Abstract
BackgroundInternational donors support the partnership between the Government of Botswana and two international organisations: U.S. Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership to implement Voluntary Medical Male Circumcision with the target of circumcising 80 % of HIV negative men in 5 years. Botswana Government had started integration of the program into its health system when international partners brought in the Models for Optimizing Volume and Efficiency to strengthen delivery of the service and push the target. The objective of this paper is to use a systems model to establish how the functioning of the partnership on Safe Male Circumcision in Botswana contributed to the outcome.MethodsData were collected using observations, focus group discussions and interviews. Thirty participants representing all three partners were observed in a 3-day meeting; followed by three rounds of in-depth interviews with five selected leading officers over 2 years and three focus group discussions.ResultsFinancial resources, “ownership” and the target influence the success or failure of partnerships. A combination of inputs by partners brought progress towards achieving set program goals. Although there were tensions between partners, they were working together in strategising to address some challenges of the partnership and implementation. Pressure to meet the expectations of the international donors caused tension and challenges between the in-country partners to the extent of Development Partners retreating and not pursuing the mission further.ConclusionTarget achievement, the link between financial contribution and ownership expectations caused antagonistic outcome. The paper contributes enlightenment that the functioning of the visible in-country partnership is significantly influenced by the less visible global context such as the target setters and donors.
Highlights
International donors support the partnership between the Government of Botswana and two international organisations: U.S Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership to implement Voluntary Medical Male Circumcision with the target of circumcising 80 % of HIV negative men in 5 years
This paper used a systems model to explore the functioning of the Safe Male Circumcision (SMC) partnership in Botswana
We conclude that external influences that come from the unseen international donors influenced the working of the in-country partnership, crippling it from resolving implementation challenges as experienced within the context of partnership functioning
Summary
International donors support the partnership between the Government of Botswana and two international organisations: U.S Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership to implement Voluntary Medical Male Circumcision with the target of circumcising 80 % of HIV negative men in 5 years. Partnerships for health The Botswana Safe Male Circumcision (SMC) program is a North-South partnership aiming to promote sexual health via voluntary medical adult male circumcision [1, 2]. The Botswana SMC program was established to help meet a particular public health target – the prevention of HIV via the medical circumcision of 80 % of HIV negative men. As important as HIV prevention is, the research reported here is not about progress in meeting that target Rather, this is a study of how the Botswana SMC program functions as a North-South partnership. By studying what factors promote and inhibit good partnership functioning in existing projects like the Botswana SMC program, the aim is to generate knowledge that may help future North-South health partnerships better meet their goals
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