Aspirations and realities in a North-South partnership for health promotion: lessons from a program to promote safe male circumcision in Botswana

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.

Twinning Partnership Helps to Accelerate the Performance of District Health Systems Towards Achieving Universal Health Coverage

“…Emerging ideas were written, and codes were created with grouping and regrouping of codes to topics with corresponding similarities (23). In addition, the Bergen Model of Collaborative Functioning (BMCF) theoretical framework, was used as a basis for interpreting the findings (19)(20)(21). Base line, mid-term and end line data were extracted, checked for its consistency, completeness, reliability and analyzed to track observed changes following the implementation of twinning partnership as a new initiatives.…”

“…countries and middle/high income countries located in Europe, North America and South Africa (11)(12)(13)(14)(15)(16). Similarly, there is ample documented evidence on prompting health behaviors through northsouth partnerships (17)(18)(19)(20).…”

Accelerating the performance of district health systems towards achieving UHC via twinning partnerships

“…Multiple studies have documented twinning partnerships between research institutes in low income countries and middle/high income countries located in Europe, North America and South Africa (11)(12)(13)(14)(15)(16). Similarly, there is ample documented evidence on prompting health behaviors through north-south partnerships (17)(18)(19)(20).…”

“…Emerging ideas were written and codes were created with grouping and regrouping of codes to topics with corresponding similarities (23). In addition, the Bergen Model of Collaborative Functioning (BMCF) theoretical framework was used as a basis for interpreting the ndings (19,20). The data and BMCF was given to a public health expert to analyze the data independently.…”

“…The Bergen Model of Collaborative Functioning (19)(20) BMCF conceptual map adopted to evaluate the Twinning partnership strategy implementation in Ethiopia. The framework depicts to the relations of input, throughput and output of collaborative functioning.…”