Pills, Politics and Partners: NGOs and the Management of the HIV/AIDS Epidemic in the Eastern Cape, with special reference to the Lusikisiki Project, 2004-2014
- Authors: Govere, Fredrick Murambiwa
- Date: 2014-06
- Subjects: Non-governmental organizations -- South Africa -- Management , AIDS (Disease) -- Prevention , HIV-positive persons -- Services for -- South Africa
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10353/25720 , vital:64473
- Description: South Africa is one of the few countries in sub-Saharan Africa where HIV prevalence rates remain stubbornly high.1 This trend is both concerning and difficult to explain given that South Africa is economically well-resourced with a better health care infrastructure relative to other African countries. The African National Congress identified the HIV/AIDS epidemic as a major public health threat to South Africa as early as the 1990s (Parikh and Whiteside, 2007; Gevisser, 2007). In response, international donors provided a substantial amount of financial resources to support improvements in South Africa’s health care infrastructure. The persistently high rates of HIV/AIDS in the population beg for answers to questions such as why South Africa’s political leadership has been unable to control the spread of the disease and what particular social, behavioural and economic factors have contributed to South Africa’s disproportionate share of the global HIV/AIDS burden. At this point in time, public health experts still have not been able to definitively isolate the factors that explain the severity of the HIV/AIDS disease burden within South Africa’s population. While international donor aid continues to play a central role in the social, economic and health betterment in developing nations, its political impact on local governance structures has been much debated.2 In particular, the roles played by non-government organisations (NGOs) in the fight against HIV/AIDS in South Africa have been found to be complex, controversial, and their lasting value contested. Specifically debated is the disproportionate global investment in HIV/AIDS prevention, care and treatment in South Africa and the ways in which it has shaped intervention strategies, public and private policy, and the governance roles assumed by various national and local governmental agencies. Despite the threat of diminished financial support from international donor agencies that has loomed heavily over recipient countries in recent years, a number of key international donors have actually scaled up their global response to HIV/AIDS, particularly in South Africa.3 These donor agencies include the U.S. government’s Presidential Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund, as well as non-profit humanitarian organisations such as Mèdecins Sans Frontiéres (MSF), commonly known as Doctors without Borders. This study aims to critically examine the prevailing intervention strategy used by these international donors to “push the pill;” that is, to push a public health agenda that holds antiretroviral (ARV) therapy as the preeminent solution to fighting the HIV/AIDS epidemic at the expense of other intervention strategies. While a biomedical approach remains the most compelling intervention strategy, the fight against HIV/AIDS needs to be more comprehensive in its scope taking into account local knowledge and culture. This study will discuss how political rhetoric delivered through the media and monitoring, evaluation, and reporting systems has been used to embed a biomedical pill agenda into the organizational culture and intervention strategies implemented by local community-based organizations. Through a process of strategic translation, HIV/AIDS has been portrayed as the number one health problem facing South Africa today; in fact, across all of Sub-Saharan Africa (World Health Organisation 2005a, 2005b). As such, the magnitude of the HIV/AIDS epidemic has justified the focus on making ARV drugs available throughout Sub-Saharan Africa at the expense of other interventions that could aim more precisely at the key social and health problems faced by the South African population which compromise health and well-being. The question about whose interests are donors and donor-funded agencies representing, and what are the intended and unintended consequences that result from these interests is the subject of this study. The study will attempt to shed light on these questions through a critical examination of the widely publicized HIV/AIDS intervention programme, the Lusikisiki Project, located in the Eastern Cape Province of South Africa. I have drawn extensively from the development discourse literature and such scholars as Ferguson, 1990; Escobar, 1994 and 1995; Rist, 1997; and Mosse, 2005, to provide theoretical grounding for answering the questions posed.4 The study will critically analyse the social and political factors that defined this reputedly successful HIV/AIDS intervention project. Further, the study wil elucidate other cultural and behavioural factors that shaped the initiative in its battle against HIV/AIDS. , Thesis (PhD) -- Faculty of Management and Commerce, 2014
