Health is fundamental to the development of a nation. Yet, in developing countries, Swaziland included, the evidence indicates that the status of health compared to developed countries is very poor. The problems facing family health, family planning, and the prevention and control of the spread of the HIV/AIDS pandemic in developing countries are enormous and cannot be a responsibility of the government alone. Government’s total health budget as a proportion of the Gross Domestic Product (GDP) over the past four years in Swaziland, for example, has been less and 3% (Nhlabatsi 1997).

The purpose of this study was to investigate the nature and the strength of collaboration between the public, private, and the nongovernmental (NGO) sector organisations in the provision of family health education, family planning, and the prevention and control of the spread of the HIV/AIDS pandemic in Swaziland. The researchers did this by surveying organisations or agencies (public, private, and NGOs) and their members which provide family health education, family planning, and the prevention and control of the spread of the HIV/AIDS pandemic in Swaziland.

It was discovered that family health education, family planning, and the prevention and control of the HIV/AIDs pandemic were provided by all sector (public, private, and NGO) organisations in Swaziland. Their programs also had similar goals, target similar groups, used similar strategies, and were more or less funded by the same donor agencies. All of the surveyed organisations collaborated, in one way or another, to deliver health services to their clients. However, they varied in the nature and extent of collaboration between them. The nature of collaboration between the organisations was both sectorial and multisectorial and included training, the production and delivery of information, education, and communication materials, message delivery, distribution of commodities to clients, sharing of technical knowledge, transport, facilities, funding, and advocating policy formulation.

The strength of collaboration between the NGOs and between NGO and industrial organisations was perceived to be weak. Alternatively, between the industry organisations, collaboration was perceived to be strong. The reasons provided for the weak collaboration between NGOs was the perceived competition for donor attention and the issue of effectiveness. Apparently, donors were not keen to the idea of NGO collaboration because at the evaluation stage it is often difficult to judge the effectiveness of each NGO’s contribution. In addition, donor funded projects are often not conceived at the same time meaning that their timeframes and program objectives are often different. This makes it difficult for NGOs to harmonise their project implementation plans. Lastly, an absence of a formal mechanism or structure for collaboration inhibited this process.

Collaboration between government agencies and organisations was not success because of red tape and bureaucracy. The government also tended to centralise the decision making process and there was a lack of policy defining the nature of collaboration between government, NGOs, and the private sector. Moreover, collaboration between NGOs and the private industry clinics tended to be weak due to the NGOs inadequate capacity to provide goods and services and charging fees for their services. Lastly, collaboration among the industry clinics was felt to be strong because their work culture among companies was generally the same as was their set up and nature of operations. This included the condition of service of the employees.

The researchers have recommended that since many donor agencies channel their funds for NGOs through the government, there is a need to formulate a policy will clearly spell out the nature of collaboration between the government and NGOs, as well as describe the mechanism for accessing donor-funding. Such a policy, however, should be flexible enough to allow the NGOs to get on with their jobs. In other words, such a policy should avoid the trappings of the government red tape and bureaucracy. In addition, the government needs to consider decentralising authority to the agency co-ordinating donor funds destined for NGOs. Decentralising authority will ensure that decision are made quickly and the work of NGOs and their efficiency is not compromised.

There is also a need for donor agencies who directly fund NGOs to collaborate in terms of project conception, implementation plan, and program supervision and evaluation. This will enable donors to jointly fund projects, thereby, cutting down duplication efforts and inefficient use of the human, physical, and financial resources and facilities, as well as the unnecessary complications between NGOs. In other words, donor co-operation in funding will lead to the harmonisation of facilities and resources. In addition, NGOs need to consider strategies of raising their own funds so that they do not entirely depend on donor funding. This can be part of the proposed national policy on collaboration between NGOs and the government.

