Partnerships, Community Participation and Intersectoral Collaboration in South Africa

Published in the Journal of Interprofessional Care in 2001, this study examined the structural characteristics and operational issues involved in collaborative ventures relating to the education of health professionals in five community partnership projects (CPs) implemented in South Africa in 1996-1997. The developmental framework behind the CPs relied on a participatory model, in which community participation and collaborative interprofessional teamwork were considered central for ameliorating deeply seated health and social problems in underserved communities. The study draws lessons from the experiences of these five CPs by identifying key structural and operational issues including communication issues that confronted participatory effort in the CP initiatives.


Evaluation/Research Methodologies:

Five community partnerships were established in South Africa's underserved communities as demonstration projects aimed at the re-orientation of health professionals' education to be more community responsive and interprofessional.



The researcher (the first author) spent several months with each of the five CPs during 1996-1997 (fourth year after the initiation of the CPs). The researcher conducted semi-structured interviews with 46 CP participants representing the following stakeholder groups: (1) health service providers, (2) academic training institutions, (3) community members, and (4) CP staff responsible for day-to-day running of CPs. Qualitative data (interview transcripts) were analysed by WEA employing NUD*IST software to delineate key ideas and issues discussed by stakeholders.



Key Findings/Impact:

The study identified a number of challenges that confronted the development of CPs:

1. Representation in CPs: Signs of an overrepresentation of academics, elites, and formal agencies and an underrepresentation of the youth, low-income groups, the elderly, and lay community members in general, led some stakeholders to a fear that tribally, geographically, and politically disadvantaged groups could be further marginalised in coalition building efforts.
2. Ownership and commitment: Different participants felt varying degrees of sense of project ownership, indicating uneven levels of commitment on coalition building efforts among participants.
3. Leadership skills: Some leaders in the CPs were not adequately accessible; some were not sufficiently open to ideas and suggestions.
4. Communication: Some partners felt that information flow was not quantitatively and qualitatively sufficient among partners, leaving some partners uninformed about the progress of their efforts.
5. Capacity building and social capital: The relative lack of social capital in each local community (knowledge, organisational skills, technical expertise and so forth) might have hampered more active engagement and empowerment of community members.
6. Power issues and self interests: Some stakeholders expressed concerns regarding (perceived) unequal distribution of power among CP project partners, citing the presence of caucus meetings and selfish motives for project participation among certain partners.
7. Vision, clarity and transparency: Some stakeholders felt uncertain about the very meaning of forming community partnerships, citing the lack of clarity in the project goals, operational structures, and the relationships among partners. Issues concerning the inclusiveness/exclusiveness of the CPs were also cited; the CP initiatives were not sufficiently visible or publicised in certain parts of the intended coverage areas of the CPs.

The authors invite health administrators and partnership executives to devote attention to these components that could impinge on the effectiveness of the multifaceted nature of interprofessional joint working arrangements. The authors suggest that in order for a CP to maximise health gains, all the above interacting components need to be woven into long-term preventive and promotive strategies that are acceptable, appropriate and accessible to the participating communities.