that rather than being limited to delivery of services as response to HIV, organizations can explore learning based in local experience and action. It must also be kept in mind that mindset with which home visit is done can be a determining factor in its success.

[Sadia Jafrin]

There’s so much to learn from you, Rituu. I could really relate to what you shared. I still feel anxiety before home visits, but I manage to focus on the importance of them. Since being introduced to the SALT approach, I also feel a tremendous drive to do it from the heart.

[Santi rambari]

Your writing is excellent. There was much to learn here. I am enriched by reading this article. thank you

[Rituu B. Nanda]

Experience from Botswana ( Constellation partnership with UNAIDS Botswana)

Mogorosi Shakes Domkrag I gained a lot from SALT,more especially house to house salt visit,it waorked a lot for me,cauz it got everything u may need,u observe/learn,you take the concerns,the solutions frm a person frm there the strength of that person at the same tym,so im now a strong facilitator out all that,nd also gained more experience thru group conversations lyk Youth Pitso nd kgotla/ward gatherings,i learned a lot nd im capable of doing that

[Rituu B. Nanda]

Glocon UK 

Stepney, UK: Week 15 Groups alone are not sufficient –the personalized intimacy of home based conversation is complemented by issue-centred group conversation. Both are confidential-they differ in context and quality. Both are needed to ignite ownership and movement. Person to person and family to family conversation that is at the same time invited, facilitated, and (sometimes) accompanied is the obvious and natural next step. This should happen on a wide scale soon, given enough authentic relationships of trust with the ‘connector’ already exist. The challenge is for the connector entity to adapt to a dominant function of facilitating connections directly between others. The connector will not own but will usually belong, via respect, invitation, trust, shared change which is acknowledged, and genuine car

[Rituu B. Nanda]

Glocon Estonia 

Estonia

I had the privilege to see what the (SALT) home visit looks like in a family that has problems. When we have this type of visit, usually the visitors try to teach the people how to live, like ‘you shouldn’t take drugs’ or ‘don’t drink so much’. I saw a different way, that we can come and share with the family. I looked at Natasha yesterday, did not know she took drugs until I heard she is the mother of Leira, because I know Leira, and that Leira’s mother is addicted. No matter what, there was this hospitality and communication, showing her history of awards for sport, and handicrafts, and how she is accepted at home. I did not see her as an addiction problem. I saw her as a person. It wasn’t the same feeling as before, and when I left I stayed in the house until the very last moment so I could shake her hand. No matter her problems, I have a real respect for her. -Sveta

[Rituu B. Nanda]

Glocon Chiangmai, Thailand 2012

Home visit to Dara, who has been living with HIV for 15 years, and her 16 year old daughter Suchada: ‘I could not wait’ ‘I could not wait for others to come and do something for us. It was 16 years ago. I had my daughter in mind. I had to act myself. Disclosing helps me, and is also good for others. Hospital staff could not go to homes, so I went, encouraging people and explaining the benefit of disclosure. Then I began the support group.’

Ian – This family has influenced many other people. The family living experience gives power to the movement in community.

https://dl.dropboxusercontent.com/u/51648609/Comm%20synth%205%20Tha...

[Rituu B. Nanda]

‘Home AIDS visits us at home and it is very good, because the family can feel upset, not knowing what to do. The team brings a kit for care at home.’

‘When they come home they care for us in body, mind and life, if we have no food they will help.’

Glocon China ( where home visits were earlier difficult as people did not like others visiting their homes) 

 https://dl.dropboxusercontent.com/u/51648609/comm%20synth%206%20Chi...

[Rituu B. Nanda]

Ian Campbell 

We see accumulated effect – it is alive, because neighborhood groups take ownership. Ownership is facilitated by home visits, don’t forget. Both home and group/neighborhood processes are needed. The team is still working because it is beyond the boundaries of any one institution. Always think beyond institutions, to the Spirit of God, and the human connection. –Ian

 

Glocon Kenya

https://dl.dropboxusercontent.com/u/51648609/Comm%20synth%208%20Ken...

[Rituu B. Nanda]

Glocon Rwanda

Week 7 Rwanda: Masoro village ‘Shared confidentiality’ Home is no longer a place of isolation –community includes and everyone is normalising HIV. Picking up ART from the hospital is no longer a secretive stressful journey. It is normal and everyone is talking about moving on with life. There has been a shift from secrecy to shared confidentiality in eight months of interaction with a community cooperative which represents many local communities and their families and neighbourhoods. Transfer has been very fast to many local communities of the members, because of confidence that each member cares about the others, and Tabara accompanies, and listens, and facilitates conversation about next steps. The local government is supportive. The origin of Tabara in 2006 was care of a neighbourhood member in the home by the founder of what became Tabara. Neighbours were included, they helped, and everyone relaxed. The axis of shift is varied depending on context –but whether from home to neighbourhood to wider community, or from community group to home to neighbourhood, the results can be the same- including destigmatisation, via shared safe intimacy or confidentiality, better sustained care at home and health facility, increased treatment access and adherence, income generation, improved nutrition, locally driven expansion prevention , increased self-confidence , and ambition for the future. Hope flourishes

https://dl.dropboxusercontent.com/u/51648609/Comm%20synth%209%20Rwa...

[Rituu B. Nanda]

Other posts on home visits

http://aidscompetence.ning.com/profiles/blogs/home-visits-lead-to-w...

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http://aidscompetence.ning.com/profiles/blogs/care-leads-to-change-...