Family health education is of crucial importance in the development of many developing countries, including Swaziland (World Development Report 1990). As a result of its importance to national development, family health education has attracted a number of providers. In developing countries, providers of family health education have generally included, among other, government agents (hospitals and clinics), non-government organisations (NGOs) and private companies. No single provider of family health education has been able to cope with the demand. In order to avoid clashes among family health education providers, it becomes necessary for them to collaborate in the provision of health services. In Swaziland, for example, evidence indicates that government agents, NGOs, and the private sector agencies collaborate in the provision of family health education (Ministry of Health 1996). However, information regarding the nature, strength, and weakness of such collaboration among the stakeholders in the country is lacking.

In spite of the collaboration among providers of family health education in developing countries, research evidence indicates that the status of health in developing countries compared to developed countries is very poor. The United Nation Development Report (1991) states that about 25 million children and young adults die each year mostly from preventable causes. The World Development Report (1990) states that under-nutrition and micro-nutrition affect more than one billion people who live in poverty in developing countries. Pregnancy and child birth in many developing countries account for more than a quarter of all deaths of women of childbearing age. About half a million women, 99% of them in the developing world, die in child birth each year. Of every 100,000 women who give birth in Africa, between 200 and 1,500 of them die, compared with fewer than 10 in most developed countries. Of every 100 African women who take the contraceptive pill for a year, one dies (World Development Report 1991). This situation is further exacerbated by the widespread of the HIV/AIDs pandemic in developing nations.

In Swaziland, life expectancy is about 58 years, while infant mortality is 94 per thousand children (National Development Plan 1997). According to the Ministry of Health Sector Study (1996), Swaziland's maternal mortality rate is estimated at 100 to 110 per 1,000, while the dependency ratio is 104 per 100 of the working population. The fertility rate is 6.9 births per female of childbearing age, a figure which ranks amongst the highest in the world. Despite this high birth rate, the number of women of childbearing age using modern methods of contraception is estimated at 30% (Family Life Association of Swaziland 1996). A high fertility rate is usually associated with high rates of mortality in both mothers and children (Ministry of Health 1983). Although only 7% of the rural population has access to safe water and 36% has access to adequate sanitation, 85% of the population is within 8 kilometres of health facilities (National Development Plan 1997). About a third of the children less than five years suffer from poor nutrition (Ministry of Health Sector Study 1996).

Furthermore, Swaziland, like most developing nations, is faced with the HIV/AIDS pandemic. While the first infected person in Swaziland was identified in 1986, a total of 124 cases was reported up to the second quarter of 1996 (Swaziland National AIDS Programme 1997). Cumulatively, as of June 30th, 1996, 941 cases have been identified. According to the Swaziland National AIDS Programme (SNAP), this figure represented a 35% underestimate of the actual extent of the HIV/AIDS pandemic in the country. SNAP has estimated the prevalence of HIV/AIDS at 22% of the sexually active population in Swaziland. More than 60% of AIDS cases are believed to occur in adults between 20 and 49 years. Eighteen percent of the sexually active student population is estimated to be HIV positive (Ministry of Education 1994). The prevalence of HIV/AIDS is estimated at 23% among 15 to 19-year-olds, 32% among 20 to 24 years age group, and 18% among 25 to 30-years age groups. Sexual intercourse is the predominant mode of transmission (SHAPE 1995).

The need for effective provision of family health education cannot be overemphasised in developing countries. Family health education seeks to provide knowledge, skills, attitudes, and values conducive to good health, and encourages creative and critical thinking in solving health problems (Ministry of Health 1997). Family health care provision contributes to poverty alleviation and increased contribution to the Gross Domestic Product (GDP) of the country (National Development Strategy 1997). Research has shown that better health and nutrition raises workers’ productivity, decreases the number of days the workers are ill, and prolongs their potential working lives (World Development Report 1991). It has also found that health and nutrition have long-run effects on productivity and output because they influence children’s ability and motivation to learn; and that disease and malnutrition in infancy retard mental development, while illness and temporary hunger reduce children’s ability to concentrate and keep them away from school.

