IMPLEMENTING THE NSP: NGOs ROLE Government, NGOs and CBOs collaboration in HIV and AIDS: AFSAs exper

1
IMPLEMENTING THE NSP NGOs ROLE Government,
NGOs and CBOs collaboration in HIV and AIDS
AFSAs experience

• AFSA Learning and Sharing conference
• October 2008
• Vhumani Magezi

2
SA implementing NSP Role of NGOs

• South Africa has one of the most severe HIV and
  AIDS epidemics in the world.
• 5.7 million South Africans were living with HIV
  at the end 2007(UNAIDS report 200840).
• Although data from antenatal clinics reported by
  the Department of Health 2007 suggests that the
  epidemic might be stabilising, there is no
  evidence yet of major changes in HIV-related
  behaviour.
• The high level of HIV prevalence is not matched
  by relevant behaviour change which reveals the
  depth of the challenge posed by the epidemic.
• These challenges among other things clearly
  indicate that HIV and AIDS responses should be
  scaled up and intensified.
• It is, however, encouraging for South Africa that
  all the strategic responses to turn the HIV tide
  are clearly outlined in the countrys HIV AIDS
  and STI National Strategic plan (NSP) (2007
  -2011).

3
SA implementing NSP Role of NGOs

• The NSP clearly points out that addressing the
  epidemic, far from being the role of a single
  player (i.e. the government) is the
  responsibility of all government departments and
  sectors of civil society (NSP 56).
• Consequently, one of the six guiding principles
  for the NSP implementation strategy is Effective
  Partnerships All sectors of government and all
  stakeholders of civil society shall be involved
  in the AIDS response (NSP 59).
• However, the NSPs reference to government and
  civil society partnership - popularly termed
  collaboration - has been a general global
  discussion, which the South African policy makers
  have made a significant effort to embrace.
• We shall return to the collaboration discussion

4
NGOsmajor player in implementing NSP
5
NGOsmajor player in implementing NSP
6
How may GVT and NGOs Collaborate?

• With the realisation that
• Implementing the NSP should be a
  collaborative effort and
• NGOs/CBOs (civil society) play a
  critical role
• We should ask In what ways could government and
  NGOs collaborate in implementing HIV and AIDS
  interventions particularly in South Africa?

7
CollaborationAFSAs bold step?

• To understand at least one way how government and
  NGOs could collaborate in implementing HIV and
  AIDS interventions in South Africa we will turn
  to Aids Foundation of South Africa (AFSA) and
  government's partnership in the National
  Integrated Plan (NIP) a.k.a Drop-In-Centers
  (DICs).

8
Collaboration what is it?

• However, in order to develop a clear
  understanding and provide background on
  collaboration we will
• First define the concept collaboration and
  developments in South Africa
• and then
• 2. Present an overview of the study with
  particular emphasis on findings.

9
Collaboration - a BUZZ word with little meaning?

• Collaboration - 122,000,000
• Collaboration in South Africa - 7,620
• Government and NGO collaboration 419
• Government and NGO collaboration - 0
• Government and NGO collaboration - 972,000
• "Government and NGO collaboration in HIV and AIDS
  in South Africa" 0
• Conclusion Collaboration is often spoken about
  in HIV and AIDS work and Social development but
  there are little or no studies that have been
  conducted to ascertain the efficacy and
  practicality of it particularly in South Africa.

10
Closest collaboration study?

• NGO COLLABORATION IN SOUTH AFRICA A FRAMEWORK
  FOR EXAMINING THE INFLUENCE OF FUNDERS ON
  COLLABORATION PERFORMANCE (Jane Cooke-Lauder
  January, 2007)
• The purpose of the study was to test whether
  collaboration performance was related
• 1. To conflict management, inter-organizational
  trust and role clarity, factors generally seen
  to be important drivers of collaborative success
  but in a very different context, and
• 2. The role played by funders through the
  supports and controls applied to the
  collaboration

11
Collaboration no concise definition

• There is no agreed definition of the term
  collaboration.
• Throughout the literature, stress is placed on
  the need for social partners to complement one
  anothers services, capabilities, strengths, and
  assets of others.
• However, in all definitions espoused and
  explanations advanced, it is agreed that
  collaborative relationships are likely to happen
  between social partners who share similarities in
  terms of both ideals and the strategies for
  attaining such ideals.
• Notwithstanding the value of the discussion on
  terminology in clarifying collaboration, the
  nature of NGO-CBO-government collaboration seems
  more evident in its theoretical and practical
  context. To which we turn

