Putting Communities at the centre of Multi-

Stakeholder partnership approaches to HIV and AIDS management: A

Rural South African case-study

Dr Yugi Nair

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Introduction

•Report on intervention research (case study) in Entabeni•Presentation-one part of a holistic intervention –facilitating acccess to skills and services required to address HIV in community •Rural communities in SA burdened by the impact of AIDS epidemic•Often lack the skills, confidence, networks and political & economic influence & resources to drive forward health projects without significant outside support

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Context

•80 000 people•30km from nearest town or hospitals•Access to health & welfare services limited- few roads, people often lack money for transport•Cholera, TB & HIV/AIDS rife (43% of pregnant women are HIV positive)•High rates of adult illiteracy, unemployment & poverty •Droughts & hilly landscape

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Context

•Area controlled by Inkosi •Power structures patriarchal•Men practice polygamy•Informal care-overextended women•Patients & carers lack money, food, transport to hospitals & basic resources for home nursing•CHWs only community response to HIV & AIDs•Patients and Carers isolated-stigma

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Aims of the Partnership

• Empower community stakeholders to lead HIV-prevention and AIDS-care efforts through the support of local government departments, NGOs and the private-sector

• Achieve ‘collective ownership’ for meeting the challenges posed by HIV & AIDS within Entabeni & the strategies required to manage & limit the negative impacts of this pandemic by:

-supporting the work of the health volunteers or home based carers (HBCs) & community stakeholders in the community; -facilitating community access to resources & services needed for the effective care and support of PLWHAS, especially grants and skills building;-developing service providers’ understanding of the community’s challenges & needs; -securing community & external partners’ commitment to their time & resources to meeting small practical goals

• Build sustainability into process of project implementation

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Methodology

• A longitudinal, qualitative case study involving intensive field work, participant observation, constant monitoring, introspection and regular evaluation (6 years)•180 interviews and focus group discussions•Partnership building-4 phases•‘Learning by doing approach’ adopted

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Methodology

•Ensuring their active participation in planning and decision making throughout the six year partnership building process•Women and youth focus•Strengths based approach•Intensive training of community stakeholders by partner organisations to empower and capacitate stakeholders (e.g. board management skills, facilitation, advocacy)

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Results

•External service-provider support limited & constrained by resource, capacity and transformational challenges- prevented them from fully committing to the partnership or assuming long term ownership for jointly managing HIV & AIDS in the community (Nair & Campbell, 2008)•Community stakeholders ultimately assumed ownership of the project because of their involvement in the process from the very beginning•Strengthening the capacity of community stakeholders created bottom-up pressure on local service-providers and ensured their direct involvement in shaping the enabling environment

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Results cont.

•Role of the external change agent (researcher) crucial to the facilitation of the partnership & achievement of key outcomes (formalization of partnership committee, outreach centre, capacity building, empowerment, etc.), despite the challenges encountered •Researcher’s focus on building trust & nurturing relationships-compliance with, & respect for community protocols and norms in the process of entry, community engagement, and partnership facilitation-key to success of project

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Conclusions

Community involvement is crucial in: i/planning and facilitating HIV and AIDS interventions,ii/ensuring ownership for the sustained positive impacts of suchinterventions and, iii/the assumption of responsibility for the continued facilitation of innovative interventions that are inclusive and based on the reality of the changing experiences and needs of the community.

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Contact Details

Dr Yugi NairTelephone: (w) 27-31-2601736; (cell) 083 640 7136E-Mail: nairy3@ukzn.ac.za