The Minister for Social Development, Dr Zola Skweyiya, today opened the HIV and AIDS in Africa: Getting Research into Policy and Practice Colloquium hosted by the Human Sciences Research Council (HSRC). Speaking at the colloquium Dr Skweyiya reminded the group of civil society, academia and government representatives that their meeting was an answer to the call by the Special Summit of the African Union on HIV and AIDS, tuberculosis and malaria.
PART 2 - PARTNERSHIPS IN CONTEXT12 2.3 An Overview of the Health NPO Sector in South Africa15 3.
PART 4 - MANAGING YOUR NPO ENGAGEMENTS 33 4.1 Components of Supervision ofNPO Activities 33 4.3 Engaging NPOs40 4.
District need analysis/assessment53 5.
Improving the NPOs Chances91 7.
PART 8: REPORTING109 8.
The Department of Health through the EU Partnerships for Health Programme initiated and supported the development of partnership arrangements betw een provincial government and not for profit organisations for the rendering of primary health care services. Importantly, the programme is supporting the development of a knowledge base in South Africa on how to enter into and manage partnerships within the health sector between government and not for profit organisations. Initially, these partnerships were to be in the formof PPP but later it wasfound out that it will not be possible.
This guide must be read and implemented w ith other three guidelines that had been developed for the purposes of empow ering Department of Health and NPOs in the country. This guideline addresses, amongst other issues, the requirements contained in the Public Finance Management Act and the Section 16 regulations for public private partnerships. Again, the content of the Guideline is targeted toward a specific user, namely provincial and other government officials.
Who is this Guideline for?
The Guidelines already drafted for Health Partnerships programme w ere used as the baseline material for this Guideline. Key information relevant to the Technical Assistant was extracted and modified for its inclusion. Some desktop researchwas undertaken to address the specific needs of the Technical Assistant.
It is important that this Guideline is used with other guide packs that are available for example, the Department of Health, Department of Social Development, donor agents and other capacity building and support NPOs.
Part 1: This is the introductory section to the Guideline explaining its purpose, who the Guideline is for, how it was developed, how it will be piloted and how the Guideline should be used.
Part 4: This part examines the roles and responsibilities linked to the partnership for health programme, the components of supervision of NPO activities and a possible structure for NPOs.
This section of the Guideline provides an explanation of the delivery of the primary health care services in South Africa, the role of the health sector NPOs and the growing use of NPO/Government partnerships for the management of this relationship.
In contracting w ith government, it is important to know and understand w hat sphere of government is responsible for what function. It is illegal for a provincial department or municipality to sign a contract for service if it does not have the responsibility to provide that service. Within this context, who is then responsible for and what is primary health care services?
Almost all of the primary health care services are a function of provincial government. This responsibility has only recently been clarified through the definition of health services as contained in the National Health Act No 61 of 2003. How ever, for historical reasons, some municipalities have also been rendering part of the primary health care services mainly in the form of municipal clinics. All provinces are now in the process of "provincialising2" these services. This means that all clinics, community health centres, districthospitals etcwill be run by provincial departments of health in the near future.
South Africa is now divided into a number of health districts w hich, in almost all cases, are aligned to either a metropolitan or a district municipality boundary. This allows for the delivery of health services within manageable areas that have economies of scale but which are also close to the community3.
There are a number of key aspects linked to the primary health care approach.
3 SeeDrIToms"LocalGovernment ViewsofProgresstoDHS"DBSA WorkshopReport ontheImplementationoftheDistrict Health System; Johannesburg13October 2005 2.3 An Overview of the Health NPO Sector in South Africa wide geographic area are being funded. Many have been operating for awhile and are well recognised in the communities in which they render services. On the other hand in Limpopo and the Eastern Cape, the organisations are often much smaller serving a local community. Often the area served is set by the walking distances of the health care givers.
The CASE report provides a breakdownwith each category of organisation.
Generally, the sector employs women. This is especially true within the health sector.
The NPO sector generates an annual income of approximately R14 billion of which almost R6 billion is funded by government8.
17 benefit from it, and all those who can use it to the benefit of communities, and listen willinglyand carefullyto the inputs made bycivil society organisations.
Develop the NPO sector to be better able to provide service.
Other problems cited are the political resistance to the use of NPOs in the delivery process and, the lack of capacity within government to manage partnership arrangements. In addition, Netshipale notes that "the lack of guidelines and frameworks for supporting both the government sector and the NGO sector in development and managing service delivery mechanisms and agreements 13" remains a major challenge in the South African context.
