Building partnerships for HIV and AIDS management in a deep rural community in South Africa.

Abstract

The importance of partnerships between marginalised communities and support agencies (from the public sector, private sector and civil society) is a pillar of HIV & AIDS management policy. Such alliances are notoriously difficult to promote and sustain. The thesis presents the findings from a longitudinal, qualitative case study of a project seeking to build partnerships to facilitate local responses to HIV & AIDS in a remote rural community in South Africa. The partnership aimed to empower community stakeholders to lead HIV-prevention and AIDS-care efforts through the support of local government departments, NGOs and the private-sector, and make public services more responsive to local needs. I highlight the value of building longterm relationships with, and ownership of the project by community stakeholders, i/ by involving community stakeholders in partnership building and facilitation from the very beginning of the process, and; ii/ through a compliance with, and respect for community protocols and norms in the process of entry, community engagement, and partnership facilitation. I illustrate how features of the local public sector environment have actively worked against effective community empowerment and partnership. These include a rigid hierarchy, poor communication between senior and junior health professionals, lack of accountability, limited social development skills, and the demoralisation and/or exhaustion of public servants dealing with multiple social problems in under-resourced settings. I outline the obstacles that have prevented private-sector involvement, suggesting a degree of scepticism about the potential for private-sector contributions to development in remote areas. The most effective partners have been the NGOs — run by committed individuals with a keen understanding of social-development principles, flexible working styles and a willingness to work hard for small gains. Despite the challenges, the partnership has achieved many positive outcomes, including the formalization of the partnership and its institutionalization within a permanent government structure. I outline these achievements and discuss the essential role played by an external change agent in facilitating the process of partnership building. I conclude with eight key lessons learnt and recommendations which emerged out of the research. Firstly, partnerships are embedded in and influenced by the contexts within which they are located; secondly, stakeholder organizations must create an enabling environment to encourage and sustain partnership participation; thirdly, capacity building and empowerment of partners is crucial for ensuring ownership and sustainability of the partnership; fourthly, partnerships within resource (human and physical) poor contexts like Entabeni, where skills and resources are scarce, require the services of a dedicated, skilled facilitator or external change agent; fifth, partnership building needs to be guided by regular monitoring and evaluation and a systematic documentation of the process; sixth, relationships based on trust are a central pillar of partnerships; seventh, partnerships are as much about individuals as they are about communities and organizations, and; finally, partnerships can and do work, in-spite of the many challenges that may be encountered. of partnerships between marginalised communities and support