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, Sep 2014

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.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://academic.oup.com/heapol/article-pdf/29/6/742/1539858/czt058.pdf

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)


This is a preview of a remote PDF: https://academic.oup.com/heapol/article-pdf/29/6/742/1539858/czt058.pdf

van Pletzen, Ermien, Zulliger, R, Moshabela, M, Schneider, H. 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, 2014, pp. 742-752, Volume 29, Issue 6, DOI: 10.1093/heapol/czt058