12
Govt NGO collaborationsuspicion and tension

• NGO-CBO-govt collaboration has been generally
  marked by suspicion and tension.
• Governments are generally reluctant to
  collaborate with NGOs and CBOs fearing that NGOs
  success would challenge their power, as well as
  raise questions about government development
  failures.
• Moreover, governments also fears that their
  assumed know-how will be demystified if their
  governance processes are liberalised in a free
  working environment with NGOs and CBOS.
• As a result, they fear that their hold on
  instruments of decision-making, such as budgeting
  and planning, could be contested (DeJong 2001).
  This seems to have been the case for example in
  Kenya, Zimbabwe and South Africa.

13
Government and NGO collaboration in SA

• In South Africa, NGO-government relationship has
  been characterised by discord on the response to
  the pandemic.
• Friedman (200027) described the relationship as
  hostile.
• However, this does not mean that collaboration
  between them has been non-existent.
• The development of a country response to the
  epidemic since the 1994 democratic transition
  depicts strained debates and strife, but also
  instances of quasi-cooperation, especially in
  policy development, and indeed in established
  collaborative strategies in project
  implementation.

14
SA Govt NGO developments in HIV AIDS
15
SA Govt NGO developments in HIV AIDS

• The table above shows that out of the eleven
  landmarks that have defined the development of a
  country response to the HIV and AIDS pandemic,
  six have involved collaboration between
  government and social actors in policy
  development, with at least five collaborative
  frames of implementation.
• However, what has characterised relations between
  government and civil society organisations (CSOs)
  in the HIV and AIDS intervention in the country
  is what Butler (2005) has categorised as a
  rivalry between a nationalist, ameliorative
  paradigm held by the former (government) and a
  mobilisation, biomedical paradigm held by the
  latter (civil society).
• While the government portrayed a more
  conventional, epidemiological view of the
  pandemic from 1994 to late 1999, it has certainly
  portrayed a much more controversial political
  perspective regarding the link between HIV and
  AIDS since early 2000.
• This is despite the fact that provision of ART is
  now a standard public policy, as established in
  the 2000-2005 and 2007-2011 HIVAIDS and STI
  Strategic Plans for South Africa, and is being
  carried out under the provision of the 2003
  Operational Plan for Comprehensive HIV/AIDS
  Treatment and Care.

16
SA Govt NGO collaboration in HIV AIDS NIP - a
true attempt!

• From the developments in SA, it can be noted that
  the NIP is the only major programme the
  government has designed for direct collaboration
  between government and community-based
  organisations in response to the HIVAIDS
  pandemic since the democratic transition in 1994.
• The programme was established in 1999.
• Its central aim is to develop Drop-in-Centres
  (DICs) in vulnerable communities in partnership
  with local organisations.
• The objective of the NIP was to strengthen the
  capacity of families by providing a variety of
  caring and supportive services, which they badly
  needed in view of the health and socio-economic
  challenges posed by the pandemic.
• The Cabinet approved a R450 million budget for
  this development of an integrated response to the
  epidemic. This was placed under the auspices of
  three public departments Social Development
  (DoSD), Health (DoH) and Education (DoE) (RHRU
  200514).

17
NIP activities to meet its central objective

• To achieve the objective of strengthening the
  capacity of families, the NIP (DICs) are to
  implement the following caring and supportive
  services
• day-care facilities
• homework supervision
• identification and referral of OVCs
• home visits, assistance in obtaining documents
  for accessing grants
• provision of food parcels
• attending to the special needs of child-headed
  families, linking families with income-generating
  activities
• HIV and AIDS awareness, care, counselling and
  support
• establishment of support groups, provision of
  meals and food gardens (DoSD 2004).

