Shaped by asymmetrical interdependence: a qualitative case study of the external influences on international non-governmental organizations’ implementation of equity principles in HIV/AIDS work

International Journal for Equity in Health

Stephen Brown²  Richard Muga¹  Ian McDowell³  Nancy Edwards⁵  Elizabeth Dyke⁴ 

[1] Great Lakes University of Kisumu, Kisumu, Kenya;School of Political Studies, University of Ottawa, Ottawa, Canada;Department of Epidemiology & Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada;Independent Health Consultant, Gatineau, Canada;School of Nursing, University of Ottawa, Ottawa, Canada

关键词: Case study;    Vulnerable populations;    Non-governmental organizations;    HIV/AIDS;    Equity;   

Others  :  1137645
DOI  :  10.1186/s12939-014-0086-2

 received in 2014-05-12, accepted in 2014-09-19,  发布年份 2014

【 摘 要 】

Introduction

Addressing inequities is a key role for international non-governmental organizations (INGOs) working in health and development. Yet, putting equity principles into practice can prove challenging. In-depth empirical research examining what influences INGOs’ implementation of equity principles is limited. This study examined the influences on one INGO’s implementation of equity principles in its HIV/AIDS programs.

Methods

This research employed a case study with nested components (an INGO operating in Kenya, with offices in North America). We used multiple data collection methods, including document reviews, interviews (with staff, partners and clients of the INGO in Kenya), and participant observation (with Kenyan INGO staff). Participant observation was conducted with 10 people over three months. Forty-one interviews were completed, and 127 documents analyzed. Data analysis followed Auerbach and Silverstein’s analytic process (2003), with qualitative coding conducted in multiple stages, using descriptive matrices, visual displays and networks (Miles and Huberman, 1994).

Results

There was a gap between the INGO’s intent to implement equity principles and actual practice due to multiple influences from various players, including donors and country governments. The INGO was reliant on donor funding and needed permission from the Kenyan government to work in-country. Major influences included donor agendas and funding, donor country policies, and Southern country government priorities and legislation. The INGO privileged particular vulnerable populations (based on its reputation, its history, and the priorities of the Kenyan government and the donors). To balance its equity commitment with the influences from other players, the INGO aligned with the system as well as pushed back incrementally on the donors and the Kenyan government to influence these organizations’ equity agendas. By moving its equity agenda forward incrementally and using its reputational advantage, the INGO avoided potential negative repercussions that might result from pushing too fast or working outside the system.

Conclusions

The INGO aligned the implementation of equity principles in its HIV/AIDS initiatives by working within a system characterized by asymmetrical interdependence. Influences from the donors and Kenyan government contributed to an implementation gap between what the INGO intended to accomplish in implementing equity principles in HIV/AIDS work and actual practice.

【 授权许可】

   
2014 Dyke et al.; licensee BioMed Central Ltd.

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