Delivering HIV services in partnership: factors affecting collaborative working in a South African HIV programme
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RESEARCH
Open Access
Delivering HIV services in partnership: factors affecting collaborative working in a South African HIV programme Geoffrey A. Jobson1*, Cornelis J. Grobbelaar1, Moyahabo Mabitsi1, Jean Railton1, Remco P. H. Peters1, James A. McIntyre1,2 and Helen E. Struthers1,3
Abstract Background: The involvement of Global Health Initiatives (GHIs) in delivering health services in low and middle income countries (LMICs) depends on effective collaborative working at scales from the local to the international, and a single GHI is effectively constructed of multiple collaborations. Research is needed focusing on how collaboration functions in GHIs at the level of health service management. Here, collaboration between local implementing agencies and departments of health involves distinct power dynamics and tensions. Using qualitative data from an evaluation of a health partnership in South Africa, this article examines how organisational power dynamics affected the operation of the partnership across five dimensions of collaboration: governance, administration, organisational autonomy, mutuality, and norms of trust and reciprocity. Results: Managing the tension between the power to provide resources held by the implementing agency and the local Departments’ of Health power to access the populations in need of these resources proved critical to ensuring that the collaboration achieved its aims and shaped the way that each domain of collaboration functioned in the partnership. Conclusions: These findings suggest that it is important for public health practitioners to critically examine the ways in which collaboration functions across the scales in which they work and to pay particular attention to how local power dynamics between partner organisations affect programme implementation. Keywords: Global health initiatives, Health partnerships, Health systems strengthening, South Africa, Collaboration, HIV
Background Global Health Initiatives (GHIs) have become an integral part of the delivery of health services in many low and middle income countries (LMICs) since the mid-1990s [1]. These initiatives include bilateral aid relationships managed by a government agency, such as the President’s Emergency Plan for AIDS Relief (PEPFAR); multilateral initiatives established by global agencies, such as the Global Fund; and public-private partnerships [1]. Several of these GHIs focus specifically on the treatment and prevention of HIV, and have massively increased the resources available for HIV related programmes in the countries most severely affected by * Correspondence: jobson@anovahealth.co.za 1 Anova Health Institute, 12 Sherborne Rd, Park Town, Johannesburg 2190, South Africa Full list of author information is available at the end of the article
the epidemic. This focus has contributed to the significant progress made in reducing HIV transmission and increasing the uptake of antiretroviral therapy (ART) [2]. However, the effects of the increase in resources for HIV-related care on country health systems have been m
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