18
NIP making progress but far below optimum
potential!

• In November 2004, the Department of Social
  Development contracted the Reproductive Health
  HIV Research Unit (RHRU) at the University of
  Wits to conduct an impact study of four
  Drop-in-Centres in KwaZulu-Natal to facilitate
  the process of monitoring and evaluating the
  programmes influence policy rectify mistakes
  and bring the integrated plan together and
  enable the three responsible departments to work
  in a collaborative manner (RHRU 200510).
• The study revealed that the DICs are making
  significant progress to meet the needs of OVCs
  but they have not been able to optimise their
  potential due to several limitations such as
  staff shortages poor role descriptions of staff
  lack of incentive due to the low stipends for
  volunteers increasing service demand on account
  of the growing number of beneficiaries lack of
  community support for OVCs, apart from DICs
  services and lack of support from the relevant
  government departments (RHRU 200510-11).

19
NIP challenges problem identified

• The RHRU report clearly indicated that there were
  challenges that should be overcome in order for
  the DICs to optimise their potential in community
  service deliver.
• The constraints largely arose from limited
  resources (personnel and financial) and the lack
  of organisational capacity (skills and
  knowledge), both at DICs and in government
  departments, to effectively implement an
  integrated programme.
• The situation is further worsened by, among other
  things, governments lack of flexibility in its
  funding methods.
• AFSA therefore posed the following questions
• 1. Could a model of government NGO CBO
  collaboration be developed to improve and
  strengthen the DICs?
• 2. How could AFSA, as a NGO, collaborate with
  government and DICs (CBOs)?
• 3. What are some of the opportunities and
  limitations of such a collaborative effort?
• 4. What are some of the critical lessons that
  should inform policy in pursuing such civil
  society and government collaborations?

20
Programme (working) hypothesis

• Considering the following aspects
• The critical socio-economic impact that HIV and
  AIDS is continuing to have on communities
• The poor DIC-government relationship and the
  realisation of the critical role that DICs could
  play in communities
• The constraints arising from limited resources
  and organisational capacity, both at DICs and in
  government departments, and the much- vaunted
  collaboration and
• Coupled with AFSAs quest to develop a model of
  NGO-Government collaboration,
• AFSA conceptualised and developed a DIC programme
  intervention that would function as an
  exploratory longitudinal study.
• This initiative was reinforced by Friedman and
  Harpers (2005) assessment report of AFSA Scaling
  up support to the AFSA to strengthen community
  health-care worker programmes the potential and
  challenges that also identified the DICs as
  organisations where AFSA could play a supportive
  and complementary role to the government in
  strengthening the capacity and quality of service
  delivery within a selected number of NIP DICs.
• Therefore AFSA viewed this involvement in
  supporting a number of NIP DICs as an approach
  that would provide the opportunity to develop a
  model of best practice for future collaboration
  and the development of an effective
  community-care programme.
• Although AFSA was not in a position to respond to
  all the challenges pointed out by the RHRU
  report, its considerable experience in mentoring
  and developing the capacity of community-level
  organisations placed it in a suitable position to
  play this complementary role to the government.

21
AFSAs goal in the NIP programme

• Through this programme AFSA seeks to explore and
  develop a model for government-NGO-CBO
  collaboration through partnering with the
  government in implementing the National
  Integrated Plan (NIP)
• With the view to strengthen the capacity of
  Drop-in-Centres (DICs) and develop an example of
  best practice collaboration model for such
  partnerships in the provision of community care.

22
AFSAs rational for the programme

• Why go this route AFSA?
• With Friedman Harpers assessment of AFSA
  having identified the Drop-in Centre (DICs) as
  the best model for future collaboration and the
  development of a sustainable community-care
  programme and
• AFSAs vested interest in ensuring that
  community-care projects succeed - as evidenced by
  its investment of 80 of its annual income in
  supporting community interventions
• AFSA strives to ensure that the long-term
  sustainability and development of community-care
  programmes are secured through intersectoral
  collaboration and government financial and
  material support.

23
Methodology 1

• AFSA in consultation with DoSD and DoH selected
  organisations 10 NIPs -DICs (6 in KZN and 4 in
  Limpopo).
• These organisations are being given grants of
  R250 000 per annum.
• The funding is used to co-fund the internal
  capacity of the DICs and to strengthen their
  outreach and community-care services.
• AFSA deployed two Project Officers one in
  Limpopo and another in KwaZulu-Natal - who
  monitors the implementation and management of the
  programme.
• The Project Officers facilitates and participates
  in DICs and government meetings and
  decision-making processes, provide on-site staff
  training, and on-going holistic support for all
  the DIC issues, including operational and
  strategic ones.
• These PO in addition to formal trainings, provide
  on-the-job training to address CBO capacity
  limitations while the funding provides soft
  money to fill the gaps caused by government
  delays and inflexible spending lines.

