School of Arts and Communication Malmö University, Sweden
CBO Challenges & the Ikhala Model
Challenges amongst CBOs working with multi-disciplinary HIV/AIDS initiatives in the
Eastern Cape, South Africa and the role of a participatory intermediate grant maker.
CBO volunteers outside container used as office and meeting place
Ulrika Celin Wedin
Communication for Development
Master thesis, August 2007
Supervisor: Jackie Davies
Dedication
This work is dedicated to the people involved in small CBOs in Eastern Cape, everyday working hard with
insufficient recourses, trying to meet the needs of their fellow beings and making a positive change in their
communities.
Acknowledgements
My local contact person Bernie Dolley for being a true mentor
My ComDev supervisor Jackie Davis for being a great and encouraging teacher
The interviewees listed in Appendix III and IX for sharing their knowledge and insights
Oscar Hemer and his colleagues at Malmö Högskola for offering this accurate, thought provocative and
inspiring Communication for Development course
SIDA for granting me a Minor Field Study scholarship
My husband Johan for making the field study possible by coming with me to South Africa with our two
daughters and for being a constructive reader and an important moral support
My parents for always encouraging me to do what I believe in and teaching me that with hard work and
conviction everything is possible
Abbreviations
ABC strategy
Abstain, Be faithful, use Condom
AIDS
Acquired Immune Deficiency Syndrome
ART
Anti Retroviral Therapy
ARV
Anti-Retro Virals
CBO
Community Based Organisation
CFSC
Communication for Social Change
CSO
Civil Society Organisation
FBO
Faith Based Organisation
HBC
Home Based Care
HIV
Human Immunodeficiency Virus
NGO
Non Governmental Organisation
NPO
Non Profit Organisation
OVC
Orphans and vulnerable children
PLWHA
People living with HIV/AIDS
PMTCT
Prevention of mother to child transmission
2
STD
Sexually transmitted diseases
STI
Sexually transmitted infections
VCT
Voluntary counselling and testing
Abstract
(Will be included in the final version)
3
TABLE OF CONTENTS
DEDICATION
ACKNOWLEDGEMENTS
ABBREVIATIONS
ABSTRACT
CHAPTER 1: INTRODUCTION .......................................................................................................................... 7
1.1 MOTIVATION................................................................................................................................................ 7
1.2 AIM AND OBJECTIVES ................................................................................................................................... 8
1.3 JUSTIFICATION OF THE STUDY ...................................................................................................................... 8
1.4 LIMITATIONS ................................................................................................................................................ 9
1.5 OUTLINE OF THE THESIS ............................................................................................................................... 9
CHAPTER 2: INTRODUCTION TO THE CASE STUDY ............................................................................... 11
2.1 IKHALA TRUST ........................................................................................................................................... 11
2.1.1 Staffing and resources .............................................................................................................. 11
2.1.2 Strategy/approach ...................................................................................................................... 12
2.1.3 Methods ......................................................................................................................................... 12
2.2 THE PARTICIPATING CBOS ........................................................................................................................ 12
CHAPTER 3: RESEARCH METHODOLOGY................................................................................................... 14
3.1 THE RESEARCH PROCESS ............................................................................................................................ 14
3.2 THE METHODS ........................................................................................................................................... 14
3.2.1 Desk study and document review .......................................................................................... 14
3.2.2 Semi-structured interviews...................................................................................................... 15
3.2.3 Group interviews ......................................................................................................................... 15
3.2.4 Observations ................................................................................................................................ 15
3.3 THE RESEARCH SAMPLE .............................................................................................................................. 16
3.3.1 Ikhala Trust ................................................................................................................................... 16
3.3.2 CBOs ............................................................................................................................................... 16
3.4 QUOTATIONS AND ANONYMITY ................................................................................................................. 16
CHAPTER 4: THEORETICAL FRAMEWORK .................................................................................................. 17
4.1 HIV/AIDS COMMUNICATION .................................................................................................................... 17
4.1.1 Health versus development problem .................................................................................... 17
4.1.2 Individual versus societal problem ........................................................................................ 18
4.2 DIFFUSIONIST APPROACHES ....................................................................................................................... 18
4.3 PARTICIPATORY APPROACHES .................................................................................................................... 18
4.3.1 Not a unified model ................................................................................................................... 19
4.4 COMMUNICATION FOR SOCIAL CHANGE .................................................................................................... 19
CHAPTER 5: BACKGROUND AND CONTEXT ............................................................................................. 21
5.1 HIV/AIDS BACKGROUND .......................................................................................................................... 21
5.2 SOUTH AFRICAN CONTEXT ........................................................................................................................ 21
5.3 EASTERN CAPE CONTEXT ........................................................................................................................... 23
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5.4 GOVERNMENT RESPONSE TO HIV/AIDS ................................................................................................... 23
5.5 DONOR RESPONSE TO HIV/AIDS ............................................................................................................. 24
5.6 OTHER STAKEHOLDERS .............................................................................................................................. 26
5.6.1 NGOs ............................................................................................................................................... 26
5.6.2 Networks........................................................................................................................................ 26
CHAPTER 6: FINDINGS ABOUT CHALLENGES RELATED TO OTHER STAKEHOLDERS .................... 28
6.1 GOVERNMENT CHALLENGES FROM THE CBO PERSPECTIVE......................................................................... 28
6.2 DONOR CHALLENGES FROM THE CBO PERSPECTIVE................................................................................... 29
6.3 NGO CHALLENGES FROM THE CBO PERSPECTIVE ...................................................................................... 30
6.4 NETWORK CHALLENGES FROM THE CBO PERSPECTIVE ............................................................................... 31
CHAPTER 7: FINDINGS ABOUT CHALLENGES WITHIN THE CBOS AND THE SURROUNDING
SOCIETY .............................................................................................................................................................. 33
7.1 POVERTY AND RESOURCE CHALLENGES ...................................................................................................... 33
7.2 SOCIETAL CHALLENGES.............................................................................................................................. 34
7.2.1 Lack of social support systems .............................................................................................. 34
7.2.2 Discrimination and stigma ....................................................................................................... 35
7.2.3 Gender inequality ........................................................................................................................ 35
7.2.4 Religious obstacles ..................................................................................................................... 36
7.3 ORGANISATIONAL CHALLENGES ................................................................................................................. 36
7.3.1 Lack of knowledge and specialisation .................................................................................. 36
7.3.2 Power relations and lack of participation ............................................................................ 37
7.3.3 Psychological pressure .............................................................................................................. 39
7.4 COMMUNICATION RELATED CHALLENGES .................................................................................................. 40
7.4.1 Lack of voice ................................................................................................................................. 40
7.4.2 Insufficient use of strategic communication ...................................................................... 40
CHAPTER 8: THE IKHALA MODEL ................................................................................................................ 42
8.1 THE CAPACITY BUILDING APPROACH .......................................................................................................... 42
8.1.1 Small grants to build capacity ................................................................................................. 42
8.1.2 Capacity appreciation ................................................................................................................ 43
8.1.3 Capacity development – to work with budgeting.............................................................. 44
8.1.4 Capacity development – to work with other donors ........................................................ 45
8.2 PARTICIPATORY COMMUNICATION APPROACH ........................................................................................... 45
8.2.1 Close to the field ......................................................................................................................... 46
8.2.2 Participatory workshops ........................................................................................................... 46
8.2.3 Language ....................................................................................................................................... 47
8.2.4 Networking ................................................................................................................................... 48
8.2.5 Community participation .......................................................................................................... 48
8.2.6 Participatory monitoring and evaluation ............................................................................. 49
8.3 REPLICATING THE MODEL? ......................................................................................................................... 50
CHAPTER 9: CONCLUSION ............................................................................................................................. 51
9.1 SUMMARY OF MY FINDINGS ........................................................................................................................ 51
9.2 MY THOUGHTS REGARDING THE IKHALA MODEL ........................................................................................ 52
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9.2.1 Advantages of the model ......................................................................................................... 52
9.2.2 Weaknesses of the model ......................................................................................................... 52
9.3 RECOMMENDATIONS .................................................................................................................................. 53
9.4 SOME FINAL REMARKS ................................................................................................................................ 53
REFERENCES ....................................................................................................................................................... 54
APPENDICES:
I Methodology
II Interview guides
III List of interviewees
IX List of workshop participants
X Call for proposals advert
XI Ikhala Trust Monthly Reporting Form: HIV/AIDS
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Chapter 1: INTRODUCTION
In this study I am looking at how participatory communication methods may be used to support Community
Based Organisations (CBOs) in meeting different challenges, and to acknowledge and make better use of
their capacity and knowledge.
I have done this by carrying out a qualitative case study based on Ikhala Trust, a micro-fund for CBOs
operating within the Eastern Cape Province in South Africa. The CBOs participating in the study are working
with multi-disciplinary HIV/AIDS initiatives and have all received or are about to receive, small grants and
capacity building from Ikhala Trust. The overall research question addressed in this study is “How does the
Ikhala model support CBOs in meeting their challenges?”
The theoretical framework mainly influencing this study is the use of participatory communication to
promote dialogue and increase participation, and the Communication for Social Change strategy.
1.1 Motivation
South Africa is one of the countries in the world hardest hit by the HIV/AIDS epidemic. Approximately 5.5
millions, almost one in five adults, are living with HIV and everyday 800 persons die in AIDS or AIDS-related
diseases (UNAIDS, 2006, UNAIDS/WHO, 2006). When several other African countries report decreasing
diffusion pace or even reversed transmission rates, the epidemic continues to grow in South Africa. In the
absence of sufficient governmental responses, small grassroots organisations play a vital role in meeting
the needs in poor communities and addressing the epidemic. Still, these locally based initiatives lack
resources and receive little recognition for their efforts. They struggle with numerous challenges on both
societal and organisational level, as well as with problems to obtain funding and making their voices heard
in the debates about HIV/AIDS.
My initial motivation to carry out this study originates in a belief that, although words like participation,
empowerment and ownership are gaining ground within mainstream development, there may be a problem
with real on-ground participation when major donors and development agencies support small CBOs.
“Although extensive funding is available for HIV/AIDS activities, it can be difficult to access these resources
and/or to meet donor requirements in relation to reporting, monitoring and financial management” (Birdsall
& Kelly, 2005:10). I thus believe it is important to find models that move beyond “buzzwords” and actually
create “a positive change in peoples’ lives – as they themselves define such change” (Parks, Gray-Felder,
Hunt and Byrne, 2005:3). I decided to use Ikhala Trust as my case study to find out if the model, with an
intermediate organisation, may be a way to create greater grassroots participation. During the field study
this hypothesis was verified. However, although cooperation with donors and access to funding are major
difficulties, a number of other challenges faced by CBOs and addressed by the Ikhala model were also
identified and the approach and scope of the study widened. Ikhala plays an important role as an
intermediate between donors and CBOs, but the participatory methods used addresse a wide range of
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challenges. Furthermore, several other relevant stakeholders, posing both challenges and opportunities,
were identified during my study.
My point of departure is an examination of the challenges faced by CBOs. Based on these findings, I
examine the role of the Ikhala model. Furthermore, the role of other important stakeholders in relation to
CBOs and Ikhala is discussed.
1.2 Aim and objectives
The aim of this qualitative case study is to find out how the Ikhala model supports CBOs in meeting their
challenges.
My objectives have been to:

Find out what challenges CBOs working with multi-disciplinary HIV/AIDS initiatives in the Eastern
Cape Province in South Africa faces

Investigate the role of the Ikhala model, based on:
o
The capacity building approach
o
The communication-related approach
1.3 Justification of the study
To mitigate and reverse the severe HIV/AIDS epidemic in South Africa a number of stakeholders needs to
be involved. CBOs play a vital role and, with sufficient support, have the prerequisite to have an even
greater influence, but are often not recognised enough. In South Africa “local level responses to HIV/AIDS …
have often been overlooked and marginalised in favour of emphasis on large-scale centralised approaches
to HIV/AIDS prevention, care and treatment” (Birdsall & Kelly, 2005:5). Yet, “researchers who have looked
across South Africa at the response to HIV and AIDS have found that CBOs present potentially the most
effective agents for positive change” (Assessing Ikhala Trusts Support to Health and HIV/AIDS-Sector
Grantees, Impact assessment carried out by the Grahamstown based development consultants The Project
People, 2006:14). There seems to be a large agreement on the importance of community based initiatives,
still it is an area poorly examined. Birdsall & Kelly writes that “Few, if any, systematic studies have been
undertaken on community responses to HIV/AIDS” (2005:12).
The lack of sufficient knowledge about CBO response to the South African HIV/AIDS epidemic, combined
with my belief that there is a need to find models that recognise and support local initiatives based on
grassroots participation has inspired this study.
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1.4 Limitations
It is important to acknowledge that this is a case study and as such has no intention of making claims
beyond that scope. However, I do believe that some of the findings in this study may be of relevance in a
wider development context. The Ikhala model offers an interesting approach to funding and capacitating
grassroots organisations.
I have not looked into the relationship between the intermediate Ikhala Trust and its donors. It should be
emphasised that Ikhala very much depend on the understanding of the Ikhala model amongst its donors.
Without their benevolence and support it will be very hard to work according to the model, since donors
cannot always expect traditional monitoring and evaluation and since impact of participatory initiatives
often is long-term.
Furthermore, I have not included the number one stakeholder in this study, community members infected
and/or affected by HIV/AIDS. This group may be called many things; clients, beneficiaries, target groups
etc. I prefer the term participants, since I believe that is the way they need to be viewed if the HIV/AIDS
epidemic is to be reversed. However, almost all CBOs call them clients and for consistency I have chosen to
use this term myself. Ironically it may seem this group is not included in my study. However, due to the size
and scope of this study it was important to adapt to what was manageable and to focus on a limited area of
investigation. The participation of community members as well as volunteers in the work of CBOs is an area
I believe should be paid further attention, since it is of great importance but also a major challenge.
1.5 Outline of the thesis
This thesis report is divided into nine chapters. This chapter states the aim and objectives of the study and
explains the motivation behind it. The next chapter offers an introduction to the case study.
In Chapter Three the methods used and the research sample is briefly presented. The interested reader
may find a more thorough presentation of the methodology and the processes surrounding the field study
in the methodological appendix (Appendix I).
Chapter Four tackles the theoretical framework and gives insights to the main approaches within
Communication for Development; the diffusionist and the participatory paradigm and their influence on
HIV/AIDS communication. Furthermore, an overview of the development of HIV/AIDS communication is
given, as well as a presentation of Communication for Social Change, a theory that is believed to be of
special interest to this case study.
In Chapter Five the background and context of the study is presented as well as some important
stakeholders and in Chapter Six CBO challenges related to these stakeholders are discussed.
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Chapter Seven gives a in-depth presentation of findings about CBO challenges on organisational and
community level and in Chapter Eight the role of the Ikhala model and participatory communication is
discussed and analysed. Finally, in Chapter Nine, I summarise my findings, share my thoughts regarding the
model and present some recommendations.
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Chapter 2: INTRODUCTION TO THE CASE STUDY
In this chapter I am introducing Ikhala Trust, the organisation my case study is based on. I will give a brief
overview of the organisation and describe the strategy and methods used. Furthermore I will briefly present
the CBOs that participate in the study and describe the features that distinguish them.
2.1 Ikhala Trust
Ikhala Trust an intermediate grant maker for CBOs operating in the Eastern Cape Province. The
organisation functions as a link between major donors and small grassroots organisations, providing grants
and building organizational capacity. By doing so, Ikhala makes it possible for small CBOs to receive funds
and capacity building without having to make applications and accounts to several different donors. Most
CBOs are too small to be recognised by other donors and through the Ikhala support, the organisations are
strengthened and prepared for a future relation of their own with donors or government. Furthermore,
Ikhala believes in recognising and value local knowledge and capacity and encourage CBOs to
communicate and share information within the organisation as well as amongst themselves.
Ikhala Trust was established in 2002 with the purpose “To raise block grants from donor agencies
including government that will be effectively and efficiently disbursed to successful, applying community
based organizations involved in Social and Economic Transformation” (www.ikhala.org.za/purpose.htm,
retrieved 15/04/2007). Since the start up to August 2006 Ikhala had disbursed 2.5 million Rand
(approximately 250 000 Euro, according to rates 10/08/2007).
Ikhala is not only focusing on HIV/AIDS projects, but also supports rural and urban development initiatives
and people living with disabilities. However, the great needs have resulted in a large number of grantees
working partly or full time with HIV/AIDS issues.
2.1.1 Staffing and resources
Ikhala has a very small number of employees, besides from the director only one fieldworker and one
administrator works for Ikhala. Instead Ikhala has a large network of people and organisations with
different competencies that are used to link CBOs with service and training providers in different areas.
The external service providers include a number of locally based assessors with “extensive experience of
development work in their respective communities coupled with connections to NGO and local government
networks” (The Project People, 2006:4). These assessors help Ikhala to find and evaluate applicants as
well as to support and monitor grantees.
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2.1.2 Strategy/approach
Ikhala functions as a link between major donors and small CBOs. Today Ikhala have six funding partners,
both international and national. The idea is to make small grants, between 5000-30 000 Rand
(approximately 500-3000 Euro, according to rates 10/08/2007) to grassroots organizations that are
otherwise overlooked by donors. The funding period includes a capacity building program where CBOs are
trained in different matters mainly related to organisational development to make them better suited to
apply for funds from other donors. Training is also carried out in cooperation with other organisations within
areas identified as weak by the CBOs themselves.
2.1.3 Methods
The methods used are very participatory since “Ikhala Trust believes that the only way to make a
meaningful difference in the lives of the poor and marginalised is to have them involved as major
stakeholders. They best understand their needs and challenges and can ultimately offer solutions to many
of the problems they experience.” (www.ikhala.org.za/overview.htm, retrieved 15/04/2007) Ikhala works
closely with the grantees during the whole grant period and have an on-going dialogue with the CBOs about
budgeting as well as capacity building needs and other needs and challenges. During workshops and
conferences the participating CBOs take great part in deciding what should be discussed, and sharing of
knowledge and experiences amongst organisations is viewed as an important tool for learning.
2.2 The participating CBOs
A total number of twelve CBOs who have received or are about to receive grants from Ikhala Trust, have
participated in the study. It should be acknowledged that the CBOs differ in size, structure, context and
activities, among other things. However, they have important similarities that make it justifiable to speak of
them as a group. They all work with multi-dimensional HIV/AIDS initiatives on community level in the
Eastern Cape, they are started by the poor and affected themselves as a respond to the urgent needs they
see around them, and they face similar challenges.
The CBOs’ activities differ, but the main focus of interventions falls under the area of care and support,
aiming at mitigating the effects of the epidemic through Home Based Care, support groups for PLWHA
(People Living With HIV/AIDS), programs for OVC (Orphan and Vulnerable Children), vegetable gardens,
soup kitchens etc.
Most CBOs work with some activities related to prevention, focusing on education and awareness. These
activities are mainly focused on information dissemination, like school visits and public talks while more
interpersonal strategies like door to door-campaigns and counselling are used to identify and support
PLWHA. Messages are mainly based on the ABC-approach (Abstain, Be faithful and use Condoms). Some
12
CBOs also focus on empowerment of the community in general and especially PLWHA. The CBOs are
typically not experts, but respond to all needs within their communities, HIV/AIDS being one of the most
severe, thus being paid much attention.
All CBOs rely heavily on the work of volunteers that are paid a small stipend or work without
reimbursement. Both staff and volunteers experience high workloads and psychosocial pressure due to the
nature of the work carried out.
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Chapter 3: RESEARCH METHODOLOGY
The field study was carried out during eight weeks, January to March 2007, in Port Elisabeth and its
surroundings. In order to address my aim and objectives I used a qualitative approach, with interviews as
my main source of information combined with observations and a desk study. In this chapter I will briefly
present the methods used and describe the research sample.
3.1 The research process
For a more thorough discussion on the premises surrounding the fieldwork, the research process, and
different methods used and their strengths and weaknesses I refer to the methodological appendix
(Appendix I). Among the appendices a list of interviewees (Appendix III) and the interview guides used
(Appendix II) can also be found.
3.2 The methods
This study has a clear case study approach, with the intermediate grant maker Ikhala Trust and a limited
number of its grantees as the main subjects of study. Due to the size of the study and the chosen
objectives the methods presented below were found most appropriate to use.
3.2.1 Desk study and document review
To obtain background information and understanding of the context as well as of the subjects studied, an
extensive desk study was carried out both pre, during and after the field study. Several reports have been
important to this study, not least the impact assessment Assessing Ikhala Trusts Support to Health and
HIV/AIDS-Sector Grantees carried out by The Project People during August 2006. The assessment provided
me with thorough information about the Eastern Cape development context as well as background material
on Ikhala Trust and the CBOs.
I have tried to find relevant literature mainly related to the key words CBO, community, HIV/AIDS and South
Africa. This has foremost led me to reports from institutes/associations like CADRE, CDRA, INTERUND and
PANOS that have greatly contributed to my understanding. Another source of information has been
materials from Ikhala Trust and the CBOs, listed among References.
14
3.2.2 Semi-structured interviews
Semi-structured interviews were carried out with representatives from both the CBOs and Ikhala Trust. The
interviews were based on semi-structured interview guides (Appendix II), but I ended up doing rather semifree or semi-unstructured interviews only using the themes of the guides and instead trying to ask relevant
follow-up questions and focus on the areas where the interviewees seemed to have most to share. I
constructed different interview guides for different interviewees based on their roles, but covered the same
themes in all interviews.
Themes discussed in the interviews include:

