There are growing calls for the involvement of multiple agencies to address health inequities. Many international non-governmental organizations (INGOs) working in health and development mention equity principles in their vision statements, missions, or strategic directions, and many authors view equity, including focusing on vulnerable populations, as an important role for these INGOs. However, there is a lack of in-depth empirical research on what influences INGOs’ implementation of equity principles in their work. The present study helps to fill this gap by using a case study to examine INGOs’ implementation of equity principles in their HIV/AIDS initiatives.
In this case study, I focused on HIV/AIDS initiatives in Kenya to illustrate the nature of the implementation gap between the intent of INGOs to ensure equity in their work and actual practice, and to examine the various influences that affected the implementation of INGOs’ equity principles. I used HIV/AIDS as the exemplar because of the global epidemic of HIV/AIDS and the resulting large monetary investments made by donors to Southern countries and INGOs to address the disease.
I conducted an in-depth case study of an INGO operating in Kenya. The research questions were: “What is the nature of the implementation gap between the intent of an INGO to ensure equity in its HIV/AIDS work and actual practice? What characterizes multi-level influences that affect an INGO’s implementation of equity principles in its HIV/AIDS work? How do multi-level influences affect an INGO’s implementation of equity principles in its HIV/AIDS work?”
The case study design employed multiple methods including document reviews, interviews with staff of the INGO in Kenya, as well as its Northern INGO counterparts in Canada and the U.S., interviews with partners and clients of the INGO in Kenya, and participant observation with staff of the INGO in Kenya.
I found that many players (e.g. Southern country government and the Northern donors) from different levels (e.g. in-country as well as Northern donor countries) shape INGOs’ implementation of equity principles in their HIV/AIDS work. Influences from donors include donor agendas and the focus of donor funding, as well as donor country policies. Influences from the Southern country government include government priorities and legislation. These influence INGOs’ implementation of equity principles in their HIV/AIDS work, and in some cases can outright contradict equity principles. However, since INGOs are often reliant on donor funding and need Southern governments’ permissions to work in-country, INGOs work within a system that is characterized by asymmetrical interdependence. They have to find a middle ground for implementing equity principles in their HIVAIDS work. Hence, these influences help give rise to an implementation gap between what INGOs intend to accomplish in implementing equity principles in HIV/AIDS work and actual practice.
Implications for policy and practice include the need to: increase awareness of the roles various players have in implementing equity and the need for ongoing collaboration to achieve equity aims; continue work in capacity building on equity for INGO staff and its partners; and develop and refine tools for measuring and monitoring the implementation of equity. The present research clearly shows the significant role that INGOs play in equity, and the importance of understanding the multiple players and levels that influence INGOs’ implementation of equity principles in HIV/AIDS. The research can help INGOs, Southern country governments, and donors to better understand the system within which INGOs work in implementing equity principles, as multiple organizations continue to try to address health inequities around the globe.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:OOU.#10393/24932 |
| Date | 23 August 2013 |
| Creators | Dyke, Elizabeth |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Thèse / Thesis |
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