24
Methodology cont2

• To assess the effectiveness of the collaborative
  effort two evaluations would be conducted. The
  mid-term internal evaluation would be conducted
  in the second year of programme implementation.
  This will be an implementation evaluation to
  determine areas that require adjustment and to
  ascertain whether it is on course. Secondly, an
  external evaluation to assess whether the
  programme met its overall objective will be
  conducted in the fourth year.
• The objective of both the mid-term, formative
  evaluation and the end-ofprogramme, summative
  evaluation will remain unchanged. It will seek
  firstly, to assess the extent to which the
  interventions strengthened the capacity and
  enhanced the service delivery of the DICs
  secondly, to determine whether the model could be
  adopted as best practice for the collaborative
  partnerships and thus provide an alternative
  approach to managing DICs that could be adopted
  by government and thirdly, to systematically
  document the lessons learnt in order to inform
  other NIP programmes.

25
Methodology cont3

• The programme is being implemented for a period
  of four years.
• This presentation is drawn from a mid-term
  cross-sectional assessment of AFSAs impact and
  the extent to which the collaboration is working.
• The data was collected from the 10 NIP DIC
  sites, and the collaborative partners, through
  qualitative methods and to a lesser extent
  quantitative, using such methodologies as
  interviews with key people and focus groups. All
  interviews and focus group discussions were
  transcribed and captured electronically. The
  transcriptions and translations were done by the
  fieldwork team the analysis was done manually by
  the Principal Investigator.

26
Distribution of interviews

• The following were interviewed at AFSA the
  Deputy Director, the KZN and Limpopo Project
  Officers. The Deputy Director is responsible for
  the operationalisation of AFSA programmes, while
  the two Project Officers are responsible for
  implementing the programmes. The interviews with
  the Deputy Director sought to capture the
  programmes motivation, vision, and purpose,
  while interviews with Project Officers sought to
  capture experiences in the various activities and
  phases of project implementation.
• The 30 DICs management representatives
  interviewed were 10 Management Board
  representatives, excluding Project Managers, 10
  DIC Managers and 10 DIC Coordinators/Administrato
  rs. The Management Board representatives provided
  information such as perceptions regarding DICs
  managers, funding, accountability and
  relationships between the Boards and managers.
  This information shed light on the capacity of
  the DICs Management to manage the organisations
  effectively. The DIC managers and
  Coordinators/Administrators are responsible for
  the daily management of the programme hence they
  provided information on the dynamics of the
  programme from a management perspective.
• The government departments representatives
  provided information regarding, among other
  things, the nature of the assistance rendered by
  the government, and the quality, challenges and
  opportunities of partnerships with the DICs and
  AFSA.

27
Findings 1a AFSAs complementary role in DICs
(filling gaps)1
28
Findings 1a..cont AFSAs complementary role in
DICs (filling gaps)2
29
Findings 2aPerceptions and experiences of the
DICs pre-AFSA and the present performance
30
Findings 2bPerceptions and experiences of the
DICs pre-AFSA and the present performance
31
Findings3 AFSAs greatest impact

• Indiscriminate coverage (breadth) of and holistic
  intervention to the OVC
• Interventions that do not only benefit children
  orphaned by AIDS but also other vulnerable and
  disadvantaged children in the communities
• Establishment of halfway houses to reach more
  children
• Holistic assistance of OVC and disadvantaged
  children through providing them with food, school
  uniforms and fees, homework supervision and
  laundry
• Providing counselling to children heading homes,
  giving food parcels, and assisting with applying
  for documents to access grants and services and
• Teaching children over 18 life skills.
• Effective targeted trainings for DICs management
  and staff which include trainings that are
  differentiated between management and staff.
• Management trainings enabled - viable internal
  structures, financial accountability and ability
  to compile work plans and operate within
  guidelines
• Staff training enabled - proper need assessments
  and ability to provide quality service.
• Flexible funding support
• Funding that covers diverse expenses of the DICs
  such as daily expenses, salaries/stipends,
  transport fare to ARV clinics, childrens trips,
  pocket money for children, youth education
  activities, food parcels, funding new initiates
  and activities (e.g. soup kitchens, creation of
  halfway houses and satellite DICs, purchasing
  seeds for vegetable gardens).

