Experiences of collaboration, coordination and efficiency in the delivery of HIV/AIDS home-based care in Zimbabwe
AbstractThe difficulties of achieving successful collaboration between stakeholders can lead to uncoordinated and fragmented outcomes for HIV/AIDS programming, which has consequences for the immediate health and livelihood security of the intended beneficiaries. This article examines the collaboration between local, national and international partner organisations in the delivery of and coordination of HIV/AIDS home-based care in Zimbabwe. The purpose of the research was to provide an external assessment of home-based care and to identify the problems that impede the delivery of health resources. Fieldwork was conducted between 2005 and 2008 at rural and peri-urban locations in Zimbabwe, using a combination of informal interviews, focus groups and participant observation. The findings suggest that the delivery of healthcare is impeded by problematic relationships between programme stakeholders — government, non-governmental and community-based. The outcome of poor service delivery is demonstrated to have a direct negative impact on the access to services, quality of care, and health outcomes for programme participants. The methods and findings of this research highlight the use of rapid ethnographic appraisal by social scientists to represent the interests of HIV/AIDS-affected populations in programme and policy design. This approach is crucial in situations such as in Zimbabwe where beneficiaries are less willing to voice their opinions for fear of being cut off from what little assistance is available in case what they say is viewed as uncooperative or noncompliant with a programme’s objectives. The findings question the widely held assumption that multisectoral relationships are the most efficient way to deliver services.
Keywords: community organisations; ethnography; multisectoral collaboration; non-governmental organisations; programme implementation; rapid assessment procedures; southern Africa; vulnerable populations
African Journal of AIDS Research 2009, 8(4): 443–453