Belay Kahsay, 84 years old and the father of four daughters, served as a finance officer until his retirement from Agip - an Italian gasoline, diesel and lubricants retailer.

Two years ago, Belay went to a hospital after getting sick. A urine test revealed his illness as gout arthritis, a disease that leaves patients with joints permanently damaged and swollen. Since then, his upper body has weakened, and he now requires close assistance from his relatives.

Belay uses a wheelchair to move around and needs someone to help him eat and talk to him. Ruth, one of his daughters, is his main caretaker.

Though Ruth is there for her father, she came to need someone's help in caring for him. So she started searching for someone who could dedicate their time to taking care of Belay. A nurse friend finally told her about home care service providers.

Two years ago, she ended up hiring Fikir Home Care Service Provider, a company that was established three years ago to provide healthcare services for those needing moderate care after leaving the hospital.

The company dedicated Zewdu Baykedagne, a caretaker, to take care of Belay. He goes to the client's home every morning at 8:00am and leaves late in the afternoon at 6:00pm.

"It's important we have Zewdu around to help us," she said. "He is so giving of his time and energy.”

Zewdu, who has been with the family and Fikir Home Care Sevice Provider for two and three years, respectively, was initially a healthcare extension worker.

"It has always been my passion to care for those who can't help themselves," says Zewdu. "I can't imagine there's a better calling."

Zewdu helps the family give Belay a shower, serves him his meals and talks to him as well. After hiring a home care provider, Ruth's life has been made easier, and her father is receiving better care.

Even though home-based healthcare services have been available for years, they have not been widely adopted and institutionalised. However, the service was better formalised after the issuance of a directive by the Ministry of Health in 2015. The directive defines home-based services as focused on relieving symptoms and supporting patients through physical, emotional or spiritual illnesses.

The directive indicates that service providers may look after terminally ill patients, provide long-term care for chronically ill patients or give palliative care.

So far, 11 companies are registered in the capital to provide the service, Fikir being one of them. The business employs 35 people, 10 of which are permanent. It provides training for those in the field as well.

Fikir can have anywhere from 10 to 15 patients at a time. It charges anywhere between 200 to 800 Br a day based on the services and the hours of care the customers require.

“It’s not a very profitable business," says Alemu Kibret, coordinator at Fikir, "but more people are becoming aware of it, therefore, we are sure it's going to grow."

Rohobot Home-based Health Care Service, one of the prominent home care providers in the city, is another business that has provided the service since 2017. Rohobot has 37 employees including administrative staff.

Many of the patients are stroke patients unable to move or require oxygen support, depending on where the stroke hit and to what degree, says Nebiyat Demeke, founder and general manager at Rohobot.

Rohobot, which has 10 to 12 patients at any time, like others in the business also provides other facilities such as hospital beds, wheelchairs, suction machines and other essential equipment that patients may need.

“Some of our patients can’t afford these services, thus we don’t push. But every patient has a follow-up sheet, and this is a basic service we provide,” says Nebiyat. “Almost all of our staff are nurses, but we have one doctor as well.”

The directive issued by the Ministry of Health requires home-based healthcare providers to produce staffing information and complete facility checks and other requirements before they are licensed.

Even though the business should be able to operate successfully after the companies are provided with licenses, there are a few companies that operate informally, according to Nebiyat.

“The government has taken no actions to control this," says Nebiyat, "so it makes me wonder exactly what are the benefits of having a license."

Debrework Getachew, deputy director of the Medicine Registration & Licensing Bureau in Addis Abeba, says that they have not received any complaints on this issue and that the home care service providers should take on this responsibility.

Mikias Yafet, general manager of Tirita Home Health Care Service, another prominent firm in the sector, stressed the need for companies to become registered since they are accountable for their services.