32
AFSAs least impact and weak areas

• Failure to effectively address persistent poor
  DICs management, particularly lack of
  transparency and poor communication
• Excessive control by AFSA and lack of
  consultation which tends to limit initiatives
  from the DICs
• Persistently poor service delivery at DICs and an
  unfavourable environment for encouraging
  beneficiaries openness, and rigidity of staff
  trained by AFSA
• Limited capacity on DICs HBC work and persistent
  stigma
• AFSA interventions skewed towards OVC,
  overemphasis on reports and age limit for
  participants who undergo training
• AFSA funding creating stipend disparities which
  creates friction at DICs
• Persistent limited skills to draft work plans and
  constraints to ensure DICs sustainability beyond
  AFSA
• Failure to decisively address members who
  personalize the DICs
• Tendency to promote DICs over dependence on AFSA
  
• Failure to establish effective monitoring at DICs
  level and poor understanding of AFSAs programme
  in the AFSA - government partnership
• AFSA providing very limited facilitation to
  connect DICs with other service providers
• AFSAs strictness which seems to be driven by a
  corporate approach but insensitive to DICs
  thereby threatening organisations survival
• AFSAs assistance to some extent concentrating on
  short term interventions such as feeding schemes
  rather than focusing on skills that will be used
  in the long term (for sustainability)
• Limited trainings targeting DICs management
  inadequate support from AFSA POs due to limited
  number of site visits and POs engaging DICs
  management but ignore staff.

33
Findings 4 Success of AFSA in fostering
effective collaboration1

• The respondents indicated that the collaboration
  is working effectively in the following ways
• Improving the ability of DICs to negotiate with
  and tap the resources of government which in turn
  is improving their profile with government
• In supplementing government funding to fill in
  DICs activities that are lacking and
  participating in government meetings, AFSA has
  developed a significant relationship with
  government, which will be critical for working
  togethe in future
• Through capacitating the DICs to facilitate
  community participation, the target communities
  are fully participating in the DICs activities,
  which has improved the DICs credibility in
  communities
• AFSA is providing resources and space for DICs to
  network with other organisations, which exposes
  them to other organisations (networking).

34
Findings 5 Challenges experienced by CBOs as a
result of AFSAs involvement2

• Despite the positive collaborative links that are
  being forged at different levels due to AFSA
  facilitation, there are still some challenges
  being experienced.
• These include
• Duplication of services between AFSA and the
  government
• DICs partnership with government at district
  level is ineffective due to bureaucracy, hence it
  should be done at higher (provincial) level
• involvement of AFSA in DICs in some instances is
  causing the government to reduce funding
• AFSA is having very minimal influence on the
  government.

35
Findings 6 Challenges still experienced by the
organizations despite the collaboration1
36
Findings 6cont Challenges still experienced by
the organizations despite the collaboration2
37
Findings 7cont Challenges still experienced by
the organizations despite the collaboration3
38
Findings 7cont Challenges still experienced by
the organizations despite the collaboration4
39
Findings 8 Challenges still experienced by the
organizations despite the collaboration1
40
Conclusion is AFSAs model working?

• Model for a collaborative partnership with the
  government is commendable but it seems to be
  experiencing numerous, though not insurmountable,
  challenges.
• The greatest challenges in the collaboration are
  poor communication, government bureaucracy, and a
  lack of continuity from one officer to the next
  in when there are resignations.
• This intervention should, nevertheless, continue
  to be explored and strengthened over the next two
  years of the programme.
• The DICs, however, propose a different model one
  that is driven by AFSA and not jointly
  implemented with the government. In this model
  the government manages the NIP through a service
  provider like AFSA. The government reaches the
  community through a systematic mentoring process
  established between AFSA and the DICs. The
  government would provide funding to AFSA, who in
  turn would disburse funds for mentoring and
  monitoring the DICs. The basis for this model is
  that AFSA has proved to the DICs that it is
  capable of effectively managing the DICs and has
  controls in place to avoid misappropriation of
  funds, which is sometimes encountered in the
  DoSD.

