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Ppa construction of local bloemfontein online dating back to share this is book of institution: sasolburg base. This makes them strong candidates for contributing managerial experience and developmental expertise to the overall process of re-engineering PHC. However, many moderately resourced NPOs may find it hard to survive the changes or may struggle to reposition themselves in communities if there is radical rearrangement of NPO structures and resources in relation to the PHC outreach teams. This may in turn jeopardize some of the developmental activities not included in the scope of work defined for outreach teams.
For instance, many of these organizations currently develop capacity in communities to generate income or food security, which assists households made vulnerable through illness or disability. It would be important to support the continuation of such activities by NPOs playing a broader developmental role through relevant ministries such as Social Development, Education and Agriculture. The finding that few health-related NPOs had an activist orientation, and that these organizations were mainly found in urban and well-resourced environments, is cause for concern given the emphasis placed in current policy and research on the role of community participation and mobilization in responding to health needs in low- and middle-income countries Birdsall and Kelly ; Campbell and Cornish : Wilson et al.
In this respect Habib cautions that too close a relationship between NPOs and the state may limit their ability to respond critically to the interests of the poor and marginalized. An important question for both government and NPOs to consider is how a stronger association with the state might influence the orientations of some of the most experienced health-related NPOs in the country. The question is made more pertinent given the important relational role that NPOs with an activist orientation played in the partnership networks of two of the sites in this study.
The finding that the majority of poorly resourced NPOs had a single orientation towards service delivery has similar implications.
These NPOs focus mainly on services like home-based care of seriously ill, frail, disabled or mentally ill clients , psychosocial support and alleviating poverty by facilitating access to basic material resources, for instance, by running soup kitchens. Some of these services may likewise fall outside the scope of work described for the ward-based outreach teams. It is possible that workers from poorly resourced NPOs, offering a flexible combination of care and welfare services, would not be integrated into the outreach teams.
At the same time, they risk losing funding for the services they provide and may find it particularly hard to survive in a new dispensation. The question remains, then, what the prospects are for poorly resourced community-based organizations: whether they risk becoming further marginalized, or whether the state could find a way of harnessing the work they perform in communities, and of building on their potential to form strong partnership networks with one another.
Hanneman and Riddle explains that the density of networks may indicate social capital. Wilson et al. Given the importance attached to community participation and mobilization in responding to health needs and service delivery, especially in marginalized communities, the importance of maintaining and strengthening such partnership networks should not be overlooked. Our study fills a serious gap in the literature by providing insight into the health-related NPO sector and its partnership networks in South Africa, and more generally into the roles of community-based organizations involved in health-related activities in low- and middle-income countries.
The study faced challenges inherent in its study design and methods of gathering data. Firstly, transferability of the study may be limited as the sites selected purposively are not representative of the country as a whole. The selection of an urban, a semi-rural and a deep rural environment in three different provinces goes some way towards addressing this limitation. Secondly, the list of NPOs constructed for each of the study sites may not be comprehensive.
Organizations were asked to self-identify whether they had a health focus and to identify other organizations. Organizations may have been incorrectly omitted or included. To address this limitation, we cross-checked the list of NPOs using different data sources and inclusion criteria.
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Overall, our research aims to inform both government and civil society, and points to a need for further research on how to harness existing strengths in communities and community-based organizations, and how to pre-empt unintended consequences of policy changes. In particular, our research indicates that many moderate to well-resourced organizations in South Africa have the capacity and infrastructure to contribute staff and developmental expertise to the process of deploying ward-based outreach teams and strengthening PHC in communities.
In this respect, the research points to the importance of maintaining strong partnerships between government departments and the NPO sector. Our research further highlights the potential wealth of social capital locked up in organizational networks operating in otherwise impoverished environments with a high burden of disease. The conditions under which constructive networks come into being and their potential to mobilize communities to participate in policy-making and implementation deserve further attention.
Our research also cautions against potential pitfalls in implementing new policy guidelines on re-engineering PHC in South Africa. An important risk identified is that funding could be channelled away from the NPO sector in order to strengthen national health programmes as happened post Lacking resources or experienced staff, NPOs may find it difficult to survive. Activities not taken over by the outreach teams may fall away, depriving communities of important resources and social networks.
Finally, our research suggests that a uniform approach to policy implementation may not adequately accommodate regional differences and variations in the NPO sector. This paper only uses 'community health worker' when the term has been drawn specifically from Department of Health documentation.
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