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10. Partnerships/Alliances
   Last updated: 16.08.02
 

Since all of the above strategies with the possible exception of the first, organisational expansion, involve some sort of relationship with other organisations, key questions that must be addressed would include: What incentives are there for the other organisations to take over or adopt the new activities? Is there compatibility between the two types of organisations? Are there salary differences between the different types of organisation that could affect the expansion from pilot to programmes of greater scale? For example, if the initial effort is established by an NGO and then transferred to government services where civil servant salaries are lower in relation to the NGO, how can sustainability be achieved? Will the initiating organisation eventually withdraw or transfer the programme to the other organisation and if so, when and how? In what follows, some aspects of these questions in light of the specific relationships involved will be examined.

Government-NGO Relations
Co-operation between government and NGOs in HIV/AIDS depends both on the political context and the degree to which governments are open to such input, and whether NGOs perceive the benefit of interacting more closely with government. As HIV/AIDS prevalence rises rapidly, governments often look to NGOs for expertise in addressing the epidemic, and therefore may be more open to collaboration. But high prevalence is not a necessary condition for successful partnerships. Often, however, governments and NGOs tend to regard each other with mutual suspicion (see cartoon below), rather than seek channels of collaboration. NGOs are often frustrated with the inability of public sector delivery mechanisms to be flexible or innovative, or to respond to changing community needs. They may inevitably feel – depending on political context -- that unequal power relations between government and NGOs means that the NGO is inevitably the junior partner and government “calls the shots.” (Geoff Foster, Family AIDS Trust, Horizons/Alliance Seminar). Similarly, governmental staff may be wary of involvement with NGOs whom they may regard as opportunistic and donor-driven, or representing the interests of particular social groups and not addressing the wider national picture. In many cases, mutual competition over resources and particularly donor funding can inhibit co-operation.

Figure 7 - Government – NGO Relations

Source - Illustration used in Cambodia presenting the challenges of starting up a joint Ministry of Health / NGO home care programme for local NGOs/CBOs involved in HIV/AIDS. [Cartoon showing different ideas, seen as pictures, of what NGO and government workers represent to each other]

There are a number of clear advantages for both governments and NGOs to foster partnerships to increase the scale of HIV/AIDS activities. Government services have the advantage of greater coverage at relatively low cost (given low civil service salaries in most countries) but often lack the understanding of community dynamics and process approaches and risk being overly intrusive or directive. Here, NGOs can have a key role in encouraging more participatory methods as well as influencing the content of HIV/AIDS programmes.

Governments and NGOs may complement each other in terms of access to different social groups. On the one hand, governments may have sole or better access to groups such as the military or the police, both of whom are highly relevant to HIV/AIDS, and be able to reach them on a much larger scale than non-governmental organisations, such as through the public education system. Yet on the other hand, governments may be restricted in access to population groups engaged in illegal or stigmatised activities and have little political interest in working with the socially marginalised. One of the NGOs’ comparative advantages lies in their ability and willingness to work with such groups.

NGOs may also have a particular contribution in broaching sensitive issues and then increasing the legitimacy of addressing this social problem, thus opening the door for government involvement. In other contexts, however, the fact that NGOs are active in some areas of HIV/AIDS may deter governments or let them off the hook from addressing these issues. It should be noted, moreover, that this is far from a one-way process in that not only might strategies described here influence government policy regarding the provision of public AIDS programmes, but policies can in turn have an impact on the environment in which NGOs operate as well.

Successful examples of NGO-governmental collaboration in development more broadly illustrate that strong relationships between individuals are critical (Edwards and Hulme 1992), even though political exigencies may bring unanticipated changes in personnel within governmental institutions, and staff turnover is often high in NGOs.

Within the field of HIV/AIDS a number of instances of successful collaboration were discussed at the Horizons/Alliance Seminar. In Cambodia, for example, the governmental HIV/AIDS programme has greater fears of cultural resistance and is more risk averse in trying new models, but once NGOs start and show a particular model can work, then the government may be more prepared to replicate it (Cambodia presentation and small group discussion, Horizons/Alliance Seminar). Participants in the Government-NGO collaboration for home-based care, described above, note that critical ingredients of its relative success is that both parties are aware of the benefits of partnership and respect and understand each other’s systems and structures. In this case, the groups involved developed a joint mission statement and they operate as much as possible with full transparency (of funding and programme direction).

The government-NGO collaboration in Cambodia also successfully avoided a problem characterising many other community-initiated home-care programmes in their failure to institutionalise connections or referrals to existing governmental health services. As Wilkinson and co-authors note: “a home care programme which, at the onset, links grassroots organisations with existing public health services, and encourages shared ownership is more likely to achieve sustainability, impact and cost-effectiveness.” (2000). This ingredient of a particularly successful collaboration illustrates a broader theme, which is the importance of NGO programmes being linked into existing HIV/AIDS related services and the dangers of NGOs assuming they can “go it alone.”