41
Recommendations to AFSA..1

• Despite AFSAs impact on the NIP programme, there
  are areas that require improvement and increased
  focus in the next implementation phase. For AFSA,
  these areas among other things include
• Stepping up efforts that effectively address the
  challenge of persistent poor management,
  particularly in the areas of transparency and
  communication
• Playing a more facilitative role, which is
  consistent with the organisations community
  developmental practice in order to avoid
  perceptions of excessive control and lack of
  consultation, which tends to limit initiatives
  and perpetuate donor dominance
• Inculcating an open and learning attitude on DIC
  staff undergoing training to discourage
  rigidities and encourage openness to suggestions
  from other staff
• Capacitating the DICs to effectively conduct HBC
  work and address persistent stigma
• Prioritising DICs interventions to ensure that
  all areas are addressed in order to avoid the
  perception that AFSAs interventions are skewed
  towards OVC
• Proactively communicating to DICs the value and
  importance of reporting not only as compliance
  measure but an organisational reflective process.
  
• Consulting with the DICs regarding people to
  undergo training particularly justifying AFSAs
  age and education level restriction on
  participants
• Resolving disparities in stipends created by AFSA
  funding, which is causing friction among staff

42
Recommendations to AFSA..2

• Strengthening skills in drafting work plans and
  implementing initiatives that promote DICs
  sustainability (beyond AFSA)
• Providing assistance focusing on skills that
  could be used in the long term (for
  sustainability) in addition to the current
  short-term interventions, such as feeding
  schemes
• Assisting DICs to deal decisively with members
  who tend to personalise the DICs
• Creating an environment that promotes the DICs
  to be self-supporting (sustainable) and
  discourage over-dependence
• Establishing effective monitoring at DICs level
  and increasing efforts to make the government
  understand AFSAs programme in the AFSA -
  government partnership
• Increased facilitation to connect DICs with other
  service providers in addition to the government
• Increasing consultation and communication with
  the DICs regarding the benefits of control
  structures and systems to encourage buy in by
  the organisations in order to avoid perceived
  strictness, which is viewed to be driven by a
  corporate approach but insensitive to DICs,
  thereby threatening their survival
• Increasing trainings targeted on DICs
  management
• Increasing POs field visits to the DICs to
  provide support
• POs engaging all levels of DICs staff rather
  than concentrating on management only in order to
  develop an understanding and perspective on
  grassroots
• Improving coordination and communication with
  government to avoid duplication of services
• Doubling efforts in facilitating DIC Gvt
  partnerships to foster effective partnerships
  particularly at grassroots (district) level due
  to overcome bureaucracy and
• Playing a more active advocacy role to
  significantly lobby for DICs.

43
Recommendation to government

• And for government, it should focus on
• Exploring ways of increasing funding to DICs
• Long-term planning for OVC
• Improving coordination and communication with
  AFSA and the DICs to avoid duplication of tasks
• Long-term planning on sustainability of the DICs
  when AFSA stops funding (sustainability
  planning)
• Stepping up capacity development efforts to
  address persistent lack of capacity to
  effectively manage the DICs and
• Limited facilities and assets to effectively
  deliver services.

44
Acknowledgements

• The evaluation was commissioned by the Aids
  Foundation of South Africa with financial support
  from Atlantic Philanthropies. AFSA would,
  therefore, like to thank Atlantic Philanthropies
  for its contribution to this work.
• Secondly, we would like to thank the people who
  participated in the interviews for sparing time
  to speak to AFSA field researchers. These people
  include all those who were interviewed in
  KwaZulu-Natal and Limpopo Provinces, Project
  Officers, AFSA Deputy Director, and Government
  representatives from DoSD and DoH.
• Thirdly, sincere thanks to the Research team that
  comprised UKZN, DUT, UNISA and UniLimp
  Internship Students and AFSA Research Support
  Officer.
• for their hard work in data collection,
  transcription and ongoing support throughout the
  analysis phase
• http//www.aids.org.za/research_internal.html