|
|
AEGIS European Conference on African Studies
11 - 14 July 2007
African Studies Centre, Leiden, The Netherlands
Show panel list
ART service provision in Western Uganda: Ambiguous role boundaries and negotiation within the State-NGO-Donor triangle
| Panel |
44. Negotiating statehood in Africa
|
| Paper ID | 63 |
| Author(s) |
Leusenkamp, Alexander
|
| Paper |
No paper submitted
|
| Abstract | This paper is based upon empiric research on the interrelationships between state institutions, NGOs and donors regarding the recent provision of antiretroviral therapy (ART) as a means to care for those who live with HIV/AIDS in Kabarole District, Western Uganda. The element of negotiation within ART policy processes is the core of this research. Each actor, whether donor, NGO or governmental pursues its own legitimate interest and where conflicts arise, a process of negotiation is a prerequisite.
The Ugandan response to the HIV/AIDS epidemic in the ´80s/´90s coincided with structural health care reforms, in which decentralisation processes transferred authority to lower governments thus limiting the role of the central state. However, hampered by insufficient funding to plan and implement health activities at district governments as well as incapacity at the public health sector, an increase in donor involvement and NGO activities could – more within the HIV/AIDS field than with any other human crisis – be observed. In literature on the relationships between administrative institutions, donors and NGOs, the main emphasis has been put on possible means of co-operation and strategies on how to improve this. With this normative point of view dominating most discussions on state-NGO relationships, little research has been conducted on appropriation strategies and mechanisms that motivate actor’s pursue of their favoured interests.
The relationship between state institutions, donors and NGOs with regard to ART policy in Uganda can be analysed by taking into account the ambiguous nature of each stakeholder. They exist without the fixed boundaries that are characteristic to normative and pluralistic visions, leaving much space for policy appropriation and informal politics and entailing constant negotiation between those involved. In this paper I particularly focus on these negotiations; how district state institutions in Uganda function in informal daily reality; how they are intertwined with public health centers, NGOs and donors and how their activities shape their imago’s and mutual perceptions. It will be outlined that many institutions are implementing ART activities without a coordinated fundament in which priorities in terms of needs assessment and geographical coverage are set. The District health team, formally responsible for coordinating all HIV/AIDS activities, perceives them self as working within the health regulating body, and infer from the authority of its being the mandate to plan and supervise ART service elements. A view which is not shared in the field. The paper also exemplifies that in some occasions artificial walls between actors are deliberately being erected to limit involvements of other stakeholders, while at other times these ´walls´ are broken down in order to seek necessary assistance or cooperation from each other. Ambiguous relationships and blurred boundaries between state actors and non-state institutions can thus create a tension between what organizations involved in ART services are formally expected to deliver, and what happens in informal daily reality. In my view these perspectives offers an authentic and fresh perspective on studying state-NGO interactions within the African HIV/AIDS epidemic.
|
|