Local/regional context

About the CBO/Ikhala Trust

Relationship between Ikhala Trust and CBOs

Other donors/funders (including government)

Communication strategies used

Participatory aspects

Power structures

Networks and coalitions
The formal interviews were complemented with more informal discussions mainly with the director of Ikhala
Trust, but also with other people involved in the work of Ikhala or the CBOs.
3.2.3 Group interviews
In connection with a Ikhala workshop I carried out two group interviews with representatives from the nine
organisations working with HIV/AIDS, one with project leaders and one with other workshop participants
from the CBOs. Furthermore, one group interview was carried out with volunteer caregivers from one CBO
during a CBO visit.
3.2.4 Observations
Observations were carried out during a week-long workshop on organisational development arranged by
Ikhala Trust for new grantees. Participants from ten different organisations, nine of them working mainly
with HIV/AIDS issues, took part in the workshop. Observations were also carried out during field visits to
CBOs that I did both together with Ikhala Trust staff and on my own, and during one meeting with volunteer
caregivers.
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3.3 The research sample
The participants have been selected to represent a wide scope of knowledge and experiences important to
the study. Due to time and economic resources all interviewees participating in the study live in or in the
area nearby Port Elisabeth.
3.3.1 Ikhala Trust
Interviews have been carried out with five representatives from Ikhala Trust: the Director, the Fieldworker,
one Trustee, one Assessor and one Consultant/Associate. These interviewees were believed to offer as a
complete picture of the Ikhala model as possible. The interviews were complemented with observations
and document reviews.
3.3.2 CBOs
The nine CBOs participating in the group interviews were selected because they attended the Ikhala Trust
workshop and thus were easy to access. Three other CBOs were selected for a more extensive study
including visits and qualitative interviews with their leaders. The selection was mainly based on
accessibility, since they were based within a reasonable distance from Port Elizabeth. Furthermore, they
had received support from Ikhala for some time and were familiar with Ikhala’s way of working. They had
been successful in some areas, but experienced challenges within others.
3.4 Quotations and anonymity
Based on different considerations discussed further in the methodological appendix, I decided to let my
interviewees be anonymous when I quote them. Instead I have chosen to refer to quotations from CBO
interviews, both from individual and group interviews, as “CBO interviewee” and quotations from the Ikhala
representatives as “Ikhala interviewee”.
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Chapter 4: THEORETICAL FRAMEWORK
In this chapter I will discuss the development of HIV/AIDS communication and the different views on how to
use communication in the fight against the epidemic. I will give a brief overview of the development of the
field and more carefully examine the influence of the main development paradigms. Special attention will
be paid to the aspects most relevant to my case study, e.g. the use of participatory communication to
promote dialogue and increase participation, and the Communication for Social Change strategy.
Since participatory communication may be used in several different ways I believe it is important to clarify
my use of the concept. This case study focuses on the dialogical processes and communication as a tool to
create participation, as a way to engage people in changing their own lives and their communities. Thus,
the focus is not on participatory production of community media or the use of the participation of audiences
and target groups to formulate messages used in campaigns.
4.1 HIV/AIDS communication
4.1.1 Health versus development problem
Theorists and practitioners have tried to find solutions to prevent HIV to disseminate since the infection
rates took off during the 80s. In the mid-90s there was “a disproportionate emphasis being placed in
HIV/AIDS education on biomedical aspects of the epidemic, to the neglect of behavioural and contextual
factors” (Winskell & Enger, 2005:405). But for some years now there has been a growing awareness of the
need to use multi-disciplinary, holistic approaches and to view the epidemic as a development problem.
However, the picture is not clear-cut and according to Tufte the “current high emphasis on rolling out antiretroviral treatment (ARV) is changing the current emphasis from focus on prevention or integrated
approaches to an almost complete focus on HIV treatment” (2005, p. 106). Although there is a renewed
tendency to focus on HIV/AIDS as a health problem and a biomedical question, many theorists and
practitioners seem to agree on the importance to also integrate social, cultural, economical, spiritual and
other dimensions, and to deal with both prevention, treatment, care and support (Tufte, 2005, Singhal &
Rogers, 2003, Freimuth et al, 2000, Campbell & Williams, 1999). Tufte writes that “HIV/AIDS is obviously a
problem of poverty and unequal power relations in society [and] a symptom of social and economic
injustice” (2005:107).
The tension between HIV/AIDS as a medical problem versus a development problem is also mirrored in
different global institutes, where UNAIDS takes a much wider grip on the situation, while the Bush
administration’s PEPFAR program focus much on treatment, with abstinence as the key prevention solution
(ibid, 2005). PEPFAR do not promote condoms for young people, but only for so call “risk groups” like
prostitutes and substance abusers. UNAIDS on the other hand recognise that abstinence is not always a
realistic option due to contextual reasons like gender inequality (www.avert.org/abc-hiv.htm, retrieved
13/08/2007).
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4.1.2 Individual versus societal problem
Another discussion within HIV/AIDS communication, related to the health versus development discussion,
is whether the epidemic is to be viewed as an individual or a societal problem, followed by the discussion
on whether possible solutions are to be found in individual behavioural change or in collective action.
Different communication schools advocates different strategies.
HIV/AIDS communication, like the rest of the communication for development field, has been influenced by
the main development paradigms and dominated by the discussions between the diffusionist paradigm and
the participatory paradigm and lately a call for more multiplicity and holistic approaches. Several authors
(Morris, 2005; Waisbord, 2005; Parks et.al, 2005) emphasise that this sharp distinction between different
paradigms has been much more present in theoretical discussions than in practical field work. However,
since the distinction offers a background and understanding of different ways to view beneficiaries/target
groups/participants and the use of strategic communication, I will briefly discuss the diffusionist
communication schools before continuing to more thoroughly focus on participatory and multiplicity
approaches.
4.2 Diffusionist approaches
The diffusionist paradigm emphasise individual behaviour change and draws on a framework originating in
modernisation theories and Everett Rogers’ Diffusion of Innovations theory (Morris, 2005). Lack of
knowledge and information is seen as the main problem and transference of information, which will lead to
increased knowledge and in turn changed attitudes and practice, is the main solution. Communication is
mainly one-way, from a sender to a receiver, and different mass media are used to disseminate the
information. Approaches emanating from the diffusionist paradigm are among others Social Marketing,
early Entertainment-Education, Information-Education-Communication and Behaviour Change
Communication.
A critique against these approaches is that development problems often have more to do with politics and
power structures than lack of information and that there is a need for greater participation and more
horizontal communication on ground (Waisbord, 2001). Furthermore, the link between gaining knowledge
and awareness and changing behaviour has proved to be weak (Tufte, 2005). Merely disseminating
information is not enough; there is a need for something more to influence the behaviour.
4.3 Participatory approaches
The participatory paradigm originates from the Brazilian educator Paulo Freire’s theory of dialogical
communication and “focuses on community involvement and dialogue as a catalyst for individual and
18
community empowerment” (Morris, 2005:124). Communication should be participatory and culture
sensitive and value local knowledge. Dialogue and understanding is more important than information
transmission. Community members should not be viewed as passive targets of interventions, but instead
be active in, and in control of processes of change. Instead of being time-limited, goal oriented
interventions, development projects should facilitate critical thinking and community dialogue that will
impact communities beyond the time-bound specific project (Waisbord, 2001). Interpersonal communitybased forms of communication should dominate over mass mediated, one-way communication.
Participatory theories have been criticized for not being clear on when and how to be used, for undervaluing
the potentials of mass media and also for being too idealistic and not sensitive to the funding agencies’
needs to prove impact. Critics have also argued that participatory communication are not automatically
indigenous, but may also be a foreign intervention from above. Furthermore, many participatory initiatives
struggle with monitoring and evaluation frameworks and with how to measure impact (Morris, 2005;
Waisbord, 2001).
4.3.1 Not a unified model
Participatory communication might be either a tool used to reach certain desired outcomes or an end in
itself. Often it is a combination of both (Morris, 2005; Waisbord, 2005). It is important to recognise that
what ‘participatory communication’ means is not clearly defined either in academia or in practical field work
(Morris 2005; Servaes & Patchanee, 2005; Tufte 2005; Gumuncio Dagron, 2001). While there appears to
be a discursive consensus regarding the terminology, the definitions of words like ‘participation’,
‘empowerment’ and ‘ownership’ are not always clear and uniform (Tufte, 2005) and ‘participation’ has
become something of a ‘buzz word’ resulting in many projects defining themselves as participatory without
being very participatory per se. However, Gumucio Dagron writes that “participatory communication may
not be defined easily because it cannot be considered a unified model of communication. The eagerness
for labels and encapsulated definitions could only contribute to freeze a communication movement that is
still shaping itself, and that maybe more valuable precisely because of its variety and looseness” (2001:8).
4.4 Communication for Social Change
As noted above there has been a call for more multiplicity and holistic approaches, focusing more on what
unites than what differs. One effort to integrate different theories and approaches that has gained
increasing attention is Communication for Social Change (CFSC). Parks et al. writes that “CFSC can be
defined as a process of public and private dialogue through which people themselves define who they are,
what they need and how to get what they need in order to improve their own lives. It utilizes dialogue that
leads to collective problem identification, decision-making and community-based implementation of
solutions to development issues” (2005:3). Looking at strategies used, CFSC has much in common with
other participatory models, but it is more sensitive to the needs of donors to produce results and “stresses
the need to define precise indicators to measure the impact of interventions” (Waisboard, 2001:35). CFSC
19
advocates a strategy called Participatory Monitoring and Evaluation (PM&E) which should be carried out
locally and involve local stakeholders. External specialists involved should facilitate rather than direct the
M&E processes (Parks et al, 2005).
Communication for Social Change is interesting to this case study since it has much in common with
strategies used by Ikhala Trust and offers a framework to discuss the methods used. CFSC emphasise the
involvement of key stakeholders during all stages of a project; from problem identification, planning and
implementation to monitoring and evaluation. Furthermore, CFSC like Ikhala believes that local knowledge
and capacity should be acknowledged and appreciated.
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Chapter 5: BACKGROUND AND CONTEXT
To better understand the conditions surrounding the work of Ikhala Trust and the CBOs I believe it is
important to have an insight to both the background of HIV/AIDS and the development context of South
Africa in general and especially the Eastern Cape Province. Furthermore, I have identified several important
stakeholders who impact the work of Ikhala and the CBOs. In this chapter I will provide background
information that enhances the understanding of the findings presented in the following chapters. The
information is mainly based on the desk study carried out both prior, during and after the field study.
5.1 HIV/AIDS background
Some 25 years after the first discovered case, HIV/AIDS has grown into a global epidemic described as one
of the most urgent and serious threats towards progress and stability in the world. In the Report on the
global AIDS epidemic (2006) UNAIDS writes that
AIDS exacerbates every other challenge to human development, from maintenance of public services to food
security and conflict avoidance. Efforts to address the epidemic must simultaneously focus on preventing
new infections caring for those already infected and mitigating the economic, institutional and social impacts
of AIDS. (Executive summary, p. 23)
Access to effective treatment and prevention programs has increased, but the number of people living with
HIV, as the number of AIDS related deaths, continues to rise. Approximately 39.5 million people around the
world are living with HIV (UNAIDS/WHO, 2006). In 2006 alone an estimated 4.3 million people have been
infected and 2.9 million died of AIDS.
Sub-Saharan Africa is unquestionably the part of the word that has been hardest hit with two thirds, or 63
percent, of all HIV cases and nearly three quarters (72 percent) of all AIDS-related deaths. Furthermore,
over 85 percent of all HIV-infected pregnant women live here (WHO, 2007).
In the affected countries society has to account for huge health care and medical costs and large groups of
people in working age are unable to support themselves. In most African countries state interventions are
not sufficient and communities without enough resources struggle to attend to the sick and support and
care for a growing number of orphans and vulnerable children.
5.2 South African context
According to development index South Africa is a middle-income country and it is one of Africa’s richest
countries measured by GDP per capita. But it is also one of the most unequal countries in the world and the
gap between different segments in society is enormous. This gap goes back to the apartheid system that
ruled South Africa for more than 40 years, with its roots going much further back, and although apartheid
officially came to an end in 1994, it still has a huge impact on the lives of South Africans. The inequalities
21
are found everywhere in society and are reflected in figures of illiteracy, unemployment and child mortality,
among others.
The South African society struggles with high rates of unemployment and criminality, but HIV/AIDS is
described as the biggest challenge for the country, socially and economically
(www.sida.se/sida/jsp/sida.jsp?d=352, www.avert.org/aidssouthafrica.htm, retrieved 10/06/2007). South
Africa has one of the world’s highest incidences of HIV and the epidemic continues to grow. According to
Report on the global AIDS epidemic (UNAIDS, 2006) some 5.5 million people, and almost one in five adults,
are HIV positive. Among people aged 15 to 49 years 71 percent of all deaths are caused by AIDS. In 2005
staggering 30.2 percent of pregnant women attending public antenatal clinics carried the infection. UNICEF
estimates that there were around 240 000 South African children living with AIDS by the end of 2005 and
1.2 million children orphaned by AIDS, compared to 780 000 in 2003
(www.unicef.org/infobycountry/southafrica_statistics.html#25, retrieved 08/05/2007).
All these figures might be hard to grasp, but according to the international HIV/AIDS charity AVERT a survey
published by SA Advertising Research Foundation (SAARF) “found that South Africans spent more time at
funerals than they did having their hair cut, shopping or having barbecues. It also found that more than
twice as many people had been to a funeral in the past month than had been to a wedding”
(www.avert.org/aidssouthafrica.htm, retrieved 04/05/2007).
A large number of national campaigns have been carried out, several of them well-known and
internationally acknowledged like Soul City, Beyond Awareness and loveLife, but AVERT states that “the
prevailing high rates of HIV found across South Africa suggest that either the message isn’t getting through
to many people, or that people are receiving information but not acting upon it” (ibid). Furthermore, many
HIV/AIDS organisations feel that they have been working in headwind. The government has been blamed
for being slow to respond to the epidemic and not recognising the seriousness of the virus. The role of the
South African government will be further discussed in section 5.4.
According to UNAIDS/WHO “a large proportion of South Africans do not believe that they are at risk of
becoming infected with HIV. [Furthermore] approximately two million South Africans living with HIV do not
know that they are infected and believe they face no danger of becoming infected – and therefore are
unaware that they can transmit the virus to others.” (UNAIDS/WHO, 2006:13)
Getting more people to test and know their HIV status is seen as an important goal. There has been a large
increase in the number of voluntary counselling and testing sites, but concerns are raised regarding the
quality of the service in some areas. It is important that counsellors are properly trained and have the
necessary medical knowledge, which may not always be the case. Furthermore, many experience high
burdens of work and each patient are not paid the time and attention necessary for proper counselling
(Palitza, 2006).
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5.3 Eastern Cape context
“From whatever angle considered, the Eastern Cape, South Africa’s second largest province, is one of the
poorest” (The Project People, 2006:11). Unemployment rates are high and household incomes low
resulting in many people living in poverty. In poor communities social problems like crime, gangsterism,
alcoholism, violence and women abuse are common. Children drop out of schools because their parents
can not afford to pay school fees and uniforms. People are dependent on social grants like disability and
child support grants. Bad housing and bad nutrition contributes to various diseases and the number and
quality of health care facilities is insufficient.
The province is divided into six District Municipalities where the number of people living in poverty range
from 38.5 percent in The Nelson Mandela Metropole to 79.2 percent in Alfred Nzo (Ibid). The economic
development that has occurred in the latest years has benefited different municipalities very unequally.
The Eastern Cape HIV prevalence rate for 2005 was 29.5 percent, compared to 23.6 for 2002 (Eastern
Cape Department of Health, HIV and Syphilis Antenatal Sero-Prevalence Survey in the Eastern Cape 2005,
p. 15; Department of Health, National HIV and Syphilis Prevalence Survey South Africa 2005, p. 11, quoted
by The Project People, 2006). Eastern Cape is one of three South African provinces where life expectancy is
below 50 years (UNAIDS/WHO, 2006) and unspecified HIV diseases account for the highest number of
deaths (Eastern Cape Department of Health, Annual Report 2005/2006).
This is a gloomy picture indeed, but people living in the Eastern Cape do what they can to survive and many
are actively involved in different formal and informal initiatives trying to make a change. In most
communities there are a number of initiatives, raging from church and women’s groups to political
movements and different Civil Society Organizations, trying to impact their societies and make a difference.
In the absence of sufficient governmental response, people living in poverty do what they can to help
themselves and each other and try to change their communities for the better.
5.4 Government response to HIV/AIDS
The South African government has been criticised for being devastatingly slow in responding to the
HIV/AIDS epidemic. President Thabo Mbeki is notorious for some of his statements around HIV/AIDS and
ex-Deputy President Jacob Zuma’s remarks in a rape trial in March 2006 about how showering after sex
with an HIV-positive woman would reduce his risk of being infected outrage AIDS educators (SA’s Zuma
‘showered to avoid HIV’, 5 April, 2006). Minister of Health Manto Tshabalala-Msimang has been severely
criticised for not recognising the seriousness in the situation and promoting olive oil, garlic and beetroot