In the Philippines there has been relatively smooth NGO-government co-operation in HIV/AIDS partly because the government recognises that it cannot do everything – that although there is a National AIDS Plan it would take a long time to implement it fully. One example is that NGOs initiated an effort to train public school teachers in HIV/AIDS, a model which the government subsequently adopted (Ruthie Libatique, PHANSuP, Horizons/Alliance Seminar).

A number of key lessons for fostering dialogue between NGOs and government emerge from the case study of KANCO. Allan Ragi noted that governments find collective networking threatening and therefore one has to actively look for opportunities to encourage the participation of government representatives. At the same time, governments will only respect the viewpoints and arguments of NGO coalitions if they authentically represent the views of grassroots organisations (Allan Ragi, KANCO, Horizons/Alliance Seminar).

NGOs note, however, that relationships or collaborations with government are not always sustainable. ASI found, for example, that having sought and developed a fruitful collaboration with government, with the change of government they had to start again and agreements made with previous administration were not upheld. Moreover, in Cambodia – where the government finances NGOs in home-based care, financial sustainability was not necessarily assured.

Surmounting these attitudinal and procedural barriers to greater co-operation between government and NGOs in HIV/AIDS is critical and has a potential for high returns. For ultimately, governmental services are unique in their national scope, and only governments possess full information of the situation at the national level as well as being accountable to the general public to a degree most NGOs are not.

NGO-CBO Relations
A number of successful efforts to scale up HIV/AIDS programmes have worked through collaborations between professional NGOs and small, community-based organisations (CBOs). The experience of FACT/FOCUS illustrates that it is feasible to build on existing community initiatives by volunteer and community-based organisations. Their first pilot was established in 1993 in a particular region of Zimbabwe where communities were already addressing HIV/AIDS through a church. At its inception, 19 volunteers working in 19 villages led this effort. After 1 year FOCUS did an evaluation and found that the programme identified most orphans and targeted the neediest and most vulnerable in material terms. FACT/FOCUS then played a catalyst role to replicate the initiative to 9 sites (with the number of families reached increasing from 798 to 2764). In this case, the role of the NGO FACT/FOCUS was to supervise the existing programme, by providing both technical and organisational development assistance, assisting in the replications by the same CBO (strategy 1, organisational expansion) and by other CBOs (strategy 2, catalyst).

As noted above, however, the risk in relying solely on community initiatives is that there may be reluctance to address marginal social groups, or sensitive issues. In this case, the external agency may need to intervene to counter this resistance, while at the same time not undermining existing momentum. A similar dilemma was faced by the Family Health Trust when it found that the Anti-AIDS Clubs tended to exclude young girls.

Another potential drawback of many such partnerships is the failure to ensure that the community initiatives are sufficiently linked into health and other service structures, whether public, private or charity-based. There is a danger that the effort may stimulate demand for services on a scale to which the supply of services (or commodities) is insufficient to respond. If a continuum of interventions – from prevention to care and support – is to be provided, fostering these links in advance of expansion is particularly critical.

NGO-Research
A number of examples of successful scaling up efforts by NGOs emerged out of collaborations with research institutions. The added benefit of this type of partnership is the opportunity to build into the NGO effort research and evaluation capacity that is rigorous. For example, the Program Support Group in Zimbabwe evolved from the University of Zimbabwe from a research project into a service-delivery organisation. Staff at the university had been conducting an ethnographic study of HIV-vulnerable low income women in Bulawayo, Zimbabwe and the women who participated in the study requested STD/HIV/AIDS education and services (PSG Case study, p. 35). Research continues to inform the PSG programmes, although as their activities have expanded in three Southern African countries, they note a continual challenge entailed in maintaining the quality of their research.

In some cases, organisations found that there was particular value in affiliations to outside training and research institutions if national capacity in that particular area did not exist. For example, SIAAP, in its diffusion of the concept of community counselling, co-operated with a number of European institutions with expertise in that area since the concept was not known in India. This helped to increase the legitimacy of this field. And as noted earlier, ASI enlists medical students to assess the quality of its interventions.

As the above examples of successful collaboration in HIV/AIDS make clear, NGO partnerships may be essential in whichever scaling up strategy NGOs adopt. There is now increasing recognition – on the part of both NGOs and donors – that NGOs acting alone are not likely to make a dent in the epidemic, either in terms of preventing it or mitigating its effects, particularly in high-prevalence countries. Moreover, partnerships are often essential if a continuum of interventions from prevention to care and support is to be available. But such collaborations necessarily require time to develop, and each partner has to establish their reputation and legitimacy in the eyes of the other. As Annie Hirschmann of ASI notes, this inevitably means that NGOs need to anticipate slower processes. The rewards, as the Cambodian example described above illustrates, are potentially high.

Source: A Question of Scale
This is an extract from A Question of Scale: The challenge of expanding the impact of non-governmental organisations’ HIV/AIDS efforts in developing countries,
by Jocelyn DeJong, published by the Horizons Project of the Population Council with the International HIV/AIDS Alliance in 2001. To view the whole report follow this link.

To download, complete with graphics, in pdf format (which requires Adobe Acrobat software to read it) follow this link (file size 1.43 Mbytes).