- Full Text:
- Authors: Govere, Fredrick Murambiwa
- Date: 2014-06
- Subjects: Non-governmental organizations -- South Africa -- Management , AIDS (Disease) -- Prevention , HIV-positive persons -- Services for -- South Africa
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10353/25720 , vital:64473
- Description: South Africa is one of the few countries in sub-Saharan Africa where HIV prevalence rates remain stubbornly high.1 This trend is both concerning and difficult to explain given that South Africa is economically well-resourced with a better health care infrastructure relative to other African countries. The African National Congress identified the HIV/AIDS epidemic as a major public health threat to South Africa as early as the 1990s (Parikh and Whiteside, 2007; Gevisser, 2007). In response, international donors provided a substantial amount of financial resources to support improvements in South Africa’s health care infrastructure. The persistently high rates of HIV/AIDS in the population beg for answers to questions such as why South Africa’s political leadership has been unable to control the spread of the disease and what particular social, behavioural and economic factors have contributed to South Africa’s disproportionate share of the global HIV/AIDS burden. At this point in time, public health experts still have not been able to definitively isolate the factors that explain the severity of the HIV/AIDS disease burden within South Africa’s population. While international donor aid continues to play a central role in the social, economic and health betterment in developing nations, its political impact on local governance structures has been much debated.2 In particular, the roles played by non-government organisations (NGOs) in the fight against HIV/AIDS in South Africa have been found to be complex, controversial, and their lasting value contested. Specifically debated is the disproportionate global investment in HIV/AIDS prevention, care and treatment in South Africa and the ways in which it has shaped intervention strategies, public and private policy, and the governance roles assumed by various national and local governmental agencies. Despite the threat of diminished financial support from international donor agencies that has loomed heavily over recipient countries in recent years, a number of key international donors have actually scaled up their global response to HIV/AIDS, particularly in South Africa.3 These donor agencies include the U.S. government’s Presidential Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund, as well as non-profit humanitarian organisations such as Mèdecins Sans Frontiéres (MSF), commonly known as Doctors without Borders. This study aims to critically examine the prevailing intervention strategy used by these international donors to “push the pill;” that is, to push a public health agenda that holds antiretroviral (ARV) therapy as the preeminent solution to fighting the HIV/AIDS epidemic at the expense of other intervention strategies. While a biomedical approach remains the most compelling intervention strategy, the fight against HIV/AIDS needs to be more comprehensive in its scope taking into account local knowledge and culture. This study will discuss how political rhetoric delivered through the media and monitoring, evaluation, and reporting systems has been used to embed a biomedical pill agenda into the organizational culture and intervention strategies implemented by local community-based organizations. Through a process of strategic translation, HIV/AIDS has been portrayed as the number one health problem facing South Africa today; in fact, across all of Sub-Saharan Africa (World Health Organisation 2005a, 2005b). As such, the magnitude of the HIV/AIDS epidemic has justified the focus on making ARV drugs available throughout Sub-Saharan Africa at the expense of other interventions that could aim more precisely at the key social and health problems faced by the South African population which compromise health and well-being. The question about whose interests are donors and donor-funded agencies representing, and what are the intended and unintended consequences that result from these interests is the subject of this study. The study will attempt to shed light on these questions through a critical examination of the widely publicized HIV/AIDS intervention programme, the Lusikisiki Project, located in the Eastern Cape Province of South Africa. I have drawn extensively from the development discourse literature and such scholars as Ferguson, 1990; Escobar, 1994 and 1995; Rist, 1997; and Mosse, 2005, to provide theoretical grounding for answering the questions posed.4 The study will critically analyse the social and political factors that defined this reputedly successful HIV/AIDS intervention project. Further, the study wil elucidate other cultural and behavioural factors that shaped the initiative in its battle against HIV/AIDS. , Thesis (PhD) -- Faculty of Management and Commerce, 2014