instead of ARV to treat HIV (Mail & Guardian Online, 21/18/2006). In the beginning of August 2007 Deputy
Minister of Health Nozizwe Madlala-Routledge was fired for openly criticising Tshabalala-Msimang and the
lack of sufficient responses to the crisis (Mtshali, 10 August, 2007).
23
The government hesitated about providing ARV to people in need and only in 2004 they started to supply
drugs (www.avert.org/aidssouthafrica.htm, retrieved 08/07/2007). The scaling up of treatment has been
slow and by the end of 2006 only about one third of the people in need received treatment. However,
“growing national and international concerns about the response led to a renewed political commitment by
the South African Government in late 2006 to roll out treatment” (WHO, 2007:59). Government has also
been accused for being reluctant to provide ART to prevent HIV-positive mothers from infecting their babies.
Although South Africa is the only country in southern Africa providing prophylaxis to more than 25 percent
of the HIV-positive pregnant women, much more is needed.
Attitudes are however changing and HIV/AIDS is today seen as a fatal question for the South African
Society. In March 2007, the government released its five-year HIV and AIDS and STI Strategic Plan for
South Africa 2007-2011. The new plan builds on the National Strategic Plan of 2000-2005 and “seeks to
provide continued guidance to all government departments and sectors of civil society” (Republic of South
Africa, Department of Health, 2007:8).
The primary aims for the coming five years are to reduce the rate of new HIV infections with 50 percent and
provide treatment, care and support services to at least 80 percent of all PLWHA. Other goals are to
increase the number of people who have been tested for HIV to 70 percent of the population and reduce
mother-to-child transmission of HIV to less that 5 percent.
Past failures now recognised are lack of a monitoring and evaluation framework and clear targets as well as
poor coordination by the South African AIDS Council (SANAC). SANAC, chaired by Deputy President Phumzile
Mlambo-Ngcuka, was established in 2000 to bring together government and civil society in a multi-sectoral
partnership against HIV/AIDS.
A large number of stakeholders from different sectors, including civil society representatives have been
included in the rounds of consolations prior to finalising the 119-page document. NGOs and lobby
organisations are carefully positive to the new National Strategic Plan since “Whilst it is not a perfect plan,
it’s by far the best plan the country has ever had.” (Treatment Action Campaign, TAC, spokesman Mark
Heywood to AFP qouted at www.aegis.com/news/afp/2007/AF070431, retrieved 07/07/2007) They are
now waiting to see the actual implementation and way forward. However, many CBOs and other grassroots
representatives feel overlooked and argue that they are excluded from discussions taking place at
provincial and governmental level.
5.5 Donor response to HIV/AIDS
Describing the donor community and how funding is channelled is not easy given the complexity of different
connections. The South African government receives both bi- and multilateral funding from other countries.
Furthermore, money from government agencies to civil society organisations are both channelled though
the South African government and given directly to organisations. There are also a number of different
24
initiatives like the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States Government’s
President’s Emergency Plan for AIDS Relief (PEPFAR). UNAIDS and other UN organs also support a variety of
HIV/AIDS activities in South Africa (The Henry J. Kaiser Family Foundation, 2007, Nhlanhla Ndlovu, 2005).
My main focus is on donor NGOs and fundraising organisations directly supporting NGOs and CBOs in South
Africa. However, there are both domestic and international donor organisations and they differ a lot in size,
structure, methods and aims. “Funding to NGOs [and CBOs] is particularly difficult to track because there is
no centralised reporting mechanism in place for all international aid to the NGO sector” (Nhlanhla Ndlovu,
2005).
HIV/AIDS is high up on donor agenda and according to Analysis of Aid in Support of HIV/AIDS Control
(UNAIDS/OECD, 2004) 99 percent of all health-related donor aid to South Africa 2000-2002 was allocated
for HIV/AIDS initiatives. The Donor Matrix for HIV and AIDS financial commitments to South Africa from
Department of Health showing large commitments made available for HIV/AIDS for the period 1997-2008
confirms these figures (Nhlanhla Ndlovu, 2005).
Huge amounts are being spent, but it is questioned whether the money is actually making accurate change.
Many interventions tend to be donor-driven and rather short term, mostly carried out as 1-2 years projects,
often being expert-led public health campaigns. In the PANOS report Missing the message? 20 years of
learning from HIV/AIDS Thomas Scalway “critically re-examines the successes and failures of the last 20
years of the global response to AIDS” (2003:1). One of the major difficulties recognised is that “donors
increasingly have to prove impact, showing how money distributed is used to optimum effect. This results in
an overemphasis on simple indicators and short-term results, at the cost of long-term change. Yet AIDS is a
long-term and complex problem requiring approaches which will not all be simple to measure.” (Ibid) The
central conclusion in the report is that
the most effective responses to HIV/AIDS are those which emerge from within societies; and they tend to
be long-term, complex and difficult to evaluate. These are precisely the strategies which donors, despite
their best intentions, find most difficult to support. We argue that some strategies, particularly those which
involve large sums of money being spent rapidly in the expectation of rapid results, are often ineffective
and may even sometimes do more harm than good. (Ibid:4)
Donors have also been accused of competition and lack of coordination leading to similar initiatives being
carried out parallel in the communities without learning from each other or looking at long term effects.
According to Nhlanhla Ndlovu there is a need to “prevent unnecessary competition and funding duplication
between donors” (2005:10).
In many communities lots of money has been spent without seeming to have had any, or small, impact on
the infection rates. In the INTERFUND report The Cinderellas of Development? Funding CBOs in South Africa
(2004) Nhlanhla Ndlovu show that only few donors funding CBOs in South Africa have sufficient knowledge,
skills and experience about the special conditions surrounding the sector and use appropriate methods.
Most of the donors who have knowledge about funding CBOs are themselves intermediates and dependent
on fundraising from larger donors and on their understanding of the context where funding is carried out.
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5.6 Other stakeholders
Government and donors play an important role, but there are a number of other important stakeholders. I
have limited my discussion to the ones identified as most relevant by the interviewees themselves, i.e.
NGOs and different kinds of networks.
5.6.1 NGOs
NGOs are often included in the group referred to as Civil Society Organisations (CSOs) and merged with
CBOs and FBOs. In South Africa many CSOs have its roots in pre-94 or the members of new organisations
have been part of the struggle against apartheid and greatly influenced by it (CBO interviewees). In recent
years there has however been a mushrooming of new CSOs working with HIV/AIDS (Birdsall & Kelly, 2005).
Given the blurring between different organisational types it has been very hard to find exact figures of the
number of organisations identified as NGOs. Charm Govender (2001) estimated some years ago that there
was between 55,000 and 100,000 organisations active within civil society in South Africa and that “a bulk
of these organisations are welfare oriented.”
CBOs and NGOs are often treated like the same kind of organisations, sometimes referred to as CSOs and
seen as representatives of civil society and voices of the communities. However, there are a number of
important differences between the two kinds of organisations. According to Nhlanhla Ndlovu “NGOs and
CBOs are doing completely different work and their personnel have different levels of knowledge and skills.
They also operate at different levels with unequal budgets and dissimilar outcomes.” (2004:4). This will be
further discussed in Chapter 6.
5.6.2 Networks
There are a number of different networks, coalitions, consortiums and development forums in South Africa
where organisations come together to share information, build capacity, advocate, get access to funding
etcetera. In Eastern Cape the most well known network for CBOs and NGOs is the Eastern Cape NGO
Coalition (ECNGOC) with more than 370 member organisations (www.ecngoc.co.za, retrieved
08/05/2007). The coalition was formed in 1995 to represent common interests, provide training and
support and to share information. The goals are among others to make member organisation more
effective in their development work and able to influence policy and practice. ECNGOC arrange a large
number of trainings, workshops and forums. However, critical voices are raised questioning how well the
coalition represents its members, arguing that they have become too institutionalised and by receiving and
distributing government money they have lost their advocacy edge. “What is guiding them is that they don’t
want to upset the government too much” (Ikhala interviewee). However, many CBOs still seem to think it is
important to take part in the coalition’s meetings and trainings.
26
There is an inter-sectorial meeting every month by the NGO coalition where they share information and
discuss how to handle problems. They do workshops and things like that and it is important to attend
meetings to get information. (CBO interviewee)
Several interviewees mentioned these civil society networks, but I have found it hard to get an over all
picture and to find much concrete information about these networks, coalitions and forums and their
activities in the Eastern Cape.
27
Chapter 6: FINDINGS ABOUT CHALLENGES RELATED TO OTHER STAKEHOLDERS
As described in Chapter 5 several stakeholders impact the work of Ikhala and the CBOs; government,
donors, NGOs and different kinds of networks being identified as the most important once. In this chapter I
will discuss different CBO challenges related to these stakeholders.
6.1 Government challenges from the CBO perspective
Most interviewees were highly critical to the work of the government, feeling that not enough is being done
although HIV is now being recognised as one of the biggest challenges in South Africa and despite the very
obvious impact of the epidemic in communities. “They [the government] know the needs, but they are not
responding to the needs. They say they are, but they are not” (CBO interviewee). The CBOs feel that they are
doing government work, but without getting paid. “CBOs are taking over work of the government, which is to
actually provide social security and health services, but they are not getting money to do it” (Ikhala
interviewee). Most interviewees seemed to agree that much of the work done by CBO should be taken over
by government. “We should not have to be here. They [the government] should help us” (CBO interviewee).
However, others thought that the only way that much of the work will continue to be carried out is through
CBOs, but that they should get more recognition and reimbursement for their work.
I don’t think there is sufficient recognition by the state and major decision makers within the political arena,
of the work that actually happens on the ground… And if they [CBOs] stopped tomorrow, doing what they do, I
don’t even want to think about the implications of that … We don’t have the resources for hundreds of
thousands of people on salaries to nurse the sick. (Ikhala interviewee).
Several interviewees testified about the low recognition from government of work carried out by CBOs.
“NGOs and CBOs don’t get attention from the government, they ignore us” (CBO interviewee). The CBOs
also feel that government are not listening to them and do not value their knowledge and experience. One
interviewee talked about an important planning meeting on provincial level that had recently taken place.
The people that are really working with it [HIV/AIDS] weren’t there. It was decision makers and leaders from
churches etcetera that were there. They were influencing what is happening, but the real people that are
receiving the service, the real people that are delivering the service on grass level weren’t there to say;
‘These are our problems and our needs’. (Ikhala interviewee)
In most communities CBOs and government are not working together, but rather have parallel initiatives.
According to an Ikhala-interviewee government pay community health workers much more to do exactly the
same work as CBO volunteers do while only getting small stipends. This divides the communities into those
who are CBO volunteers and those who are government volunteers and creates envy and mistrust.
One major source of dissatisfaction among CBOs is the difficulty to get access to government funding. Often
calls for proposals are only advertised in major newspapers and getting access to all the documents
needed and fulfilling all requirements is often very complicated. Most CBOs lack both transport and money
and do not have enough resources to apply for funds.
There was an advert in the paper last week from the government, provincial government, calling for
community based organisations doing home based care, to apply for funding. But it was advertised like a
28
tender. You have to pay 30 Rand to get the tender document and then you have to go to a compulsory
briefing, which is what they do for engineers building bridges and things. You are supposed to pay for the
document to get at thick 50 page package. But if they are targeting home based care they should have a two
page simple terms of reference. If they want to do briefings they should do them in the different district
offices, not forcing them [CBOs] to come to the capital. The advert is targeting CBOs, it clearly says C B O, but
they are dealing with it like it was engineers. Number one, to get from the north of the province or the west of
the province to the capital, who’s got money for that? And then you need to pay 30 Rand for the document.
And you still have to come back to the compulsory briefing. Then you still need to, probably, get some outside
help to deal with the documents, which I haven’t seen, but I would assume that if you are paying 30 Rand for
them they are more that two pages simple terms of reference. So even our own government isn’t insuring
that what they do is accessible to the partner groups (Ikhala interviewee). (See advert in Appendix X)
Government and departments are also accused of spending lots of money without making sure that the
outcomes are sufficient.
Department of development will assist communities and they will give them a huge amount of money without
capacitate them to administrate the resources … After they have given the CBOs that money they put
pressure on them to spend that money within time, because they want to account that so much has been
spent. (Ikhala interviewee)
Another Ikhala interviewee expresses similar views:
My sense of government is that they focus on if I have spent the money, so my boss can report to his boss,
who can report to the national treasury department that they have spent their money in time and they have
all the supporting documents. And in order of reporting my department is really good. If the money has
actually helped anyone is not an issue. (Ikhala interviewee)
One CBO that had been approved for funding from the social development department and received a
rather large sum felt that the only thing that mattered was that the money was spent, not what impact it
had actually made or how the CBO was doing.
The only report they want is about the finance. They want to see how the money is being used. We are in the
middle of February and this year I haven’t seen or heard from them, not even a phonecall. (CBO interviewee)
6.2 Donor challenges from the CBO perspective
Most CBOs do not have access to any funding other than what the members themselves manage to
contribute with, and lack of sufficient resources is one of the major challenges identified by CBOs. A
common notion seems to be that “there is lots of money out there, you just have to get access” (Ikhala
interviewee). However, the process of applying for funds is often complicated and it is important to write
applications in a way that is sufficient in the eyes of the donors. “You might think ‘I have been within the
organisation for several years’, but when you are going to apply for funds it’s not easy. You know all the
practical things, but you can’t write applications. This makes people crazy” (CBO interviewee). The language
used by many big organisations is also seen as an obstacle.
When the big organisations go to these communities, the language that they speak, even if they speak
English they speak with words which people do not understand and you find when they define their target
group, the target group is the poorest of the poor, but the language that they speak is not for the poorest of
the poor. Like when they say they need a call for proposals, they [the CBOs] don’t even understand what is a
call for proposals? Even the system of reporting is not for the poorest of the poor (Ikhala interviewee).
29
When CBOs do receive funds, donors often have their own missions and visions that tend to influence the
work of the CBOs, countering more participatory approaches. According to the CBOs their clients often have
ideas about what the CBO could work with “but the budget usually say this is the money and this is what
you are going to spend them on. So you can’t take money here and do something else” (CBO interviewee).
Still, “many donors will spend money and have expectations without understanding the context” (Ikhala
interviewee). Furthermore, reporting activities and finances in what the donors view as a sufficient manner
may cause difficulties for CBOs with limited or no staff. Especially if they work with several different donors
that want reports and evaluations carried out in different ways. Major donors also prefer to give major
funds which are often hard for small CBOs to manage. CBOs experience that they have to meet deadlines
for proposals, submission of reports etcetera, while donors do not care as much about their own deadlines.
Interviewees testified about the stress of being promised funds and then have to wait for money that does
not come when it is supposed to. Sometimes the actual benefits within a community may also be
questioned.
One issue is that in terms of performance management the emphasis is on spending money, in time, within
budget ends, having all the supportive documents about how the money was spent, receipt slips, attendance
registers etcetera. The emphasis isn’t on impact, quality, who benefited, was there a change (Ikhala
interviewee).
6.3 NGO challenges from the CBO perspective
Looking at the requirements from government and donors when organisations are applying for funding it is
rather obvious that CBOs experience difficulties when they are to compete with NGOs for money. A large
majority of donors and agencies prefer to work with NGOs, which have more formal structures and are seen
as more professional. There are several reasons why donors prefer to work with NGOs including 1) NGOs
have employed staffs who are experts and have time and resources to fulfil the requirements from funders;
2) NGOs know how to respond to call for proposals and fill in applications correctly; 3) NGOs know how to
report, use budget in time, log frame etcetera; 4) NGOs are capable of handling and account for large
grants, which makes the administration costs for the donors lower.
It should be noted that these NGO challenges were not mentioned explicitly in any of my interviews, but
something I picked up during more informal conversations and participatory observations and found more
support for in my desk study, especially in The Cinderellas of Development? Funding CBOs in South Africa
(Nhlanhla Ndlovu, 2004). Although most CBOs seem to appreciate the capacity building that some NGOs
provide them with as well as the information they get access to through NGOs, there is a feeling that
someone else is getting the money that they should have. The NGOs are said to profit on the needs of
communities and to not really care about the people. Furthermore, there is a suspicion that some NGOs are
started merely to get access to funding. “Some of the organisations are just people who say HIV/AIDS is the
most likely thing to get money for so let’s start one of those kinds of organisations” (Ikhala interviewee).
A severe consequence of CBOs not getting access to funding is that the money might not reach the people
most in need. According to Nhlanhla Ndlovu “the sector that received most of government’s funds were
30
characterised by well-developed NPOs [Non Profit Organisations], which tend to be more active in
established working-class and middle-class communities than in poorer communities.” (2004:10)
A major strength of CBOs is that they know a lot about the local context; the environment in which they
operate, the needs of people and specific difficulties in the community. Being community based they
