Gro Th. Lie

Scaling-up and rooting-down: a case study of North-South partnerships for health from Tanzania

Background: North-South Partnership (NSP) is the mandated blueprint for much global health action. Northern partners contribute funding and expertise and Southern partners contribute capacity for local action. Potential Northern partners are attracted to Southern organizations that have a track record of participating in well-performing NSPs. This often leads to the rapid ‘scaling up’ of the Southern organizations activities, and more predictable and stable access to resources. Yet, scaling up may also present challenges and threats, as the literature on rapid organization growth shows. However, studies of the impact of scaling up within NSPs in particular are absent from the literature, and the positive and negative impact of scaling up on Southern partners’ functioning is a matter of speculation. Objective: The purpose of this study is to examine how scaling up affects a Southern partners organizational functioning, in a Southern grassroots NGO with 20 years of scaling up experience. Design: A case study design was used to explore the process and impact of scaling up in KIWAKKUKI, a womens grassroots organization working on issues of HIV and AIDS in the Kilimanjaro region of Tanzania. Data included documents, observation notes and in-depth interviews with six participants. The data were analyzed by applying an established systems framework of partnership functioning, in addition to a scaling up typology. Results: KIWAKKUKI has experienced significant scale-up of activities over the past 20 years. Over time, successful partnerships and programs have created synergy and led to further growth. As KIWAKUKKI expanded so did both its partnerships and grassroots base. The need for capacity building for volunteers exceeded the financial resources provided by Northern partners. Some partners did not have such capacity building as part of their own central mission. This gap in training has produced negative cycles within the organization and its NSPs. Conclusions: Northern partners were drawn to KIWAKKUKI because of its strong and rapidly growing grassroots base, however, a lack of funding led to inadequate training for the burgeoning grassroots. Opportunity exists to improve this negative result: Northern organizations that value community engagement can purposefully align their missions and funding within NSP to better support grassroots efforts, especially through periods of expansion.

“It can save you if you just forget”: Closeness and Competence as Conditions for Coping among Ugandan Orphans

This article explores the coping strategies of orphaned children and their caregivers supported by a community-based organization in a Ugandan slum area. In-depth qualitative interviews were conducted with eight orphans (aged 12 to 16 years) and their caregivers selected by the community-based organization. The children had experienced several co-occurring risk factors such as loss and separation, poverty, disease, and an unsafe environment. Most caregivers were extended family members. One caregiver was an unrelated foster carer. Three of the households were child-headed. Data were analysed using an adapted approach of Giorgios (Hafting, 1995; Malterud, 2001) psychological-phenomenological method. Participating children from child-headed households lacked protective factors associated with closeness (i.e., supportive dyadic relationships). All the children in the study experienced competence in the arenas of school and household chores. Cultural advice on handling adversity, including ‘forgetting’, ‘accepting’ and ‘adjusting’, appears to contradict Western theories of coping. Sommerschilds theoretical model on the conditions for coping was effective in identifying conditions in childrens lives that may impair their coping, self-worth, and resilience.

Voluntary testing for HIV among a sample of Tanzanian teachers: A search for socio-demographic and socio-psychological correlates

Abstract Knowledge of HIV status is paramount in prevention, treatment and care. This study determined the prevalence and factors associated with testing for HIV. We collected data through a cross-section questionnaire survey among 918 primary school teachers in Mwanza region, Tanzania (mean age 38.4 years). About 20% (181) of the participants had voluntarily tested for HIV. Teachers who: were aged between 21 to 30 years, had easy access to HIV testing services, had a partner with tertiary education, and perceived their health status positively were significantly more likely to have tested for HIV. Teachers who had tested for HIV were significantly less likely: to perceive that it is not necessary to test for HIV in absence of vaccine or cure for HIV/AIDS; to support that only people who suspect that they are HIV infected should test for HIV; and to believe that HIV infected people are likely to die quicker if they are tested for HIV and be informed about their positive results. The results of this study underscore the need to promote positive views of voluntary testing for HIV among Tanzanian teachers.

Mapping Synergy and Antagony in North–South Partnerships for Health: A Case Study of the Tanzanian Women’s NGO KIWAKKUKI

North–South partnerships for health aim to link resources, expertise and local knowledge to create synergy. The literature on such partnerships presents an optimistic view of the promise of partnership on one hand, contrasted by pessimistic depictions of practice on the other. Case studies are called for to provide a more intricate understanding of partnership functioning, especially viewed from the Southern perspective. This case study examined the experience of the Tanzanian womens NGO, KIWAKKUKI, based on its long history of partnerships with Northern organizations, all addressing HIV/AIDS in the Kilimanjaro region. KIWAKKUKI has provided education and other services since its inception in 1990 and has grown to include a grassroots network of >6000 local members. Using the Bergen Model of Collaborative Functioning, the experience of KIWAKKUKIs partnership successes and failures was mapped. The findings demonstrate that even in effective partnerships, both positive and negative processes are evident. It was also observed that KIWAKKUKIs partnership breakdowns were not strictly negative, as they provided lessons which the organization took into account when entering subsequent partnerships. The study highlights the importance of acknowledging and reporting on both positive and negative processes to maximize learning in North–South partnerships.

Grassroots volunteers in context: rewarding and adverse experiences of local women working on HIV and AIDS in Kilimanjaro, Tanzania

Many nongovernmental organizations in Africa rely on grassroots volunteers to provide critical health services. Considering context and the interplay of individual, organizational, and societal influences on the experience of volunteers, this paper addresses three questions: What do grassroots volunteers contribute? What organizational processes promote volunteer engagement? What are the positive and negative consequences of volunteering? Eighteen members and staff of the Tanzanian HIV and AIDS NGO, KIWAKKUKI, were selected from 6000+ women volunteers to be interviewed. The interviews were recorded, transcribed, and analyzed for themes. Within KIWAKKUKI, volunteers contributed time and local knowledge, leading to an indigenous educational approach building on local norms and customs. Volunteers’ engagement was motivated by the desire to support family members, reverse stigma, and work/socialize with other women. Benefits to volunteers included skills acquisition and community recognition; yet some volunteers also reported negative experiences including burnout, conferred stigma, and domestic violence. Positive organizational processes built on cultural practices such as collective decision-making and singing. The findings point to important considerations about context, including the synergistic effect training can have on local traditions of caring, complications of gender inequity, and how community health planning processes may need to be modified in extremely poor settings. This research also suggests good utility of the research framework (the Bergen Model of Collaborative Functioning) that was used to analyze volunteer engagement for service delivery in sub-Saharan contexts.

AIDS and Its Consequences for Families, Health Care and Education in Arusha and Kilimanjaro, Tanzania

Summary Knut-Inge Klepp, Gro T. Lie, L. Wycliffe Lugoe and Eliringia T. Ngomuo, ‘AIDS an Its Consequences for Families, Health Care and Education in Arusha and Kilimanjaro, Tanzania’, Forum for Development Studies, No. 1, 1993, pp. 63–73. Drawing on our experience from the Tanzanian-Norwegian AIDS Project currently being implemented in the Arusha and Kilimanjaro regions, we focus on some of the consequences the HIV/AIDS epidemic seems to have for families, the health care system and the educational sector in local communities. The AIDS epidemic brings with it a new kind of stress that is causing psycho-social and economic burdens for an increasing numbers of families. For families, overcoming the stigma attached to AIDS, coping with the extra economic burden when family providers contract AIDS and caring for the increasing number of orphans are three of the main challenges created by the current HIV/AIDS epidemic. Similarly, the growing epidemic is posing new challenges to an already overburdened health c...