In September 2023, an outbreak of mpox caused by the monkeypox virus (MPXV) clade Ib was reported in Kamituga, a mining region in the Eastern Democratic Republic of the Congo (DRC). More cases of mpox started to be reported across the country and in neighbouring countries in the east, including Rwanda, Uganda and Burundi.1 In February 2025, the Africa Centres for Disease Control and Prevention and the Director-General of the World Health Organization (WHO) determined that the ongoing upsurge of mpox continues to be a public health emergency of international concern (as first declared in August 2024).
Home-based care (HBC) – care provided in the private home of a person – often takes place informally for a wide range of reasons during epidemics. Home-based models of care are increasingly being explored by Ministries of Health as a strategy for managing outbreaks and providing treatment for mild forms of diseases, particularly in resource-limited settings. Reasons to implement HBC for mild forms of diseases include to provide care when there is a lack of access to or overburdened services, to prevent a risk of infection in health facilities, to accommodate people’s preferences and to empower the public when HBC is implemented in partnership with community members. Home-based models of c are for mpox should not supplant investments in the health system, but should be designed as a component of primary healthcare. Past experiences with HBC during outbreaks such as HIV and COVID-19 offer valuable lessons. However, the unique transmission dynamics of mpox – especially the risks it poses to children and those who are immunologically vulnerable in the home – require careful consideration. To date, attention has focused on infection, prevention and control (IPC) and water, sanitation and hygiene (WASH) in the home. Other aspects of mpox management and care at home also need to be considered. It is particularly important to recognise that mpox is not only a biomedical event: it is also a social phenomenon, impacting livelihoods, relationships, well-being and access to care and protection. Also, a lack of income in the absence of financial support is likely to hinder peoples’ ability to follow isolation guidance.
This brief outlines key considerations on health system requirements for safe and inclusive HBC. It also foregrounds structural constraints and socio-political dynamics shaping understandings and practices of HBC, taking into consideration local and gendered perspectives on home and caregiving. The brief also examines how ongoing funding cuts in global health, humanitarian aid and development assistance are straining the capacity of both community-based initiatives and healthcare systems, further complicating home and community-based response efforts. The focus is on Central and East Africa in particular.
The brief draws on conversations with experts and health actors active or knowledgeable in the region and outbreak, or both; the authors’ own expertise; and academic and grey literature on HBC and histories of epidemics in Central and East Africa. The brief includes two cases studies based on recent research in Uganda and the DRC.
Authors