“appear to be responding quickly to the epidemic’s changing dimensions [and] their position at community
level may allow grassroots groups to see quickly and clearly where action is needed, as well as to anticipate
the direction in which needs are evolving” (Birdsall & Kelly, 2005:9).
Furthermore, community members might feel closer to CBO volunteers and thus find it easier to share
difficulties and problems. On the other hand, it might be harder to discuss personal matters in
confidentiality with someone they might meet in their neighbourhood the next day. Being community
members themselves CBO leaders and volunteers sometimes have hard to draw a line between the
organisation and themselves. They are constantly on call and have to respond to all kinds of problems.
The more formal NGOs often have their offices located outside the community where they are working and
do not face the same difficulties and thus are seen as easier and less risky to fund.
6.4 Network challenges from the CBO perspective
A common motivation for forming networks is to improve the chances of getting access to funding. In South
Africa it is common with so called ‘forced marriages’, where small organisations come together mainly to
access funds. Donors and government departments, wanting to lower their own administrational costs,
encourage CBOs to form alliances and share a large grant. According to several interviewees these
alliances seldom work well since the main force for cooperation is money. When the money comes
everyone want to get their share and conflicts often emerge, making it difficult for organisations to focus on
carrying out the developmental work the money is intended for.
Looking at the national development agency, they don’t fund small projects one by one, they fund clusters
and the smallest amount of money they want to give is 400 000 Rand (approximately 4000 Euro, according
to rates 10/08/2007), so they just advice people to get together and form a consortium, and when the
money actually comes there is completion and fighting. There is no support about how the consortium is
formed, proper terms of reference, resources and responsibilities. That also causes complications because
it’s like a forced marriage, which suites the donor because they then can support a hundred people with one
contract, instead of needing five or ten contracts to get to the same number of organisations. So it’s all about
shortcuts. (Ikhala interviewee)
Most interviewees agree that networking is important, but that they need to be based on something else
than money.
The issue is that people only come together when there is a chance to get money. If there were some other
reasons to get together, like to have a voice, to engage with a b c d e, then they had a natural cluster doing
other things, so when the money comes they actually have a vehicle, but when you just have a vehicle to
access money it’s not working. (Ikhala interviewee)
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The competition for funding also sometimes poses an obstacle for people to network in other areas.
“People are competing for resources. So if there is only one fund for an HIV/AIDS support group in our
village and there are three support groups, are you actually going to be too friendly?” (Ikhala interviewee)
An important reason for coming together is to form a stronger voice, but a problem with many advocacy
networks is that they are not representing the poorest segments of society and often CBOs are not
represented.
I’m not saying that the role that is being played by TAC [Treatment Action Campaign] is not relevant. It is
relevant, but it is a different role. But I would love if people from the grass root level could raise their voices,
instead of having a person that raise their voice. In some instances it is maybe not an exact reflection of how
people at remote grass root level feels, probably not reflecting their real, real needs at that level, their real
life experiences. Maybe TAC will be reflecting the needs of a certain community, at a certain level, but these
communities that we are speaking about are communities at the lowest level. (Ikhala interviewee)
One critique raised against some of the networks is that they are not making any actual change. “I think
there are too many forums in South Africa. Forums are by the nature very loose and are very related to
talking and I don’t know what action comes out of forums” (Ikhala interviewee).
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Chapter 7: FINDINGS ABOUT CHALLENGES WITHIN THE CBOs AND THE
SURROUNDING SOCIETY
In this chapter I intend to describe challenges identified within the CBOs and the surrounding society,
ranging from very concrete everyday problems to overall structural difficulties, and in the next chapter I will
more thoroughly discuss and analyse how the Ikhala model can make a difference. For clarity the
challenges have been categorised, although it is important to note that they are very often interrelated. Not
all challenges on CBO level are found within every organisation participating in the study, but all challenges
included in the chapter were described by several interviewees and many of them are also discussed in
different reports (The Project People, 2006; Birdsall & Kelly, 2005; Nhlanhla Ndlovu, 2004).
7.1 Poverty and resource challenges
There was a clear agreement that poverty is a very important reason for the growing HIV/AIDS epidemic and
also a major challenge when trying to prevent the dissemination and mitigate the effects of the virus.
“Poverty! Poverty is the main challenge” (CBO interviewee). HIV/AIDS is both caused by poverty and itself
creates more poverty. In poor communities unemployment rates are high leading to criminality, prostitution
and alcohol abuse. “Poverty does play a big role, because we find that there is a lot of unemployment and
high poverty and the parents are away trying to find job elsewhere. We find that younger girls are starting to
turn to prostitution, selling their bodies for a plate of food” (Ikhala interviewee). Many people have to
migrate to find jobs and living away from family makes many men turn to prostitutes and then bring the
infection with them home. It is also common that people who have lived in the big cities return home when
they become ill and relatives are left with the emotional and economical burden of caring for the sick ones.
In the rural areas, men there are migrant workers in the mines in Gauteng and in the Free State, and also
both women and men in working age go to Cape Town and Durban to find jobs to send money back to their
families. And what we find is that many of them when they return are already in the AIDS phase. (Ikhala
interviewee)
Too little food and bad living condition are common in communities with high infection rates, making it
difficult for PLWHA to maintain a healthy life style. The ARV needs to be taken together with food, but in
many affected households there is not always food available. Despair and hopelessness makes people turn
to alcohol and drugs to deaden their worries, making them even sicker.
Many people depend on social grants like child support grants and disability grants. To qualify for grants
due to HIV/AIDS they need to be sick enough, something that is judged by a so called CD4-count.
A person must have CD4-count below 200. That is one of the biggest problems because people now, if they
receive the grant they do not take the treatment, because if they take the treatment it will improve their CD4count to more than 200 and to them to keep the CD4-count below 200 they stop taking the treatment.
(Ikhala interviewee)
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Several interviewees also said that the CD4-count is not a sufficient way to measure how sick people are,
since they may be much below 200 and still occur very healthy or actually die of AIDS while they are still
over 200. This is something many CBOs have tried to raise awareness and opinion around, but they feel
that no one is listening to them. The access to ARV is also related to poverty.
If you have money, you have access. All the clinics, or all the areas, are not yet having ARV available to
people. You have to go to the big city to have it. And then there is a limited number available. You have to go
on the waiting list. So the little money they have, they have to use to go up and down to fetch their
medication every two to three months, because it is not available here. We are in the process of rolling out,
but it is such a long process, because you need such a staffing, you need such an infrastructure and it all
costs money, so in the end, the richer you are the more access you have. (Ikhala interviewee)
As discussed in the previous chapter most CBOs experience difficulties to access funding and lack of
proper resources is a challenge that pervades much of the work. The Project People (2006) list the
following physical resource needs: 1) Office space and equipment; 2) Communication equipment like cell
phones; 3) Transportation. At a meeting with volunteer caregivers the lack of home based care kits, with
gloves etcetera was also raised.
Several CBO interviewees mentioned the lack of sufficient access to transportation, which is a great need
e.g. when visiting remote clients, taking people to clinics, access VCT (Voluntary Counselling and Testing)
and ARV sites and attending meetings outside the community. One interviewee had recently discovered a
very sick client and called the ambulance, but the ambulance only arrived the next day when the client was
already dead.
Furthermore, many CBOs do not have access to Internet and e-mail and only limited access to phones. This
makes cooperation with others and taking part of networks, government initiatives etcetera, as well as
working with advocacy and getting access to funding, very difficult.
The CBOs are small organisations and most of them are in the rural areas where it is very difficult, they don’t
have internet, or even access to cell phones, some of them have access to cell phones, but you find that in
certain areas there is not electricity, meaning that the issue of communicating with bigger organisations or
other institutions aren’t there and the issue of access information is also affected. (Ikhala interviewee)
7.2 Societal Challenges
There are a number of societal challenges in the communities that counteracts and complicates the work
of the CBOs. The once most commonly mentioned by interviewees were lack of social support systems,
discrimination and stigma, gender inequalities and religious obstacles.
7.2.1 Lack of social support systems
It is very obvious that most communities do not have sufficient access to health care and other social
services. There are too few clinics and many of them do not roll out ARV. Access to VCT is low and the
quality of the service is questionable, partly due to heavy work loads. “The counselling that is being carried
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out at clinics does not take the needed amount of time and it does not allow people to take a sound
decision” (Ikhala interviewee).
Most home based care is carried out by family members and volunteers. “There are very few social workers.
For a number of 5000 people there is only one social worker. Meaning that it will be very difficult to expect
that the social worker will be able to do their work effectively” (Ikhala interviewee). In most communities
there are many OVC that are not attended for and child headed households are becoming more common.
7.2.2 Discrimination and stigma
According to most interviewees, the changed official attitude and open talk about HIV/AIDS combined with
the fact that almost everyone know someone who is infected or has died of the virus, have contributed to
lessen the stigma. But discrimination is still very common and fear of being rejected by family and friends
makes it very hard to disclose. Many CBO interviewees witnessed about cases in their communities where
people who had disclosed had been mistreated by family and neighbours.
Stigma is a major obstacle when arranging support groups for PLWHA. “We try to organise people, but it is
difficult because people still got that stigma. We don’t like it to be known that we are HIV positive” (CBO
interviewee). What CBOs find is that PLWHA tend to disclose in the door-to-door campaigns where people
get a possibility to talk to one representative from the CBO, but they do not want to take part in the
activities arranged by the CBO. “One of our clients has HIV and she is not afraid to tell that she has the
virus. And many they do disclose to her, but they do not want to come and join the group because they do
not want to be known in public. People do not want to be stigmatised” (CBO interviewee).
In many CBOs people who are infected are themselves involved as members and volunteers and
sometimes community members discriminate against these CBOs. One CBO working with soup kitchen for
OVC said that previously they had experienced difficulties because parents were afraid that the volunteers
were going to infect the children. “Some parents tell the children not to eat the soup we make because they
say we put AIDS in the soup” (CBO interviewee).
7.2.3 Gender inequality
Gender inequality is mentioned as a major reason for the spread of HIV, since women often can not say no
to sex, negotiate for safe sex or demand their boyfriends or husbands to stay faithful. Comments like
“Sometimes the men are not faithful to the women” (CBO interviewee) and “Sometimes the guys deny to
use a condom. They want it flesh to flesh” (CBO interviewee) were common. One interviewee explained it
like this:
Women don’t have the power to challenge men and say ‘If you want sex with me use a condom’. Because,
especially in our black culture it is acceptable for men, even thou they are married, to have other women.
And they feel it is not good for them to wear condoms and women don’t have the power to stand up against
35
husbands and say use a condom if you want it, because she hasn’t got the confidence and the moment she
demands a condom then he asks her are you sleeping around? Are you HIV positive? (Ikhala interviewee)
Gender based violence is common and women are both economically and socially subordinated men.
“There is also the issue of power in terms of condoms. The issue of power in gender. That the decision to
use a condom is more in the hands of the men than in the hands of the female. The man is the person who
is working and the female is more dependent on the man” (Ikhala interviewee).
Several interviewees mentioned the female condom as a good alternative if the man do not want to use a
condom, but also the problems attached. “If the woman uses a lady condom the husband want to know
why you use a condom now. They think something is wrong. There is no trust” (CBO interviewee).
In many communities rape is common, both within marriages and attacks by strangers, and according to
CBO interviewees many young girls get the virus after being raped.
7.2.4 Religious obstacles
Religion play an important role in the life of many South Africans, and a majority of people belong to one of
the Christian churches. Many churches do not accept the use of condoms and do not encourage open talk
about sexual matters. Some CBOs are faith based and agree with the condemnation of condoms, but many
are frustrated and feel that the attitude is not in touch with the times. “They say it is not in the bible to use
a condom, but there was no HIV/AIDS when the bible was written” (CBO interviewee).
These churches counteract the awareness campaigns and although many people know that condoms are a
way to greatly reduce the risks of getting infected they hesitate using them due to their religious beliefs.
I think the awareness is very high about using condoms, but we have the cultural and religious
unacceptability of using a condom. 13 of our churches are totally against using condoms. (Ikhala
interviewee)
7.3 Organisational challenges
Besides the challenges on societal level and the previous mentioned difficulties to access funding and lack
of physical resources and infrastructure the CBOs are struggling with a number of different internal
challenges such as lack of expertise and specialised knowledge, psychological pressure and power issues
within the organisation.
7.3.1 Lack of knowledge and specialisation
I strongly want to emphasise the important knowledge that most CBOs have about the context they
operates within and about the needs in the communities. However, being started without any formal
36
structures many CBOs do not have much knowledge about governance and other matters of legislation.
They have limited or no knowledge about budgeting, report writing, evaluations and other skills demanded
by funders.
Many of the people working in CBOs do not have formal education. “We lack information and we don’t have
education” (CBO interviewee). This often makes it difficult when they have to write about the work in
applications and reports. “People are doing good work on the ground and if you sit with them and they tell
you what they are doing it’s amazing. But they don’t have the capacity to put it on paper and get to people
from outside” (Ikhala interviewee).
Furthermore, CBOs are typically not experts in one area, but respond to all kinds of different problems in
their communities and their work is based on best practise rather than theoretical frameworks. They are
organised “on the basis of lived experiences and collective suffering, rather than on complex and nuanced
worldviews or a particular ideology” (Nhlanhla Ndlovu, 2004:3). This is both a strength and a weakness.
They know a little about much and are able to act ad hoc on needs they discover. But my understanding is
that it often also means that they are not as effective and efficient as they could have been with more
expertise in the areas in which they are working.
7.3.2 Power relations and lack of participation
CBOs are of course started in a number of different ways and with different motivations, but looking at my
findings the most common ones seem to be either by a visionary leader or by a group of community
members. The visionary leader sometimes tends to run the CBO as his or her own business not involving
any others in decision making (Ikhala interviewee). CBOs started by several community members tend to be
democratic in the beginning, but as they evolve into more formal organisations, structures sometimes
change.
Initially most CBOs were started by a group of people from the community and they were running the project.
But as they become more formalised, getting a board, sometimes even getting staff and volunteers, you will
find that a group or one or two start taking the leadership role and then somehow your community or your
member participation becomes less. (Ikhala interviewee)
Both structures might result in leaders that do not share information which may cause many problems,
especially when funding is involved. There is a clear agreement that as much as money is a great need it is
also a cause for many difficulties. One CBO interviewee for example said “When the money comes there is
problem”. Many volunteers feel that they work hard and if funding is approved they think they should be
rewarded. “The volunteers are social workers. They are the ones making sacrifices and they like to get part
of the money” (CBO interviewee).
It is important to note that, even though stipends are often not more than 100-400 Rand a month
(approximately 10-40 Euro, according to rates 10/08/2007), many poor people in South Africa do voluntary
37
work to get an income. “Volunteers see their work as a way to supplement the household income. Even if
the stipend is low it makes a difference” (Ikhala interviewee).
CBO leaders have to struggle with high expectations from both the community in general and volunteers
and clients, especially when they are funded by a donor. In many cases the leader work without salary,
because donors often do not approve funding for salaries, but still have a lot of responsibilities, both
towards the donor and the CBO members.
It is sometimes strange because the leader is called staff and thus do not receive stipend like volunteers, but
is not paid a salary, because the title is mostly about prestige. Then the leader has to take all the blame from
volunteers although it may be the donor or government that is to blame. (Ikhala interviewee)
The reason for many conflicts is that it is not clearly communicated how the funds are supposed to be used
and what the donor’s expectations are.
If donors aren’t very clear in the contract, about that they have only funded a, b, c, d, e and they haven’t
funded whatever else. Then, when the money comes, some people might decide ‘Oh, we know that we
applied for that’ and they just assume that there are money for those things. Because they don’t take
contracts very seriously, because they have never worked in a contracting, legal environment. And after some
time it comes up ‘Oh, we know there were money for this. Our leader must have abused the money’. (Ikhala
interviewee)
It is thus important that the leaders of a CBO communicate at all stages, because sometimes people know
what the CBO has applied for, but mostly funding are only approved for part of the things they have applied
for and then it is important to let people know exactly what funding has been approved for.
Managing volunteers is another issue many CBO leaders find challenging. They feel that volunteers are
demanding and want to influence the work of the CBO too much. Furthermore many volunteers that have
been trained by the CBO leave and start working elsewhere. “I wish they could get stipends, because they
