Building partnerships to support community-led HIV/AIDS management: a case study from rural South Africa

The importance of partnerships between marginalised communities and support agencies (from the public sector, private sector and civil society) is a pillar of HIV/AIDS management policy. Such alliances are notoriously difficult to promote and sustain. We present a case study focusing on the first stage of a project seeking to build partnerships to facilitate local responses to HIV/AIDS in a remote rural community in South Africa. To date the Entabeni project has been successful in its goal of training volunteer health workers in home-based care, peer education, project management and procedures for accessing grants and services. The paper focuses on the project's other goal - to create external support structures for these volunteers (drawing on government departments, local NGOs and private-sector philanthropists). The partnership aims to empower volunteers to lead HIV-prevention and AIDS-care efforts, and to make public services more responsive to local needs. We illustrate how features of the local public-sector environment have actively worked against effective community empowerment. These include a rigid hierarchy, poor communication between senior and junior health professionals, lack of social development skills and the demoralisation and/or exhaustion of public servants dealing with multiple social problems in under-resourced settings. We outline the obstacles that have prevented private-sector involvement, suggesting a degree of scepticism about the potential for private-sector contributions to development in remote areas. We discuss how the project's most effective partners have been two small under-funded NGOs - run by highly committed individuals with a keen understanding of social-development principles, flexible working styles and a willingness to work hard for small gains. Despite many challenges, the partnership formation process has seen some positive achievements; we outline these and discuss the essential role played by an external change agent, and conclude with a discussion of the possibility of building long-term structures to sustain the project.