The New Zealand government's guidelines for contracting with Non Governmental Organisations comments that governments should understand the characteristics of the organisations they are partnering w ith. The report notes that contracting and funding relationships with the community organisations should be consistent with the its stakeholders '17.
"successful contracting takes a high degree of trust and collaboration between the purchaser (international agencies or government) and the NGOs"18. This is not alw ays the case as was well reflected during the apartheid period in South Africa with some organisations established solely for the purpose of opposing the State.
Ovenset al commenton the potential risks associated with the contracting of NPOs and note that they often may not have sufficient financial reserves to cover the delays in funding flows. Moreover, NPOs are often small and the loss of key individuals can affect the sustainability of the organisation. This can partially beprevented withwell directed capacity building initiatives21.
The function of this section is threefold. Firstly it defines and explains some key concepts associated with Not for Profit Service Organisations (NPOs), which for the purpose of this document are called Not for Profit Organisations (NPOs). It then reviews some of the advantages, risks and disadvantages of partnerships w ith NPOs. Thereafter it providessome hints and tips onmanaging partnershipswith NPOs.
NPOs are, first and foremost, civil society organisations. They are one of the diverse organisationalforms that exist outside of the state and the market.
surpluses are treated as retained income for the purpose of supporting the activities/services of the organisation.
Service-oriented means that the primary focus of the organisation is the provision of a service (or services) to a defined community, target group or set of individuals.
An NPSO can be a non-governmental organisation (NGO) or a community-based organisation (CBO).
Non-Governmental Organisations are national or international bodies that operate outside of the state and the business sector. They are governed or managed by a group of elected or appointed members and are accountable to this governing body. NPOs tend to be larger and more developed than CBOs and have a larger proportion of paid, professional staff.
Trust These organisations are established to receive and allocate funding and they cannot deviate from this role. Trustees are appointed to oversee management and administration. A Trust must beregistered with both the Inland Revenue and the Master of the Supreme Court and must abide by the Trust Property Control Act. This status best suits organisations that channel funds to other organisations. The trustees are then responsible for seeing that funds are properly used.
NPOs can provide services that are strategic, targeted, creative, responsive, sustainable, affordable, locally relevant and not linked to the government.
NPOs can provide a channel for inputs of external resources such as technical, human and material resources, as well as donor funding.
NPOs can contribute positively to policy formulation and programme planning by sharing their practical experience of service provision and interaction w ith communities.
NPOs can improve access to goods and services to the poor, under-served and 'hard to reach' byworking around the constraints of existing systems, structures and infrastructures.
26 o It can support participatory approaches to project development and service delivery. There may be a greater sense of community ownership and responsibility for services. This in turn can mean that there is increased accountability and responsiveness.
developing partnership agreements w ith NPOs, most of these can be addressed through appropriate support, capacity building and training interventions.
Some NPOs may find it difficult to make the shift to the output orientation required by the SLA agreement.
Keep project proposals simple and focused.
Effective partnerships are normally forged around simple, focused ideas for small-scale projects that are w idely understood and accepted. As the project 'matures' and capacity is built, interventions can be scaled-up and coverage increased.
Ensure that the issue of sustainability informs planning and action at all stages.
Create and promote an enabling environment.
Partnership agreements are most successful when they operate within a supportive legal, policy and institutional environment. Research by the Municipal Infrastructure Investment Unit (MIIU) suggests that a number of components can contribute to an enabling environment. These are represented in Diagram 1 below.
A detailed work plan or business plan can assist in the successfulimplementation of the partnership agreement. Oncethe partnership agreement has been signed, it is helpful to draw up a work plan or business plan detailing the activities involved over the implementation phase. The plan should make reference to the required outcomes, responsible parties, time frames and resources/inputs required. It may be helpful to have linked work plans for allparticipating role players. Work plans should be reviewed and, if necessary, revised regularly. It is possible to request for draft or broad work plans to be submitted as part of the competitive bid. These planswould be finalised post the signing of the agreement.
process. Similarly, performance monitoring should be regarded as an opportunity to improve the outcome andpositive impactofthepartnership.
Monitoring and evaluation of an SLA must be planned from the outset. Monitoring and evaluation is about reflecting upon what hasworked, what has not and about proposing solutions for problems. This aspect is discussed in more detail later in the Guideline. It can also support advocacy, mobilisation of resources and the strengthening of future partnership agreements.
Review orevaluation Identification and design ectiveness, efficiency andimpact proposed intervention.
NPOS are notsmall, micro and medium enterprisesor contracted individuals.
NPOs have three main formsof legal status: -Section 21 Companies -Voluntary Associations -Trust.
4.1 Understanding the Roles and Responsibilities Linked to the NPO Partnerships coordination and management.