get tired of helping us” (CBO interviewee).
However, several volunteers that I have talked to do not care much about the stipends. They are involved in
the work to make a change and help others. But they feel that the work they are doing is very important and
that they have knowledge that the leaders should value.
I believe that lack of participation both depends on and creates mistrust. CBO leaders do not want to give
volunteers and clients access to information about funding etcetera because they do not think they will
understand or might misinterpret, and the clients believe that the CBO uses them to get access to money.
“They [the clients] say that we are getting money with their IDs” (CBO interviewee). I do believe that not
sharing information also is part of a power structure. Since many CBO leaders work very hard without
getting salary or other privileges, keeping information may be one way to uphold some kind of status.
However, my observations and interviews clearly indicated that the CBOs that were most against volunteers
and clients participating in decision making and getting access to information were the ones that claimed
that they experienced most difficulties with volunteers and clients.
38
However, it needs to be stressed that even if CBOs want to create participation and involve community
members it is not always easy given that most people are very busy trying to meet their own needs and
there are lots of meetings and forums in a community to attend. “There are so many things that are calling
your attention. There will be forum on local economic development, church meetings, the local AIDS consul,
workshops, local government elections and a lot of community work” (Ikhala interviewee).
While clients and volunteers are sometimes thought of as being too eager to take part in the managing of
the CBO, many CBO leaders feel that the board members or executives are not sufficiently involved in the
work and not very supportive. They do not have enough knowledge and do not fully understand their
responsibilities. “I think I would enjoy my work much more if everybody really starts to take it seriously. The
executives should really get involved in different things. If they are not that much committed then they don’t
belong here” (CBO interviewee).
7.3.3 Psychological pressure
The CBO members work hard every day, but still people around them get infected and people die. “The
people who are caring and supporting are themselves victims of HIV/AIDS” (Ikhala interviewee). Many have
lost and keep on loosing family members and friends and may themselves be infected. There is often not
enough access to professional psychological support and burnouts are very common on all levels of the
CBO. “It is not easy for me to work with people if I don’t get counselled myself” (CBO interviewee).
Many of the volunteers have lost family members or are caring for sick people they love. Their motivation is
that they want to make a change, but caring for PLWHA also adds to their emotional pressure and when
clients pass away it is hard to keep on working. Many CBO interviewees told very touching stories about
clients they had lost. Volunteers also struggle with the expectations from clients and the wish to help them
as much as possible.
A great number of our AIDS-organisations, they go and render the home based care, but when they go to
those households they discover that the people do not have food. And before rendering the service that they
are supposed to render they need to buy something to eat and sometimes the caregiver do not have
anything and then it becomes a terrible situation, because when they come, the clients they expect that they
are bringing something. Not only the medical stuff, but also food, anything to eat. (Ikhala interviewee)
Most volunteers are living under poor conditions themselves, but want to help those in even greater need.
“People take from the little they have to help the ones who have even less” (CBO interviewee). This adds to
the pressure volunteers are already experiencing.
For me the biggest challenge for people working with HIV/AIDS is that they go out to these households and
they hear these terrible stories and they see people starving and they have nothing themselves and they give
people their children’s school money or their transport money and walk home. Because the people, their
clients, are so desperate and dying and they are not getting government support and they are not getting
government grants and they have got three children and there is no money coming from the government
because they haven’t got birth certificates or whatever. That, for me, I mean, people who are volunteering
within HIV/AIDS are generally people who have nothing themselves and because they have hardly anything
themselves they feel for people who have less. (Ikhala interviewee)
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7.4 Communication related challenges
The CBOs do not have much knowledge or experience of working with advocacy and strategic
communication and experience difficulties both to voice their insights about the situation in the
communities and their demands, as well as to use effective and efficient communication strategies in their
community work.
7.4.1 Lack of voice
CBOs have knowledge about important issues and needs in their communities, but experience difficulties in
making their voices heard. They are often not included in local or provincial government planning and
strategy meetings and other forums. They want to work with advocacy and lobbying but find it difficult since
they are small and do not have sufficient recourses.
Many CBOs believe that they have an important role in communicating the needs of the community. “We
are the voice of the voiceless” (CBO interviewee). However, many feel that it is very hard to make political
leaders and decision makers listening to them. What they are having some success in is making
government provide communities with social services like access to ARV.
In certain communities there are no ARV sites, and the CBO will go to government and speak to government
and play a role in terms of engaging different institutions to say there is a gap here. Also around the issue of
social security you find that the CBO will engage the government around the provision of social security
services. (Ikhala interviewee)
CBOs, especially if they are able to involve many community members and come together, have a great
possibility to advocate the needs of the community. However, there is also a risk, when the ones that need
to listen i.e. government and departments, are also the ones that distribute large funds to organisations.
“Nobody wants to do anything that will reduce the changes of getting money, whether it is within the
coalition, within municipality, between sectors or in communities. It is scary” (Ikhala interviewee).
7.4.2 Insufficient use of strategic communication
Insufficient use of strategic communication is a challenge I identified during observations and interviews,
but it was never explicitly expressed by interviewees themselves.
The main area of intervention for most CBOs is related to mitigating the effects of HIV/AIDS by home based
care programs, support groups for PLWHA and OVC, soup kitchen, vegetable gardens etcetera. “Everyone
doing HIV/AIDS seems to work with treatment and care” (Ikhala interviewee). In this area it is very obvious
that the CBOs are making a great change, contributing to infected people accepting their disease and trying
to live as healthy and positively as possible, and helping the families to accept and support their loved
ones. This seems to contribute to the reduction of stigma and discrimination and makes the life better for
PLWHA and OVC.
40
Talking openly about the disease also contributes to increased awareness and reduced stigma. “We are
trying to prevent by being open about everything, talking about sex, and to be clear and talking about
everything” (CBO interviewee).
When it comes to prevention, most CBOs work according to rather simplified ABC-approaches aiming at
individual behavioural change through diffusion of information in awareness campaigns etcetera. “We can
go to schools and educate them about HIV. We tell them they can not see if somebody is HIV positive. I tell
them to stay away from sex. Condoms are ok, but I do not encourage them. Abstain first” (CBO interviewee).
All CBOs witnessed about the increased knowledge related to HIV/AIDS and how the virus is transmitted.
Everyone interviewed said that people today know how they get HIV and what they should do to protect
themselves. Despite that the infection rates continue to be high. Yet the recipe is more information, mainly
transmitted in a rather diffusionist manner.
Not many have knowledge about how communication can be used as an effective tool in the fight against
HIV/AIDS. The use of communication often seems to be ad hoc and copying what is already being done,
rather than being strategic and planned.
Looking at the methods used for supporting PLWHA there are much more interpersonal strategies used,
like door-to-door campaigns to identify and counsel PLWHA and support groups where different matters
related to the disease and everyday life are discussed. The same methods could be used effectively also in
prevention efforts.
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Chapter 8: THE IKHALA MODEL
In this chapter I intend to answer my overall research question “How does the Ikhala model support CBOs
in meeting their challenges?” I will do this by describing the model based on its capacity building and
participatory communication approaches.
8.1 The capacity building approach
Building the capacity of the CBOs with methods that acknowledge and appreciate the local knowledge and
experiences is an important part of the Ikhala model. The CBOs are trained to become more professional,
but still encourage staying close to their roots.
8.1.1 Small grants to build capacity
Ikhala Trust is a micro fund for CBOs, but all stakeholders seem to agree that the money is not the most
important element. It is how the small grants are used that is innovative. “People have said to us you don’t
have to give us the money, but could you please just continue to talk to us the way you do and help us and
guide us and advice and come and visit” (Ikhala interviewee). Several CBOs expressed similar views. “It’s
not only the money, but everything related to the program. Everything that they can help us with” (CBO
interviewee).
According to Ikhala’s director Bernie Dolley the money is what initially might attract CBOs, but they often
know about the work of Ikhala when they apply for funding. Ikhala do not advertise their money or ask for
proposals. All CBOs are found through recommendations and referrals from other organisations and people
within the Ikhala network. “We do not advertise that we have money. We get grantees on reference and
recommendation” (Ikhala interviewee).
If a CBO is believed to fit the acquirements, Ikhala is very supportive already in the application stage. “The
small organisations write letters and not really applications. That’s why Ikhala has an application form. It is
much easier to be guided, to answer questions and write down your motivation” (Ikhala interviewee). Often
someone from Ikhala sits down with the CBOs and help them write the application.
The grants are then used to build the capacity of the CBOs. When an organisation receives a small grant it
enters what could be called ‘the Ikhala Trust capacity building program’. This continues for a year and
includes two project development workshops, at least two visits from the field worker, feedback on monthly
reports and possibility to get support, advice and mentoring from Ikhala Trust staff through telephone.
While they are being funded they will be part of a capacity building program that is facilitated by Ikhala to
make sure that they are able to run their projects sufficiently and that they are able to account for the
42
funding that they receive and that they are strengthened, so that once the funding stops, they will be able to
sustain what they have started and they will be able to access other resources. (Ikhala interviewee)
All CBOs funded by Ikhala are on a level where other donors do not want to approve funding due to the risk
that money will not be used appropriate. “But Ikhala is saying we understand the risk, but we are going to
risk money, we are going to trust you. We are going to take you on a certain journey and we are going to
provide you with skills. We are saying if you give these people capacity, they are on their own going to raise
issues” (Ikhala interviewee).
8.1.2 Capacity appreciation
Ikhala’s point of departure is a belief in the CBOs’ own capacity and knowledge about the context and areas
where they work.
The fact that they cannot administer resources does not mean that they cannot do the work. The thing that
they do not have a telephone does not mean that they cannot assist the one who is sick. … Probably they
might have a challenge in terms of capacity or competences, but what Ikhala is doing is providing that
capacity. (Ikhala interviewee)
Often the CBOs are so occupied looking at what they lack and what they do not have that they miss
recognising what they already have.
People don’t realise they have it [capacity and knowledge]. We need to make them aware that they have this
in the community, they have this within the organisation and that we will add to what they have and we can
do it together, because when our part stops they need to be able to continue. (Ikhala interviewee)
Ikhala is very cautious not to view poor people as less intelligent merely because they do not have access
to the same resources.
There is also the issue of people at a certain level who want to raise issues for the poor, always having this
thing that the poor does not know anything, the poor is poor and does not have a voice and that is not true.
And we are saying that we want to capacitate the poorest of the poor so that when they have capacity then
they can raise issues. (Ikhala interviewee)
Building organisational capacity is what Ikhala mainly works with, training CBOs in budgeting, report writing
and governance. However, the CBOs also need increased capacity to tackle other challenges within the
organisation and are given strategies to do so.
During the workshops Ikhala discuss the importance of choosing board members carefully and help them
understand and fulfil their obligations. CBOs are encouraged to formalise the relationship with volunteers,
writing contracts with them and to make them stay longer by offering them psychosocial support and
involve them in the organisation, not only as cheap labour, but as important stakeholders. Ikhala also talk
about the importance of’ ‘caring for the carers’ and help CBOs come in contact with organisations doing
training within the field or offering assistance.
43
The CBOs need training also within areas not directly related to organisational development, e.g. home
based care, counselling and advocacy. But Ikhala is very clear that they are not the ones that should do this
training. “We don’t have the capacity, we don’t have formal knowledge and skills” (Ikhala interviewee).
“What we can do is to link them with other resources that can help them with some of the other things that
they need and also to facilitate the capacity building” (Ikhala interviewee). Ikhala links the CBOs with other
organisations, working with similar workshop methods and sharing the same vision as Ikhala, and who are
experts in training CBOs within their area.
We facilitate it. So when they do an assessment and it comes out that they need training in counselling skills
it is not Ikhala’s job to go and train them in counselling. We don’t have the capacity there. Then we will link
them with some other organisation and those people will go and train them. (Ikhala interviewee)
It is seen as important that these capacity builders are familiar with the workshop model used by Ikhala.
Whoever goes to give the other support, we need to tell them what we do in the project development
workshop and go into some of the philosophy. ... Not to influence the content and their expertise, but maybe
how they do things and what is done and to explain the sort of level on which the projects are so they can
prepare in a certain way. (Ikhala interviewee)
Ikhala employees and board members have a lot of contacts and are planning to build a formal data base
with information about other organisations, consultants and capacity builders that work according to the
same participatory, open ended principles. The trainers should preferably be locally based. “We believe in
using Eastern Cape people first, before we look elsewhere. They know the language and they understand
the environment” (Ikhala interviewee).
Ikhala usually do not have funds allocated for training, but tries to find different funding solutions.
Sometimes the trainer will go for free, sometimes there is money within the project to pay for this, sometimes
we can go through the department of labour and they pay for the training. … If there is an urgent need and
there is a group of projects maybe that has that need, and we can’t wait for the grant to come through, we
will look if there is funding available on Ikhala’s budget. (Ikhala interviewee)
8.1.3 Capacity development – to work with budgeting
Ikhala uses the small grants as a way for the CBOs to learn about budget managing. In the first workshop,
which is compulsory for new CBOs to attend, they talk a lot about budgeting and how to manage funds.
Ikhala uses a pre-printed form that the CBOs should fill in every month for reporting (see Appendix XI). The
form makes it easier for the CBOs to understand and learn what parts should be included. If there is a
problem with the report the fieldworker or administrator will contact the CBO and discuss how to improve
the reporting. The CBO is also welcomed to phone Ikhala staff for support on budgeting, report writing or
other issues.
What makes Ikhala Trust different from most donors is the possibility to discuss the approved budget. If the
CBO have good reasons and have proved to be trustworthy, Ikhala might be open to changes in how the
44
money is used. As long as they are always consulted before the money is used. Ikhala believe that their role
is to support rather than control. “What I like about them is that when they donate money to you it’s not like
they are breathing down your neck, but they come visit your organisation, check up on you to see if there is
anything they can help you with. Other funders don’t do that.” (CBO interviewee) Ikhala do not want to be
the driver of a project, but believe that the CBOs should be that themselves. “We don’t want to push people.
We want to capacitate people and they move on their own” (Ikhala interviewee).
8.1.4 Capacity development – to work with other donors
One of the main focuses of the Ikhala model is to build the organisational capacity of CBOs to make them
more attractive for other donors to fund. Organisations should be able to do fundraising on their own when
they exit the Ikhala program and preferably have at least one new funder. But Ikhala encourage CBOs only
to accept money from a donor if they can live with the strains attached and to not accept everything just to
get money. “What we try to say to CBOs are ‘Yes, you need the money, but remember that once you get the
money the money comes with strains and you must be able to live with those strains’” (Ikhala interviewee).
The relationship with the donor should build on common understanding and mutual interests and the donor
should add something more than money, so that when they leave they have contributed to develop the
organisation.
A partnership should be equal. You should have an agreement with your partner organisation. What they do
is look at the financial management, they should not decide on activities. It should be like a mentorship. They
should leave something behind. Not only spend money and then leave you with no new learning. …
Mentorship is working together on a job, not just go to training. You should have an agreement with your
partner/mentor. Before you write the agreement, make sure they have something to add.” (Melanie Preddy
to CBOs at workshop 26/01/2007)
As noted in Chapter 6 sometimes the real problems within an organisation often start when the
money comes, creating mistrust and disagreements. Ikhala tries to prepare the CBOs for
difficulties that might occur when funding is approved.
Good organisations can be destroyed by conflict over money. It’s not because of corruption or greed, but
because people are desperate. To avoid conflicts it is important to keep records, have finance committees,
spend according to approved budget and communicate what you have got funding for. (Melanie Preddy to
CBOs at workshop 23/01/2007)
8.2 Participatory communication approach
The participatory use of communication is an important aspect of the Ikhala model. Through field visits,
participatory workshops and networking Ikhala encourage the CBOs to share their experiences and involve
important stakeholders in their work. Community participation and the use of participatory monitoring and
evaluation are encouraged.
45
8.2.1 Close to the field
Ikhala is based in Eastern Cape and has the possibility to be ad hoc and respond to urgent needs very
quickly. Since Ikhala has few employed people, everyone is close and easy to get in contact with quickly.
Decisions can be made without much bureaucracy. The CBOs know that “Whenever we need anything, we
just call Ikhala and they help us” (CBO interviewee). Both the director, the field worker and the