- Full Text:
The implementation of HIV and AIDS prevention programmes in three Universities in Zimbabwe
- Muzenda, Denias https://orcid.org/0000-0002-6552-7319
- Authors: Muzenda, Denias https://orcid.org/0000-0002-6552-7319
- Date: 2012-12
- Subjects: Universities and colleges -- Health promotion services , AIDS (Disease) -- Prevention
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10353/25022 , vital:63891
- Description: Given the nature and devastating effects of HIV and AIDS and its impact on society, the universities in Zimbabwe have affirmed the need to define their institutional policy aimed at managing and mitigating the effects of HIV and AIDS. In this regard they have also put in place programmes to address the epidemic. Among the programmes are HIV and AIDS prevention programmes which are being implemented. However, there have been concerns that despite the fact that the programmes are being implemented as planned they have not met their objectives as HIV and AIDS infections have not decreased as expected. Hence this study assesses the implementation of HIV and AIDS prevention programmes in three universities in Zimbabwe. To achieve these objectives, the researcher opted for the mixed method methodology which is embedded in the post-positivist research paradigm. Post-positivist research paradigm attempts to increase our understanding of the way things are and that objectivity is an ideal that can never be achieved, and research is conducted with greater awareness of subjectivity. The researcher had to opt for questionnaires, interviews, document analysis and observations as data collecting instruments. From the Data presented the study found that universities lack adequately professionally qualified HIV and AIDS lecturers. Results on capacity of implementers in the study revealed that an insignificant number of lecturers have the capacity while the majority significant number lacked the capacity to implement the programmes. HIV and AIDS prevention is being implemented by unqualified lecturers who lack training and prerequisite skills for the programme. Furthermore, the study found that Lecturers do not get the necessary professional and institutional support to implement successfully HIV and AIDS programmes in universities. HIV and AIDS Coordinators and NGOs expressed concern over the inadequacy of learning and teaching support material. Funding and lack of resources such as specialist rooms and learning materials are a major impediment to successful implementation of HIV and AIDS. Implementation of HIV and AIDS programmes suffers from inadequate supervision by the relevant stakeholders due to unavailability of transport and financial cost. It also emerged that Human resource is also a major problem since there is a great staff turnover as specialist lecturers leave the system for better paid opportunities in the private sector. Most university lecturer respondents cited staff turnover as long-established and skilled lecturers look for greener pastures within and outside the country. The dominant methods used to implement HIV and AIDS programmes do not give enough room for group work discussions to effect behaviour change in students. Rather, more emphasis is on factual knowledge for assignments and examination purposes. On monitoring and evaluation of HIV and AIDS programmes, the study found that lecturers and students are unaware of their programmes progress bench marks. Universities have not been carrying out internal audits over the past years. This implies that the universities are divorced from Ministry of Higher Education Policy on monitoring and evaluation. Also, less people are involved in the monitoring process of HIV and AIDS programmes. The study found from the universities records that an HIV and AIDS Policy document exists at each university. However, the implementation of HIV and AIDS prevention programmes seemed to have a number of controversies and challenges. The study made the following recommendations against each major finding: Within the organisation, university works continually to equip staff with the knowledge, skills and tools required to analyse programme, implement and monitor interventions for HIV prevention. Capacity to support innovations includes aspects which hinder or support the implementation of new practices and ideas in the new curriculum. Universities should have trained HIV and AIDS Peer educators. For a lecturer to be considered as professionally qualified personnel in universities, the Ministry of Higher and Tertiary Education should stipulate possession of a Master‟s degree or a Doctorate. The researcher provided a section on contribution of the study to new knowledge whereby the researcher proposed an alternative model for HIV and AIDS implementation for universities in Zimbabwe. This model was derived after a thorough analysis of the findings from the study as well as an extensive literature review on the subject. Areas for further research have been suggested in this study. , Thesis (PhD) -- Faculty of Education, 2012
