Abstract:
The HIV/AIDS pandemic has reached an unprecedented scale in South Africa. The
burden this has placed on the country's already restricted health care resources has
lead to a greater emphasis on the value of home-based care. Home-based care is a
service model appropriate to a number of contexts from palliative and elderly care
to support of orphaned and vulnerable children.
Home-based care not only relieves the burden on hospitals and community clinics,
but is an affordable alternative to institutional care. In order to recognise home-based
care as an equal, rather than an inferior alternative to institutional care, good
service delivery is imperative.
The numerous restrictions encapsulated by the home-based care problem, such
as adhering to time windows and effcient skill and need matching contributes to the
complexity of the problem. The wide geographical dispersion of households in South
Africa exacerbates this problem. As far as possible the assignment of beneficiaries
to care workers should be done in such a way that the travelling time of the care
workers will be minimised.
Through an extensive literature study, the home-based care problem has been
identified as a combination of the Nurse Rostering Problem and the Vehicle Routing
Problem with Time Windows. Both of these are optimisation problems that determines the optimal assignment of beneficiaries to care workers and minimise the time spent travelling, while adhering to constraints.
A hybrid approach is proposed to address this problem. A conceptual solution
algorithm that combines the Variable Neighbourhood Search and Tabu Search metaheuristics is considered in this document. The algorithm will be enhanced by adding a heuristic ordering algorithm which will construct an initial solution.
The complete hybrid algorithm was evaluated by applying it to test data from
home care visits to orphaned and vulnerable children in Hearbeat's Nellmapius Community Project.
The solution algorithm provided sufficient results with care worker schedules not
exceeding four hours a day and an equal workload between care workers.
The results indicate that the algorithm does have the ability to improve service
delivery of home-based care by improved assignment, routing and scheduling of care
workers. However, to ensure feasibility of this algorithm, careful implementation
and monitoring is imperative.