administrator often go on field visits, and are thus very aware and informed about the actual conditions on
community level.
The number of contact sessions we have per grantee over time, planned and ad hoc makes us very different
from many others. Many intermediates are not based in the province, they come in from the outside, so they
have to be structured and planned right in advance, while we are being ad hoc. (Ikhala interviewee)
The staff knows the CBOs personally; they are not just names on a paper. They know who the leaders are,
where they are located and what the conditions in that community are. “Other donors will not have time to
come to the remote areas of Eastern Cape” (Ikhala interviewee). The CBOs also feel like they are on the
same level. “The director is very present. She is down on the ground. We are all on the ground. The others
are so high up” (CBO interviewee).
The method is very ‘hands on’ responding to the needs that occur during visits whether it is a soup kitchen
that is out of food, a project that needs a fan for a sick client or a leader who needs advice on how to deal
with a board member (all examples from my participatory observations).
Ikhala do not do field visits primarily to control and monitor. They want to give support and thus want CBOs
to share their difficulties. Most CBOs also seemed to be very open about their problems and not afraid to
share things that are not going as well as expected. They are not worried to lose the funding, but want
support to change for the better. “We usually go there and sit with them and assist them, practically”
(Ikhala interviewee).
8.2.2 Participatory workshops
All CBOs take part in project development workshops arranged by Ikhala. These workshops are open ended,
i.e. the participants are very involved in deciding what to talk about. There are certain important issues, like
budgeting, report writing and governance, which will be covered during the week, but the training and
discussions are based on the participants’ own experiences and questions.
A lot of time is reserved for the CBOs to discuss issues they find important. Time is used for group work and
experience-based learning. Problems and questions that come up are discussed among participants and
the facilitator is not expected to have all the answers.
I think people learn much more from each other actually than from the facilitator and I feel my job is asking
the right questions and giving people a framework in which to view what they already know and what they are
46
already doing. … At the end of this workshop that we just have done in January, they actually said; we know
this stuff, but we didn’t know that we knew it. (Melanie Preddy, workshop facilitator)
The CBOs appreciate that the facilitator communicates with them like equals and talk about issues in a way
that is clear and easy to understand. “I can also say that their trainer is the best. She is going down to
people. If you are here you will go back home knowing what you have been coming here for and when you
go home you deliver the real and the exact information” (CBO interviewee).
Ikhala believe it is important that not only the CBO leader participates, but one more representative from
the CBO is invited to take part in the workshop. This is to increase the possibilities that new knowledge will
be shared within the organisation and to encourage greater participation. “It’s also going to help us
because they said they wanted two people within an organisation, both the one who is doing the ground
level and the higher level, so all the people are empowered” (CBO interviewee).
At the end of the year a week long grantees conference is arranged paying attention to issues and needs
grantees have expressed during the year, inviting experts in different fields and giving CBOs the opportunity
to together discuss matters they find important.
At the end of the year they have the grantees conference, where all the grantees come together and then
they are focusing on specific issues that came out of the year’s assessment and where they can share their
stories. If they have other specific needs … then a special arrangement is made with [a capacity building
organisation] to come and do a debriefing with them to give them skills. (Ikhala interviewee)
There is a discussion within Ikhala about using the money for this conference to more locally based
activities, bringing the capacity building closer to the field and making it possible for more people to attend.
8.2.3 Language
In Eastern Cape the main languages used are English, Afrikaans and Xhosa, but most of the CBOs are
Xhosa speakers and feel most confident and comfortable expressing themselves in their mother tongue.
Thus, it was seen as very important that the new field worker and administrator employed during 2006 both
speak Xhosa. Furthermore, Ikhala has developed a dictionary where the most common words in the
development vocabulary are translated into English, Afrikaans and Xhosa.
The importance of language is also recognised during the workshops and partly because the workshop
facilitator is not Xhosa speaker, group work and experienced based training in groups are important
elements and participants are also welcomed to do some presentations in Xhosa.
I understand some Xhosa, but I can’t present the training in Xhosa or facilitate in Xhosa. I have to be much
more conscious of, and that’s probably a good thing, group work and letting people do much of experienced
based learning with each other because that’s an opportunity when people can speak in the language they
are most comfortable in. … I think that is actually one of the positives of not being able to be fluent in the
local language because it makes me more accommodating and makes more space for people and real
experienced based learning and make people spending lots of time with each other speaker their language.
(Melanie Preddy, workshop facilitator)
47
8.2.4 Networking
Becoming an Ikhala grantee opens up a network of CBOs that may be used for discussing difficulties,
sharing experiences, advocate and work for joint goals. “We need to encourage each other because it can
be so stressful. Sometimes we don’t even want to do our work anymore” (CBO interviewee). Getting CBOs
organised is seen as a very important aspect of the work of Ikhala. Ikhala encourages CBOs to form
networks where they may share information and knowledge and give each other support, but emphasise
that networks needs to be based on mutual interests and shared visions. As discussed in Chapter 6,
networks based on other needs than money have better possibilities to become sustainable, but may in the
long run also be used for getting access to funds. However, the networks must be formed voluntarily and
not merely based on funding needs. The networks are also seen as a possibility for the small CBOs to get a
more uniform voice and put pressure on decision makers and donors. Working together makes the CBOs
stronger advocators and give them confidence.
They want Ikhala to go and advocate and lobby on their behalf. But that is not Ikhala’s role. Our role is to link
them or aspire their capacity building. Make sure that they get training so that they can lobby themselves for
their issues on a local level. Also to try and mobilise them into clusters. That people with similar problems
can come together and together they can go and voice, because that is part of empowerment, that you are
able to articulate your own problems and needs and advocate for it. Not for someone else to do it for you,
because that creates dependency. You need to fight your own case. (Ikhala interviewee)
The networking idea will be further developed during the coming years.
We are coming up with this new idea now that for the next three years to look at clustering. … We will help to
cluster the project in a municipality and give them the skills so they can have networking sessions, where they
can come together and learn from each other and support each other and form a voice to say we are coming
here, to the district municipality, we are speaking on the behalf of the CBOs, but also to start and look at other
networks, because there are so many forums available for the CBOs. (Ikhala interviewee)
8.2.5 Community participation
The participation of volunteers, members, clients and other stakeholders in the community is seen as very
important. There are different kinds of organisations, some of them are started by pioneering individuals
who tend to view the organisations as their own and thus may have difficulties sharing information and
including others in decisions.
Ikhala emphasises the importance of involving all stakeholders and including both volunteers and clients in
discussions and allowing them to have a say. During the workshops Ikhala discusses the importance of
transparency and sharing of information within the organisation.
Make sure that information flows. It also helps you to avoid conflict. The coordinator needs to be in contact
with the ground level otherwise something is wrong. … If you want something that is your own, start a
business. Otherwise it belongs to the community, it is not yours! (fieldworker Vuyo Msizi at workshop
24/01/2007)
Furthermore, the importance of participation of beneficiaries is emphasised.
48
It is important to tell them that the people that are actually benefiting from the service should be part of the
consultations that guide what you do, they should be part of the planning, they should be part of the
monitoring and evaluation. Because otherwise you will get lost from the real needs. You think that you think
what you perceive as the need and it might not be the need anymore that is down there. So we need to say
that even if you develop you organisation and formalise, keep close to your roots, where you are coming
from. (Ikhala interviewee)
Ikhala believes that one increasingly important task is to make not only CBO members, but all community
members more informed by disseminating information and communicate what is happening at a provincial
and national level, giving the community members an opportunity to discuss and give voice to their
opinions. Community members need to get access to sufficient accurate information and together start
advocating for change. “I believe that our role in the future will have much more to do with making
information available to communities” (Ikhala interviewee).
PLWHA also need to be informed about their rights, like access to disability grants and ARV, and that people
are not allowed to discriminate them. “We need to ensure that people know their rights, that they know that
people can’t discriminate against them, that people can’t stigmatise them because they have a chronic
disease” (Ikhala interviewee).
Instead PLWHA should be allowed to participate in the work of the CBOs and viewed as a resource, for
example by acting as role models for other PLWHA and taking part in prevention efforts.
8.2.6 Participatory monitoring and evaluation
Looking at Monitoring and Evaluation (M&E) Ikhala is in many ways working according to the method called
Participatory M&E (Parks et al, 2005), including the CBOs in the evaluations and stressing that they
themselves should gain something from the process. A focus for the coming three years is to build the
capacity within CBOs to do their own monitoring and evaluation. Each project will do a baseline, have
indicators and do impact assessment.
Ikhala has its own indicators, but each project needs to develop their own indicators. One thing we want to
focus on, and need, is to build the capacity within CBOs to do their own monitoring and evaluation, so they
can be part of the process to do the baseline and to evaluate and monitor themselves throughout the year.
(Ikhala interviewee)
One idea is to link projects, that have already successfully gone through the Ikhala program, with new
projects in the same geographical area to help gather baseline data and help Ikhala assess if the CBOs are
ready for funding or not.
After the one year funding period a new assessment is carried out to decide if the project should exit or be
refunded for another year. However, even if a CBO is exited the contacts usually do not stop there. Many
organisations continue to ask Ikhala for advice and support long after the actual funding period have
ended. All CBOs witnessed about the effectiveness of this strategy and the organisations that had been
supported by other donors pointed out how unique they experienced the model to be.
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8.3 Replicating the model?
Ikhala is noticing a growing interest in the model and has been discussing the need to formalise and
document the knowledge and experiences.
There are so many requests to say can we replicate what you are doing. So what we are starting to realise,
yes we have a lot of knowledge, but it is in the heads of all of us. It’s not written down, so we need to start to
tracking exactly what are we doing. (Ikhala interviewee)
However, this has also raised the issue of how the model might be replicated in a sufficient way.
We can not just give it to any person. Say a poor and reputable organisation takes the model and
go and implement it. It can bring a lot of negativity to what we are doing. So we need to be careful,
who is replicating what we are doing and how are they replicating it. Is it to the benefit to that
community or not? So we need to look at the pros and the cons of people taking our information
and use it, acknowledging us for developing it. (Ikhala interviewee)
If replicated in a sufficient manner, Ikhala themselves believe that the model may be very useful on many
levels. “We are not perfect, but we think that we have a model in the making that can be replicated [by
others] from mega donors to intermediates to community level, that we would like to offer” (Ikhala
interviewee).
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Chapter 9: CONCLUSION
Learning about the challenges facing CBOs working with multi-disciplinary HIV/AIDS initiatives and getting
to understand the Ikhala model has been an incredibly instructive experience. I started out with a wish to
move beyond “buzzwords” and find out how to create real grassroots participation, ownership and
empowerment. While carrying out this field study I have learned a lot and gained an increased
understanding of the circumstances surrounding work at CBO level. But I have also realised how complex
these issues are, how interrelated many challenges are and how difficult it may be to break patterns. In this
concluding chapter I will try to summarise my findings, share my thoughts regarding the Ikhala model and
come up with some recommendations.
9.1 Summary of my findings
In this study I have identified a number of different challenges facing CBOs working with multi-disciplinary
HIV/AIDS initiatives in the Eastern Cape. Some of them, mainly the ones linked to funding issues, are much
related to other stakeholders. Getting access to government and donor funding is difficult and CBOs have
to compete for funds with more formal and professional NGOs. Different kinds of networks could pose as
an opportunity to cooperate, but when they are formed mainly to access funding they do not work very well.
Networks could be used for mutual advocacy, but when members fear that open critique will lower their
chances of getting access to funding it makes them less willing to voice their concerns.
Lack of resources combined with poverty and societal challenges make the working conditions for CBOs
difficult. There are no, or very limited, social support systems in the communities and discrimination against
PLWHA is common. Gender inequality and religious beliefs counteracts the work of the CBOs. This situation
is further complicated by different organisational challenges such as lack of expertise and specialised
knowledge, psychological pressure and power issues within the organisation.
Due to lack of recourses and advocacy skills the CBOs find it hard to voice their needs and concerns. They
feel that their specific knowledge about the needs within the communities is not valued. Furthermore,
insufficient strategic communication skills limit the results of the CBOs’ prevention efforts.
The Ikhala model tries to meet these challenges by building the capacity of the CBOs through participatory
methods and thus makes them more prepared and better suited both to meet the expectations of donors
and to address the problems in the communities.
During the capacity building process Ikhala also highlights the strengths of the CBOs, e.g. their extensive
knowledge about the local context, closeness to the people in the communities and understanding of their
needs and their possibility to quickly respond to an urgent need.
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9.2 My thoughts regarding the Ikhala model
I believe that in the long run the Ikhala model, if taken to scale, actually has a possibility to influence most
of the challenges identified in a positive direction. Obviously the overall challenges require much more, but
bringing people together and with them acknowledge their strengths and weaknesses and help build their
capacity, offers a great opportunity for creating the social and environmental changes necessary to fight the
epidemic. It should be stressed that when I talk about taking to scale, I do not mean Ikhala growing into a
huge organisation, but rather the methods being duplicated through interlinked networks with a number of
Ikhala-like organisations.
9.2.1 Advantages of the model
Through Ikhala Trust small CBOs are able to access funding to improve their physical resources and get
training and capacity building. The organisations are supported during the whole process and Ikhala acts as
a mentor rather than a controller. The CBOs are strengthened and become more professional, but are at
the same time encouraged to stay close to their roots and appreciate what makes them unique and
different from more formalised NGOs.
By actually listening to the CBOs Ikhala is responding to the real needs, both in terms of resources, training
and mentoring. CBOs are also strengthened by coming together and discuss their work and help each
other. Networking also makes them better advocators. They are encouraged to include all important
community stakeholders in their work to become stronger. By becoming more professional in their contacts
with volunteers, clients and board members they are also better suited to make use of their resources.
The CBOs are provided with skills within different areas and Ikhala helps facilitate contacts with other
organisations with similar views. Ikhala guides the CBOs without controlling them and continues to offer
them support also when the funding period has ended.
9.2.2 Weaknesses of the model
In my interviews not many people criticised the Ikhala model. The only weakness explicitly mentioned is the
lack of a next level.
You can’t really talk about sort of a carrier path for projects, because they get stuck, because at the next
level, if you call us pre school, the next level is primary school and actually there is a difference and you can’t
get in. (Ikhala interviewee)
The huge gap between CBOs and the formalised professional NGOs that receive the majority of the funds
for CSOs is not sufficiently bridged after a year of Ikhala funding and there is a major risk that CBOs
continue struggling without resources and acknowledgement for their work. If leaders and volunteers who
were active in the CBO during the Ikhala funding period leave the organisation, the knowledge might get
lost and the CBO is back where it started.
52
The other weaknesses I have identified could to my understanding rather easily be counteracted by adding
some elements to the Ikhala model and will thus be discussed in the next section.
9.3 Recommendations
Like Ikhala I believe that the model should be documented and a discussion about how the learnings might
be shared should be initiated. Furthermore, I believe it would be important to discuss how the CBOs’ ability
to contribute to the preventive efforts could be further strengthened with the help of the Ikhala model.
The actual long term impact of the preventive work carried out by CBOs might be questioned. They are
making an invaluable contribution in mitigating the effects of the epidemic and caring for the sick. However,
the continued growth of the number of infected people within the communities where the CBOs work
indicates that the prevention efforts are not sufficient. Ikhala do not, and should not, play the role as a
trainer in HIV/AIDS prevention methods, but I believe that the CBOs’ needs of training within this area
should be acknowledged and encouraged more. Training in preventive activities should be as important as
training in HBC and counselling.
One area that could, to my understanding, be paid more attention is the need for well-planned HIV/AIDS
communication strategies. Most CBOs work according to simplified ABC-approaches aiming at individual
behavioural change through diffusion of information. Knowledge about participatory communication
approaches would help the CBOs diversify their efforts and hopefully make them more effective.
Furthermore, the use of participatory communication strategies as a way to empower the whole community
could be recognised following some of the thoughts within Communication for Social Change. I think this is
a very important area where external trainers are needed to support CBOs in developing more effective
methods. It is also important to make sure that the CBOs get access to new findings, research and reports
related to HIV/AIDS prevention.
9.4 Some final remarks