- Full Text:
- Authors: Muzenda, Denias https://orcid.org/0000-0002-6552-7319
- Date: 2012-12
- Subjects: Universities and colleges -- Health promotion services , AIDS (Disease) -- Prevention
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10353/25022 , vital:63891
- Description: Given the nature and devastating effects of HIV and AIDS and its impact on society, the universities in Zimbabwe have affirmed the need to define their institutional policy aimed at managing and mitigating the effects of HIV and AIDS. In this regard they have also put in place programmes to address the epidemic. Among the programmes are HIV and AIDS prevention programmes which are being implemented. However, there have been concerns that despite the fact that the programmes are being implemented as planned they have not met their objectives as HIV and AIDS infections have not decreased as expected. Hence this study assesses the implementation of HIV and AIDS prevention programmes in three universities in Zimbabwe. To achieve these objectives, the researcher opted for the mixed method methodology which is embedded in the post-positivist research paradigm. Post-positivist research paradigm attempts to increase our understanding of the way things are and that objectivity is an ideal that can never be achieved, and research is conducted with greater awareness of subjectivity. The researcher had to opt for questionnaires, interviews, document analysis and observations as data collecting instruments. From the Data presented the study found that universities lack adequately professionally qualified HIV and AIDS lecturers. Results on capacity of implementers in the study revealed that an insignificant number of lecturers have the capacity while the majority significant number lacked the capacity to implement the programmes. HIV and AIDS prevention is being implemented by unqualified lecturers who lack training and prerequisite skills for the programme. Furthermore, the study found that Lecturers do not get the necessary professional and institutional support to implement successfully HIV and AIDS programmes in universities. HIV and AIDS Coordinators and NGOs expressed concern over the inadequacy of learning and teaching support material. Funding and lack of resources such as specialist rooms and learning materials are a major impediment to successful implementation of HIV and AIDS. Implementation of HIV and AIDS programmes suffers from inadequate supervision by the relevant stakeholders due to unavailability of transport and financial cost. It also emerged that Human resource is also a major problem since there is a great staff turnover as specialist lecturers leave the system for better paid opportunities in the private sector. Most university lecturer respondents cited staff turnover as long-established and skilled lecturers look for greener pastures within and outside the country. The dominant methods used to implement HIV and AIDS programmes do not give enough room for group work discussions to effect behaviour change in students. Rather, more emphasis is on factual knowledge for assignments and examination purposes. On monitoring and evaluation of HIV and AIDS programmes, the study found that lecturers and students are unaware of their programmes progress bench marks. Universities have not been carrying out internal audits over the past years. This implies that the universities are divorced from Ministry of Higher Education Policy on monitoring and evaluation. Also, less people are involved in the monitoring process of HIV and AIDS programmes. The study found from the universities records that an HIV and AIDS Policy document exists at each university. However, the implementation of HIV and AIDS prevention programmes seemed to have a number of controversies and challenges. The study made the following recommendations against each major finding: Within the organisation, university works continually to equip staff with the knowledge, skills and tools required to analyse programme, implement and monitor interventions for HIV prevention. Capacity to support innovations includes aspects which hinder or support the implementation of new practices and ideas in the new curriculum. Universities should have trained HIV and AIDS Peer educators. For a lecturer to be considered as professionally qualified personnel in universities, the Ministry of Higher and Tertiary Education should stipulate possession of a Master‟s degree or a Doctorate. The researcher provided a section on contribution of the study to new knowledge whereby the researcher proposed an alternative model for HIV and AIDS implementation for universities in Zimbabwe. This model was derived after a thorough analysis of the findings from the study as well as an extensive literature review on the subject. Areas for further research have been suggested in this study. , Thesis (PhD) -- Faculty of Education, 2012
- Full Text:
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