Patricia Siplon

Toward Nonprofit Organization Reform in the Voluntary Spirit: Lessons from the Internet

This article identifies two models of nonprofit organization roles: the economic model, which emphasizes business-like methods, and the voluntary spirit model, which emphasizes participation and membership. Highly visible, professional nonprofit organizations must constantly struggle with the extent to which they are to emphasize their role as efficient and competitive economic actors or their role as institutions important to our democracy. After years of shifting toward the economic model, professional nonprofits may be ripe for reform. Simultaneously, they are confronting and engaging with the Internet. This article draws on examples of health-based citizen cyber-organizations to derive lessons for how professional nonprofit organizations can recapture their voluntary spirit generally and places an emphasis on participation and membership. Also derived are specific lessons on how professional nonprofits can use cyber-strategies to do so.

CYBERSPACE CHALLENGES TO MAINSTREAM NONPROFIT HEALTH ORGANIZATIONS

Nonprofits are increasingly significant to public administration. The field also is confronting the Internet. In examining health-based nonprofits, the authors ask: How are traditional nonprofits and newer radical groups using the Internet? What is the relationship between these two types of groups? Traditional groups use the Internet for organizational maintenance whereas newer groups use it for the more “radical” pursuits of empowerment, advocacy, and the provision of solidary benefits. The authors identify three relationships between traditional groups and their newer, more radical counterparts: cooperation, competition, and specialization.

Push, Pull, and Reverse: Self-Interest, Responsibility, and the Global Health Care Worker Shortage

The world is suffering from a dearth of health care workers, and sub-Saharan Africa, an area of great need, is experiencing the worst shortage. Developed countries are making the problem worse by luring health care workers away from the countries that need them most, while developing countries do not have the resources to stem the flow or even replace those lost. Postmodern philosopher Emmanuel Levinas offers a unique ethical framework that is helpful in assessing both the irresponsibility inherent in the current global health care situation and the responsibility and obligation held by the stakeholders involved in this global crisis. Drawing on Levinas’ exploration of individual freedom and self-pursuit, infinite responsibility for the Other, and the potential emergence of a just community, we demonstrate its effectiveness in explaining the health care worker crisis, and we argue in favor of a variety of policy and development assistance measures that are grounded in an orientation of non-indifference toward Others.

Roadblocks on the Road to Treatment: Lessons from Barbados and Brazil

On a beautiful tropical day, two women living thousands of miles apart enter public clinics. One walks past the neatly parked cars in the parking lot, to the front door of the newly built, well-equipped Ladymeade Reference Unit, which stands across from the largest public medical facility on the island of Barbados. Everything about this experience is neat and well-ordered, from the facilities the woman is entering, to the pill boxes bearing brand-name labels that she receives at the in-house pharmacy, to the referral system that sent her here after she delivered a baby across the street. The second woman’s experience appears a bit less ordered. The clinic she enters, which sits on the outskirts of one of Brazil’s slum-ridden cities, is shabby, with peeling paint and a utilitarian concrete structure. Inside, there are no shiny, manufacturersponsored posters to match the pills being dispensed, because these pills do not bear familiar brand-name labels. Though the pictures may appear quite different, they bear a crucial similarity—both women are living with HIV, and both are fortunate to live in countries that have committed themselves to providing universal treatment access for their HIV-positive citizens. The scourge of HIV/AIDS has affected every country across the globe, though nations have been overwhelmingly slow and incomplete in their responses. At the same time, great strides have been made in the development of treatments. It is now possible to use a combination of antiretroviral medications (ARVs) to render what was once an inevitably fatal disease into a manageable, chronic condition. However, only a few countries have made the commitment to provide these medications to all their people who need them. Within that very short list are two countries that represent extremes in size, power, history and heterogeneity. Brazil: diverse, large in geography and population, with a legacy of turbulent transitions and up-andcoming as a regional power, and Barbados: a tiny island nation, with a small acreage and citizenry, fairly homogenous population, and long-standing history of peaceful and democratic governance. The governments of both countries have made a commitment to their people to provide them with the therapies that, in most low- to middle-income countries, are only available to the few who can afford to pay for them. It is no accident that these countries have two additional commonalities that have had major consequences for people living with HIV. Facilitating both countries’ commitments has been sufficient political will as well as recognition of health care as a human right. What most clearly differentiates the effectiveness of their approaches has been the relative engagement of civil society, and especially of people living with HIV/AIDS (PLWHAs) themselves, in enforcing this commitment.

Can charity and rights-based movements be allies in the fight against HIV/AIDS? Bridging mobilisations in the United States and sub-Saharan Africa

The activist-fuelled responses to HIV/AIDS around the world have resulted in unprecedented changes to the way infectious disease is defined and treated and in the mobilisation of resources for treatment in developing countries, particularly in sub-Saharan Africa. However, the communities that have been critical sources of response are widely divergent. In the United States, where the epidemic was first identified, the strongest response was within the gay community, with its attendant rights-based orientation. In sub-Saharan Africa, faith-based communities have been critical actors, and have generally taken a charity-based approach to their work. As globalisation and the successes of the global AIDS movement draw these groups into closer contact, the question of whether these divergent approaches can work in alliance becomes ever more important. In this paper I use the concepts of collective identity and framing to examine the development of both approaches and to suggest that the activity of frame extension may be a helpful tool in bridging divergent approaches.