My theoretical framework is mainly influenced by participatory communication where issues of power play a
central role. Many of the challenges identified in this study are much related to power and politics and a
strengthened, empowered civil society where members have knowledge about their rights and know how to
advocate for them will eventually put pressure on those in charge and demand for change. However, it is
important to acknowledge that change in power relations are not easy and there is a need for change on
many different levels ranging from family and community to government and international institutions.
There is a need for change not only on a macro level, but also between men and women, children and
adults, infected and non-infected and so on. There is no blueprint to how this will be achieved, but to start
listen to the so called voiceless and acknowledge their experience and knowledge, build on their capacity
and encourage greater participation within the organisations and the communities is at least a start.
53
REFERENCES
Birdsall, K. & Kelly, K. (2005) Community Responses to HIV/AIDS in South Africa CADRE
Campbell, C. & Williams, B. (1999) Beyond the biomedical and behavioral: towards an integrated approach
to HIV prevention in the Southern African mining industry. Social Science & Medicine 48, pp. 1625-1639
Eastern Cape Department of Health (2006) Province of the Eastern Cape Department of Health. Annual
Report 2005/2006
Eastern Cape Department of Health (2005) HIV and Syphilis Antenatal Sero-Prevalence Survey in the
Eastern Cape 2005
Fangen, K. (2005) Deltagande observation Stockholm: Liber
Freimuth, V. et al (2000) Communicating the Threat of Emerging Infections to the Public. Emerging
Infectious Diseases, Vol. 6, No. 4, July–August 2000, pp. 336-347
Govender, C. (2001) Trends in Civil Society in South Africa Today. Umrabulo, No. 13, December 2001
Gumucio-Dagron, A. (2001) Making waves: stories of participatory communication for social change. A
report to the Rockefeller Foundation New York: Rockefeller Foundation
Hansen et al (1998) Mass Communication Research Methods New York: New York University Press
Hemer, O. & Tufte, T., (Eds.), (2005) Media and Glocal Change. Rethinking Communication for
Development. Buenos Aires; Göteborg: CLACSO; Nordicom
Kvale (1997) Den kvalitativa forskningsintervjun Lund: Studentlitteratur
Mail & Guardian Online (21 August 2006) Manto defends Aids policies. Mail & Guardian Online
Morris, N. (2005) The diffusion and participatory models: a comparative analysis. In Hemer, O. & Tufte, T.,
(Eds.), (2005) Media and Glocal Change. Rethinking Communication for Development. Buenos Aires;
Göteborg: CLACSO; Nordicom
Mtshali, T. (10 August, 2007) Mbeki lashes Nozizwe. Sunday Times, online version
Nhlanhla Ndlovu (2005) An explorative analysis of HIV and AIDS donor funding in South Africa. Budget Brief
No. 155, 2005 May 13 IDASA
Nhlanhla Ndlovu (2004) The Cinderellas of Development? Funding CBOs in South Africa INTERFUND
Palitza, K. (24 January, 2006) Muddling the Message. Mail & Guardian Online
Parks, W., Gray-Felder, D., Hunt, J. and Byrne, A. (2005) Who measures change? An introduction to
Participatory Monitoring and Evaluation of Communication for Social Change. Communication for Social
Change Consortium
The Project People (2006) Assessing Ikhala Trusts Support to Health and HIV/AIDS-Sector Grantees
Grahmastown: The Project People
SA’s Zuma ‘showered to avoid HIV’ (5 April, 2006) BBC NEWS,
www.news.bbc.co.uk/1/hi/world/africa/4879822.stm, retrieved 11/08/2007
Scalway, T. (2003) Missing the message? 20 years of learning from HIV/AIDS London: Panos Institute
54
Servaes, J. & Malikhao, P. (2005) Participatory communication: the new paradigm?. In Hemer, O. & Tufte,
T., (Eds.), (2005) Media and Glocal Change. Rethinking Communication for Development. Buenos Aires;
Göteborg: CLACSO; Nordicom
Singhal, A. & Rogers, E. (2003) Combating AIDS. Communication Strategies in action. New Delhi: Sage. pp.
205-241. In reader/compendium, International Health Communication Workshop, 8-11 March 2006
South Africa Department of Health (March 2007) HIV and AIDS and STI Strategic Plan for South Africa
2007-2011
South Africa Department of Health (2005) National HIV and Syphilis Prevalence Survey South Africa 2005
South Africa Department of Health (2000) HIV/AIDS/STD Strategic Plan for South Africa 2000-2005
The Henry J. Kaiser Family Foundation (2007) The HIV/AIDS Epidemic in South Africa HIV/AIDS Policy Fact
Sheet, June 2007
Tufte, T. (2005) Communication for what? How globalization and HIV/AIDS push the ComDev agenda. In
Hemer, O. & Tufte, T., (Eds.), (2005) Media and Glocal Change. Rethinking Communication for
Development. Buenos Aires; Göteborg: CLACSO; Nordicom
UNAIDS (2006) Report on the global AIDS epidemic Geneva: UNAIDS
UNAIDS/OECD (2004) Analysis of Aid in Support of HIV/AIDS Control Geneva:UNAIDS/OECD
UNAIDS/WHO (2006) 2006 AIDS epidemic update Geneva: UNAIDS/WHO
Waisboard, S. (2005) Five key ideas: coincidences and challenges in development communication. In
Hemer, O. & Tufte, T., (Eds.), (2005) Media and Glocal Change. Rethinking Communication for
Development. Buenos Aires; Göteborg: CLACSO; Nordicom
Waisbord, S. (2001) Family Tree of Theories, Methodologies & Strategies in Development Communication:
Convergences & Differences. New York: Rockefeller.
WHO (2007) Towards universal access: scaling up priority HIV/AIDS interventions in the health sector:
progress report, April 2007. Geneva: WHO
Winskell, K. & Enger, D. (2005) Young voices travel far: a case study of Scenarios from Africa. In Hemer, O.
& Tufte, T., (Eds.), (2005) Media and Glocal Change. Rethinking Communication for Development. Buenos
Aires; Göteborg: CLACSO; Nordicom
Websites
Aegis: www.aegis.com
Avert: www.avert.org
BBC: www.news.bbc.co.uk
ECNGOC: www.ecngoc.co.za
Ikhala Trust: www.ikhala.org.za
Landguiden: www.landguiden.se
Mail & Guardian Online:
Sida: www.sida.se
UNICEF: www.unicef.org
55
Ikhala Trust and CBO documents
Emmanuel Advice Care Centre (n.d) Constitution of Emmanuel Advice Care Centre
Emmanuel Advice Care Centre (n.d.) Service Plan of Emmanuel Advice Care Centre
Ikhala Trust (2007) Draft PPM February 2007
Ikhala Trust (2007) Notes from Ikhala Trust Workshop Project Development: January 2007
Ikhala Trust (2006) Ikhala Trust Abridged Annual Report 2005-2006
Ikhala Trust (2005) Process Notes from Ikhala Project Management Training Workshop: 23 rd-25th August
2005
Ikhala Trust (n.d.) Information Leaflet
Thandi Youth Development (n.d.) The Business Plan of Thandi Youth Development
56
Appendix I: METHODOLOGY
In this methodological appendix I intend to further discuss the processes leading to the final methodology
adopted, my own position and role in the study as well as in more detail explain the different methods used
and the research sample. Furthermore, I will discuss the use of quotations as well as possible weaknesses
of the methods used.
1. Methodological process
1.1 Initial phrase
When I went to South Africa I knew I wanted to carry out a qualitative study, since it seemed to be the most
suitable set of methods to fulfil my aim. My methodological preparation was mainly influenced by Kvale
(1997), Hansen, Cottle, Negrine and Newbold (1998) and Fangen (2005). I had a lot of ideas about how
the study could be carried out and what methods I wanted to use. However, I was also aware of the need to
be able to adjust my study to the realities in field and be prepared to change some ingredients to end up
with a functional working plan.
Some days after I arrived to Port Elisabeth I met with my local contact person Bernie Dolley, who is also the
director of Ikhala Trust, and together we constructed a preliminary plan for the field study based on my
needs and the actual possibilities in field. During this meeting I was informed that a workshop for new
grantees, on organisational development, was to take place the following week and this offered an
excellent opportunity for me to observe and learn more about Ikhala and the CBOs.
1.2 Changed focus
Gradually during the first week I realized that my study needed to slightly change focus. This
acknowledgement was further strengthened when reading Assessing Ikhala Trust Support to Health and
HIV/AIDS-Sector Grantees (The Project People, 2006), an impact assessment of Ikhala Trust’s work, and
other documents that was only available to me after I entered the field. My new understanding of the
environment, as well as extended knowledge about what had already been written, made my aim and
objectives gradually change focus. First I felt that, now that I had partly changed objectives, I might have
been observing the wrong things during the first week’s workshop and that the group interviews I had
already carried out may not be very useful, but later I realised that a lot of interesting and important
findings had come out from them. The questions I asked in the beginning were important because they
gave me a deeper understanding of the context, of terminology used, of the participants’ view on
development and understanding of communication as a tool. Furthermore, all the reading I had done prior
to my field study also provided me with a greater understanding of what I saw and, I believe, made me more
qualified to interpret.
57
The first intense week was followed by a period of reading, reflecting and reconstruction of my interview
guides. I was eager to start interviewing, but different circumstances made me have this involuntary, but
very constructive break from the field.
2. Methodology used
2.1 Literature and desk review
Prior to the actual field study I concentrated on reading about HIV/AIDS communication and participatory
communication strategies, as well as background materials on South Africa. When in South Africa my local
contact person Bernie Dolley provided me with two documents that would prove to be essential in my field
study. The first one was Assessing Ikhala Trust Support to Health and HIV/AIDS-Sector Grantees an impact
assessment of the work of Ikhala Trust carried out by the Grahamstown based development consultants
The Project People in August 2006. These reports provided me with a lot of background information on the
Eastern Cape context, as well as the situation in the communities where the CBOs in my study operate.
The second report, The Cinderellas of Development? Funding CBOs in South Africa (Nhlanhla Ndlovu,
2004) gave additional insight to the challenges facing CBOs in South Africa as well as a better
understanding of the objectives influencing the donor community. Furthermore, the report referred to
several other interesting reports and articles about community and civil society initiatives in South Africa.
2.2 Field research
2.2.1 Observations/ Participatory observations
Observations were carried out during a week-long workshop on organisational development arranged by
Ikhala Trust for new grantees. Participants from ten different organisations, nine of them working mainly
with HIV/AIDS issues, took part in the workshop. I was present during different workshops the whole week.
Most of the time I was a quiet observer, but during breaks I was able to interact with CBO participants,
Ikhala Trust staff and the facilitator. Thus, the workshop offered a very good introduction to the work of
Ikhala Trust and a better understanding of CBOs.
Observations were also carried out during field visits to CBOs that I did both together with Ikhala Trust staff
and on my own, and during one meeting with volunteer caregivers. The field visit observations offered a
good complement to the more formal interviews and I was able to observe both the work of Ikhala and of
the CBOs. Depending on the situations I sometimes was a quite observer and other times was able to
participate, interact and ask questions.
2.2.2 Group interviews
58
In connection with the workshop I was also able to carry out two group interviews, one with project leaders
and one with other participants from the CBOs. My intention was to carry out focus group interviews
according to the suggestions in Hansen et al. but I did not fully master the technique to “essentially …
‘facilitate’, ‘moderate’, and ‘stimulate’ discussion among the participants” or to maintain “a reasonable
balance of contributions” (1998:272).
My intention was to have 6-8 participants in each group and I asked for that number of people, but when
10-11 showed up I found it hard to ask some to leave and thus ended up with more participants than
desirable. I tried to explain the basic ideas behind a focus group discussion, but since it was new to both
the participants and me it was hard to keep everyone involved and the persons that had taken a leading
position during the workshops did so during the interviews as well. Still the group interviews provided me
with much useful information, especially when I occasionally managed to stimulate a discussion between
participants.
Later I carried out one more group interview with volunteer caregivers in one of the CBOs and this time I
managed to involve the participants more and since they knew each other it was much easier to stimulate
discussions.
2.2.3 Semi-structured interviews
I carried out semi-structured interviews with both Ikhala and CBO representatives. The interviews were
based on semi-structured interview guides, but I ended up doing rather semi-free or semi-unstructured
interviews only using the themes of the guides and instead trying to ask relevant follow-up questions and
focusing on the areas where the interviewees seemed to have most to share. Since my aim was not to
make a comparison between what different interviewees said, but to gain thorough knowledge and
understanding, I felt this was the most suitable method. I was very well prepared and knew a lot about the
subjects discussed and was very familiar with my interview guide. This made it easy for me to ask relevant
follow up questions and to jump between different parts of the guide and still be able to cover most
themes. One risk with this procedure is that I might have focused too much on the answers that confirmed
my hypotheses and been less willing to follow up tracks that did not fit into my pre-understanding. However,
all the interviews were recorded and listening to the recordings, I do not think this posture a real threat to
the validity of my findings.
When constructing the interview guides I had a number of topics or themes I wanted to cover and within
each theme I asked a number of open ended questions. I constructed different interview guides for
different interviewees based on their roles, but covered the same themes in all interviews (see interview
guides in Appendix II). I chose not to focus my questions on the context and background information
regarding Eastern Cape and HIV/AIDS or national strategies, but rather used my desk study to obtain this
information.
59
When starting the interview process I realised that my guides sometimes were a bit too academic and that
some questions presupposed knowledge about strategic use of communication. I thus avoided asking
some questions or tried to reformulate them to make sure that the interviewee would fully understand what
I was asking. Every interview was thus adapted to the interviewee and although I was careful to ask all
relevant questions I did not ask them in the same way in all interviews.
3. Research sample
The list of interviewees was not decided on and fixed, but changed during my stay. However I did my best to
select participants that I believed would represent a wide scope of knowledge and experiences important to
the study. I ended up with fewer CBO interviews than I intended, but combined with interviews with the
representatives from Ikhala and the desk study, I felt that I had gained sufficient knowledge about my
research questions when I left South Africa.
All in all I interviewed five Ikhala representatives and three CBO leaders. Furthermore I carried out three
CBO group interviews, one with CBO leaders, one with other CBO representatives and one with volunteer
caregivers working for one of the CBOs. Although I recognise that there are several different levels in the
CBOs and the leaders’ responses might not be the same as volunteers and “clients” I have chosen to
mainly focus on leaders when interviewing due to the nature and size of my field study.
4. Issues
4.1 Anonymity
Before entering the field I had, according to the recommendations from Kvale (1997), decided to let the
interviewees be anonymous to make sure they felt free to express their opinions. However, starting the
interviews by letting the interviewees know that I was not going to use their names I realized that most of
them looked a bit puzzled and also, I would say, somehow disappointed. They shared their time, knowledge
and experiences with me and I was not even going to mention their names! I thought a lot about how to
handle this and decided to mention the names of everyone I have interviewed in an appendix, but not using
the names when quoting. The reason for this is that I have not been able to reconfirm all quotations with
the interviewees as suggested by Kvale (1997). Furthermore when I started questioning if the anonymity
was necessary I had already interviewed several persons and told them that I was not going to use their
names when quoting. I have interviewed people in different positions and I am using quotes from both
representatives from Ikhala, CBO leaders and volunteers, but due to the questions asked I do not think it is
necessary to know from whom the quote is. I am not trying to compare what people with different roles
think, but instead trying to understand the situation, CBO challenges, and possibilities offered by the Ikhala
model. I have chosen to refer to quotations from CBO interviews, both from individual and group interviews,
as “CBO interviewee” and quotations from the Ikhala representatives as “Ikhala interviewee”. Since the
study is not of an evaluative or critical nature, but rather explorative I do not think anyone who participated
might experience difficulties due to the fact that their names are mentioned in the appendix. Since I had
60
told the interviewees that they would remain anonymous I still decided not to number the interviewees (e.g.
CBO interviewee 1, CBO interviewee 2 etc.). The advantage of doing that is that it would be easy to see e.g.
if I have quoted some interviewees more than others and link statements from one interviewee. However, it
would also be easier to trace different statements back to the interviewee and I thus decided not to do this.
Looking at the quotes I have selected I can see that the Ikhala interviewees are over represented. It should
be noted that often the Ikhala and the CBO interviewees expressed similar views, but several of the Ikhala
interviewees have English as their mother tongue and are also more used to express their opinions in a
language easy to quote. Furthermore, most unfortunate my voice recorder failed to work during one CBO
interview. This was only discovered after the interview and left me with only supportive notes and my
memory and thus made it harder to quote. I have tried to choose CBO quotes whenever possible, but
maybe it could have been done to an even greater extent.
4.2 My own position and role
Both prior to and during the field study I though a lot about my role as a young white woman interviewing
black men and women in a country where colour, but also gender are sensitive issues. I tried to be aware of
how this might affect the interviews and did my best to create a dialogic atmosphere of mutual interest. I
always started my interviews by explaining that I was not doing an evaluation, but was trying to understand
and learn as much as possible about the work of the CBOs and Ikhala. I was a bit surprised that most
interviewees were so open and willing to share their time and knowledge. During most interviews felt I
managed to create a good relationship, but I felt more comfortable interview women and younger men than
old men. However, also when interviewing older men I felt I managed to do it in a professional way. I never
felt that I was “above” the interviewees, but rather the power relations were rather equal during most of the
interviews or I was somehow “below” due to my age and role as a student. I took pains not to ask too
academic questions to CBO interviewees that might have made them feel less knowledgeable.
4.3 Possible weaknesses
My project work has without doubt suffered from the ‘wanting to do it all’-syndrome. Numerous of
interesting threads have led me off track and it has been difficult deciding when to leave statements,
documents etcetera that has caught my attention with no further investigation. However, as time passed
my focus became clearer and I believe it was advantageous to carry out participant observations and group
interviews as well as reading a lot of material before I started with the qualitative interviews as at this stage
my aim had become more set.
What maybe could be criticised is the important role of Bernie Dolley, the director of Ikhala Trust, who has
been my local contact person, as well as a both informal and formal interviewee and, as time has passed, a
friend and a mentor. Had this study been of a more critical evaluative nature this might have been a threat
to my objectivity. However, as Bernie Dolley has been very open about both successes and difficulties and
challenges in the organisation, she has instead been a great source of knowledge and information and a
facilitator of contacts with others.
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Appendix II: INTERVIEW GUIDES
Ikhala Trust interview guide
Validity of the Interviewee Context

