The size, characteristics and partnership networks of the health-related non-profit sector in three regions of South Africa: implications of changing primary health care policy for community-based care
Health Policy and Planning
The size, characteristics and partnership networks of the health-related non-profit sector in three regions of South Africa: implications of changing primary health care policy for community-based care
Ermien van Pletzen 2
R Zulliger 1
Moshabela 0
H Schneider 3
0 School of Public Health, University of Witwatersrand, Johannesburg and Earth Institute, Columbia University , NYC
1 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
2 Centre for Higher Education Development, University of Cape Town , Rondebosch, 7701 , South Africa
3 School of Public Health, University of the Western Cape , South Africa
Background Health-related community-based care in South Africa is mostly provided through non-profit organizations (NPOs), but little is known about the sector. In the light of emerging government policy on greater formalization of community-based care in South Africa, this article assesses the size, characteristics and partnership networks of health-related NPOs in three South African communities and explores implications of changing primary health care policy for this sector.
Accepted
Methods
Results
Data were collected (2009–11) from three sites: Khayelitsha (urban), Botshabelo
(semi-rural) and Bushbuckridge (semi/deep rural). Separate data sources were
used to identify all health-related NPOs in the sites. Key characteristics of identified
NPOs were gathered using a standardized tool. A typology of NPOs was developed
combining level of resources (well, moderate, poor) and orientation of activities
(’Direct service’, ‘Developmental’ and/or ‘Activist’). Network analysis was
performed to establish degree and density of partnerships among NPOs.
The 138 NPOs (n ¼ 56 in Khayelitsha, n ¼ 47 in Bushbuckridge; n ¼ 35 in
Botshabelo) were mostly local community-based organizations (CBOs).
The main NPO orientation was ‘Direct service’ (n ¼ 120, 87%). Well- and
moderately resourced NPOs were successful at combining orientations. Most
organizations with an ‘Activist’ orientation were urban. No poorly resourced
organizations had this orientation. Well-resourced organizations with an
‘Activist’ orientation were highly connected in Khayelitsha NPO networks,
while poorly resourced CBOs were marginalized. A contrasting picture emerged
in Botshabelo where CBOs were highly connected. Networks in Bushbuckridge
were fragmented and linear.
Health-related non-profit organizations, community-based care, policy on
primary health care, South Africa
KEY
MESSAGES
Health-related non-profit organizations are significant providers of community-based care in South Africa.
The health-related NPO sector varies from area to area, not only in numbers, but in degree of resourcing, orientation of
activities and partnership networks.
NPOs perform important developmental and activist roles in communities and a strong potential for social capital resides
in organizational networks operating in impoverished environments.
Current policy developments in primary health care reform which aim at formalizing relationships between civil society
and the state may direct funding away from health-related NPOs and in other ways limit their ability to respond
independently and critically to the interests of marginalized communities.
Introduction
Non-profit organizations (NPOs), including large international
or national non-governmental organizations (NGOs),
faithbased organizations (FBOs) and local community-based
organizations (CBOs), have a long history of providing health-related
care in South Africa, especially in impoverished communities.
They form part of a vast and diverse group of civil society
organizations that have fundamentally contributed to the
shaping of modern South Africa
(Swilling and Russell 2002)
.
Estimates of the size of the health-related NPO sector in South
Africa have differed, depending on survey methods used and time
periods studied. In 1999,
Swilling and Russell (2002)
estimated
that there were 6499 health-related NPOs, of which the majority
(4191 or 64%) were informal organizations, almost a quarter
(1570 or 24%) were ‘Section 21’ companies (associations not for
gain) and the rest (738 or 11%) religious, political or other
organizations associated with health care. Just over a decade
later, an audit conducted by the national Department of Health
focusing on NPOs providing community-based services in a
formal relationship with government counted 2963
communitybased NPOs
(Government of South Africa 2011a)
. Despite the
different estimates, the studies confirm a significant and ongoing
NPO presence in the health sector.
Overall, there is a scarcity of literature on community-based
organizations with a focus on health in low- and middle-income
countries
(Wilson et al. 2012)
. At the same time, international
policy and research increasingly emphasize the importance of
community participation and mobilization in responding to the
health needs of margin (...truncated)