Marseille 2007
| Abstract #197 - ART service provision in Uganda and South Africa: Ambiguity and negotiation within the State-NGO-Donor triangle | ||||
|
Session: 26.17: Posters B (Poster) on Tuesday in Chaired by Authors: Presenting Author: Mr Alexander Leusenkamp - Amsterdam School for Social science Research, Netherlands |
||||
| Additional Authors: | ||||
| Aim: The relationship between state institutions, donors and NGOs with regard to antiretroviral therapy (ART) policy in Uganda and South Africa is analysed by taking into account the ambiguous nature of each stakeholder. They exist without the fixed boundaries that are characteristic to normative and pluralistic visions, leaving much space for policy appropriation and informal politics and entailing constant negotiation between those involved. Each actor, whether donor, NGO or governmental pursues its own legitimate interest and where conflicts arise, a process of negotiation is a prerequisite. In this paper I particularly focus on these negotiations and ambiguity; how district state institutions function in informal daily reality; how they are intertwined with public health centers, NGOs and donors and how their activities shape their imagos and mutual perceptions. The research intends to focus on both positive findings, challenges as well as coping strategies in order to meet issues of coordination, legitimation, daily planning and implementation processes of scaling up ART services, as experienced by the involved actors themselves. | ||||
| Method / Issue: This studys focus lies at the district level. It is exploratory in nature since little anthropological research has been conducted on how these actors interact and how ART policy is appropriated in daily practices. The main methodology comprises participant observation, unstructured interviews and case studies. | ||||
| Results / Comments: The Ugandan response to the HIV/AIDS epidemic in the 80s/90s coincided with structural health care reforms, in which decentralisation processes transferred authority to lower governments thus limiting the role of the central state. However, hampered by insufficient funding to plan and implement health activities at district governments as well as incapacity at the public health sector, an increase in donor involvement and NGO activities could be observed. In contrast, the South African government choose for a highly centralized leadership style of HIV/AIDS policy formulation in which relationships with other actors remain hierarchical in nature, thus avoiding unwanted interference in policy making. As a result, international donors have, more than in other African countries, concentrated on strengthening the existing health system, instead of creating a new, parallel health care system. It is outlined that many institutions implement ART activities without a coordinated fundament in which priorities in terms of needs assessment and geographical coverage are set. The District health team, formally responsible for coordinating HIV/AIDS activities, perceives themself as working within the health regulating body, and infer from the authority of its being the mandate to plan and supervise ART services. A view which is not shared amongst others. The paper also exemplifies how artificial walls between actors are deliberately being erected to limit involvements of others, while at other times these walls are broken down in order to seek necessary assistance from eachother. | ||||
| Discussion: Ambiguous relationships and blurred boundaries between state actors and non-state institutions can create tensions between what organizations involved in ART services are formally expected to deliver according to policy, and what happens in informal daily reality. In my view these perspectives offer authentic and fresh perspectives on studying state-NGO interactions within the African HIV/AIDS epidemic. | ||||
| Go Back | ||||