Can you please tell me your name and give me a short biographical description.

Please tell me more about your background and your role in Ikhala Trust
Regional Context of Interviewee

Please speak a bit about the regional context Ikhala Trust operates within

Could you please tell me more about the HIV/AIDS situation in the communities where Ikhala
support CBOs

How about the access to health care, social workers, support groups etc?

Besides HIV/AIDS are there other problems that impact the communities negatively?
What would you say are the strengths of the communities?

About Ikhala Trust

Could you please describe the structure of Ikhala Trust?

What is the motivation behind Ikhala?

What are your development principles, goals, mission, vision etc? (short term as well as long term)

How do you work to achieve these?

What would you say you have achieved so far?

Which are the main challenges in achieving your goals?

What would you say are the main advantages with Ikhala as a link between the donors and the
CBOs?

Do you see any disadvantages?
Relationship Ikhala Trust and CBOs

Please describe the relationship between Ikhala and the CBOs

How do you decide which CBOs to fund?

Do you look at the work carried out by them as well or only governance etc?

Could you tell me more about the cycle of funding (workshops, visits, guidance, reports)

What do the CBOs gain by cooperating with Ikhala?

Do your think there are any challenges for the CBOs related to the cooperation with Ikhala?
Relationship Ikhala Trust and donors

Who are Ikhala’s donors?

Please tell me about the relationship between Ikhala and the donors

Do the CBOs and donors have contact as well? (Why, why not?)
62

How do you report your work and the work of the CBOs to the donors?

What do the donors gain by cooperate with Ikhala?

Do you think there might be anything negative for the donors to cooperate with Ikhala?
Other donors

Some of the CBOs receive support from other organization as well. Could you tell me a bit about
that? (Positive and negative sides, differences between Ikhala and the others etc)

Do you think there might be a risk with CBOs receiving funds from donors with very different
motives that Ikhala, (e.g. more controlling, trying to change the CBOs etc)
Communication strategies used

There are a number of different health communication theories and HIV/AIDS communication
strategies. Would you say that the CBOs have knowledge about these?

Is it desirable that they have more knowledge?

If yes, how do you think they could gain more knowledge?

Do you have any influence over what strategies the CBOs use to communicate with participants?
(and mediums and messages)

Do any of the CBOs work with advocacy or lobbying?
Participatory aspects / Power structures

Do you discuss participatory aspects of the organization and their work with the CBOs?

What are you opinions about participation within the communities?

What about sharing information within the CBO?

Do you see any risks that the leaders of the CBOs are the ones who make all the decisions and not
the participants?

Do Ikhala influence the work of the CBOs in any way?

What do you do if you reckon that some things are not working very well within a CBO? (not only
reporting, but the actual work)

Do you communicate with participants/community members as well or only with the leaders of the
CBO?

What kind of influence do the donors have over the work of the CBOs?

How do you evaluate your work?

Do you or anyone else evaluate the work?

How do you evaluate the work of the CBOs?

What kind of feedback do you get from the communities/community members where the CBOs
operate?
Networks and coalitions

Do you encourage the CBOs to be members of other networks, coalitions or umbrella bodies?
(Why? Why not)
63

If yes, what are the advantages of memberships?

Are there any disadvantages or challenges?

Do you encourage the CBOs to cooperate with other CBOs operating within or nearby your
community? (Why? Why not?)
64
CBO interview guide – leaders
Validity of the Interviewee Context

Can you please tell me your name and give me a short introduction of yourself.

Tell me more about your background and your role in the CBO
Local Context of Interviewee

Could you please describe the community your CBO operates within?

Tell me more about the HIV/AIDS situation in your community

How about the access to health care, social workers, support groups etc for people living with
HIV/AIDS, other CBOs/NGOs?

Besides HIV/AIDS are there other problems that impact the community negatively?

What would you say are the strengths of this community?
About the CBO

Could you please shortly describe the structure of your CBO? (board – leader – coordinator –
administrator – staff – volunteers – “clients”/ members?)

What do you call the people you are trying to help? (participants/ members/ clients/ target groups/
community members?)

What is the motivation behind your CBO?

What are your development principles, goals, mission, vision etc? (short term as well as long term)
(Do you have any written documents that I may take part of?)

How do you work to achieve these?

What would you say you have achieved so far?

Which are the main challenges in achieving your goals?
Communication strategies used

What kind of activities/projects do your CBO work with?

How do you communicate with the participants/target groups?

Do you use any special strategies to communicate with participants?

What kind mediums do you use?

What is the purpose of the communication?

There are a number of different health communication theories and HIV/AIDS communication
strategies. Do you have knowledge about these?

Do you work with advocacy or lobbying?
Relationship Ikhala Trust and CBOs

Please tell me about the relationship between your CBO and Ikhala Trust

What do you think you gain by cooperating with Ikhala Trust?

Do you see any challenges with the cooperation?
65
Other donors

Have your CBO applied for funds from other donors than Ikhala?

If you have, what are your experiences of applying for funds?

Do your CBO receive support from any other donors besides Ikhala Trust?

If you do not, would you like to? Why? Why not?

If you do, do you see any differences in the cooperation with this/these organizations and with
Ikhala?

Are there any challenges when working with donors?
Participatory aspects

How actively do community members participate in the work of your CBO?

What is the role of the community members?

What is the role of volunteers?

Does the community participation influence your work?
Power structures

Could your please describe the process of decision making within your CBO

How do you share information within the organization?

What kind of influence do the participants have over decisions?

Do you think Ikhala influences the work of your CBOs?

If you work with other donors, do they influence your work?

How do you evaluate your work?

Do you or anyone else evaluate the work?

What kind of feedback do you get from the community members?
Networks and coalitions

Do your CBO belong to any kind of networks, coalitions or other umbrella bodies? (Why? Why not)

If yes, what are the advantages?

Are there any disadvantages or challenges?

Do you cooperate with other CBOs operating within or nearby your community? (Why? Why not?)
66
Focus group interview during workshop – leaders
I would like you to start by talking a bit about your CBOs.
(What do you think they have in common? What are the differences? Do you cooperate with each other?)
Now I would like you to tell me a bit about your cooperation with Ikhala Trust.
(How do you cooperate? What is positive? What is negative?)
Could you tell me about whom the participants in your projects are?
(Does everyone in the community participate or certain groups? How do they participate?)
What is the role of the participants?
How do you think it is best to communicate with participants? (Do you use any special strategies? What
kind of activities do you arrange? What mediums do you use?)
Do the participants have influence over the work of your CBOs? How? Why? Why not?
What kind of feedback do you get from participants?
67
Focus group interview during workshop – other CBO participants
I would like you to start by talking a bit about your CBOs.
(What do you think they have in common? What are the differences? Do you cooperate with each other?)
Now I would like you to tell me a bit about your image of Ikhala Trust.
(What is the role of Ikhala? How do your CBO cooperate with Ikhala? What do you think is positive? Anything
negative?)
Who are the participants in the work of your CBOs?
(Does everyone in the community participate or certain groups? How do they participate?)
What is the role of the participants?
How do you think your CBO best communicate with participants?
(Do they communicate this way or in some other way?)
Would you say that participants/community members have influence over the work of the CBOs? (How?
Why? Why not?)
What kind of feedback do participants give to the CBO?
68
Focus group interview – volunteer caregivers
Local context

Could you please start by telling me a bit about the community your CBO operates within?
(Challenges, strengths, problems)

Could you tell me more about the HIV/AIDS situation in the community? (Number of infected,
knowledge, access to health care, social workers, support groups etc for people living with
HIV/AIDS, other CBOs/NGOs

What do you call the people you are trying to help? (participants/ members/ clients/ target groups/
community members?)
Communication strategies used

What kind of activities/projects do your CBO work with?

What is your role as volunteers?

How do you communicate with the participants/target groups?

Do you use any special strategies to communicate with participants?

What is the purpose of the communication?

There are a number of different health communication theories and HIV/AIDS communication
strategies. Do you have knowledge about these?

Do you think you have sufficient knowledge and skills to carry out your work or would you like to
have more training? (If yes, what kind of training?)
Working as volunteer

What is your motivation behind working as volunteers?

What do you experience as the main challenges in carry out your work?
Participatory aspects

How actively do community members participate in the work of your CBO?

What is the role of community members?

Does the community participation influence your work?
Power structures

Could your describe the process of decision making within your CBO?

How is information shared within the organization?

What kind of influence do the participants have over decisions?

What kind of influence do you think you have over the work of your CBO?
Coalitions

Do your CBO belong to any kind of networks, coalitions or other umbrella bodies? (Why? Why not)
69

If yes, what are the advantages?

Are there any disadvantages or challenges?
Do you cooperate with other CBOs operating within or nearby your community? (Why? Why not?)
70
Appendix III: LIST OF INTERVIEWEES
Semi-structured interviews
Nomsa Bavuma, Secretary1, Nonkqubela Women’s Project, Alicedale
Siyabonga Malunga, Project Manager, Thandi Youth Development, Uitenhage
Cynthia Jassen, project Manager, Emanuel Care Advice Centre, Port Elizabeth
Notizi Vanda, Assessor, Ikhala Trust, Jansenville (also Project Manger Jansenville Development Forum)
Bernie Dolley, Director, Ikhala Trust, Port Elizabeth
Vuyo Msizi, Fieldworker, Ikhala Trust, Port Elizabeth
Chris Engelbrecht, Trustee, Ikhala Trust, Graaf-Reinet
Melanie Preddie, Consult for Ikhala Trust (e.g. workshop facilitator), Port Elizabeth
Group interviews
Ledars of CBOs participation in workshop
Other CBO representatives participating in workshop
Volunteers/caregivers, Emanuel Care Advice Centre
1 The original intention was to interview the Project Manager, but since she was not present I interviewed Nomas
instead. Present during the interview was also five other CBO members. Furthermore, Nosi from Ikhala Trust was
present to translate from Xhosa if this should be necessary, which it only was during small parts of the interview.
71
Appendix IX: LIST OF WORKSHOP PARTICIPANTS
72
Appendix X: CALL FOR PROPOSALS
73
Appendix XI: IKHALA TRUST MONTHLY REPORT FORMAT: HIV/AIDS
74
75
76
77