According to the World Development Report (1990), research studies conducted in many developing countries (e.g. China, India, Kenya) consistently show that protein malnutrition is related to lower cognitive performance. Family planning programmes, where they have been implemented, have brought down birth rates. For example, birth rates in Costa Rica, Korea, and Singapore fell by 35% to 48% between 1965 and 1985 (World Development Report 1990). In addition, research has shown that improving women’s ncome, education, health, and nutrition greatly reduce maternal mortality and morbidity (Barmera 1990 & Caldwell 1979) and family planning information and services improve maternal health by enabling women to time and space pregnancies (World Development Report 1991).

In most developing countries, health care provision is the primary responsibility of governments through the Ministries of Health. However, since governments are not able to adequately provide family health education to all people, other stakeholders such as NGO clinics, private clinics, company clinics, mission clinics, and hospitals are also involved. In Swaziland, for instance, health activities such as family planning, family health education, health service, and the promotion of child spacing are under the jurisdiction of the Ministry of Health (Ministry of Health 1996). These family health activities are undertaken by other social partners in the private and NGO sectors. In short, providers of family health education in the public sector are directly under the control and management of the Ministry of Health, while those in the NGO sector and the private sector are indirectly under the control of the Ministry of Health.

Providers of family health education in Swaziland collaborate to a certain degree. The word collaboration means many things to many people. Generically, collaboration means to labour together, to work jointly with others to co-operate with ot hers (Webster’s New Collegiate Dictionary 1981). Collaboration means working together for a common purpose and goal, or pooling resources, facilities, and efforts to tackle a set of common problems which neither partner can solve alone (Omondi, Mutero, M warogo, & Nduba 1993). Collaboration is not domination of the weaker social partner by the stronger social partner; it is partnerships (Morsy 1991). Collaboration implies interaction of two or more social partners whose goal is to address a similar social problem. In he context of this study, collaboration was conceived of as the co-operation, interaction, or partnership between institutions and agencies in the public, private, and NGO sectors which provided family health education, family planning , and the prevention and control of the spread of HIV/AIDS pandemic in Swaziland.

The literature review reveals that collaborative relationships depend on the recognition by all collaborating social partners that they need each other’s services, capabilities, strengths, facilities, personnel, and equipment to survive (Adekanmbi & Mphinyane 1996, Commuri 1995, Fisher 1995, Mphinyane 1996, & Najam 1996). Collaborative relationships also depend on a sound organisational framework (mechanism) and financial framework. In other words, collaborating social partners need to es tablish an organisational framework as well as a financial framework which will sustain the collaborative venture.

Also, it is important for the collaborating social partners to have a common vision , similar objectives, to share similar priorities and processes for executing the collaborative activities, and to establish a clear, communication structure that will link them and create a harmonious relationship. In short, effective collaborative relationships demand a clear definition of social partners’ functions, roles, and responsibilities. It must be anchored on clear lines of communication and negotiations an d be build on mutual trust and compromises. This requires enormous patience and vigilance. Ultimately, collaborative relationships need a clearly articulated organisational and financial framework and the social partners must share similar visions and v alues (Adekembi & Mphinyane 1996, Mphinyane 1993, & Hudson 1987).

Hudson (1987) observed that collaborative relationships among social partners is fostered by a high degree of formalisation, intensity, reciprocity, and standardisation. He explains formalisation as the extent to which collaboration is formalised by a dministrative and legislative sanctions. Intensity is the amount of investment a social partner has in relation to the other collaborating social partners. Reciprocity is described as the amount of exchange of resources (financial, materials, personnel, etc.) that collaborating partners are willing to share. Lastly, he explains standardisation as the mode or mechanism of interaction agreed upon between the collaborating social partners. According to Hudson (1987), the lower the degree of formalisation , intensity, reciprocity, and standardisation, the weaker the collaborative relationship among social partners. He argues that collaborative relationships are hindered by:

1) a lack of shared vision, goals, and objectives;

2) unclear definition of roles, responsibilities, and functions;

3) dissimilar strategies and processes;

4) unwillingness to share information and physical, human, and financial resources;

5) competition over the same target groups;

6) absence of a sound administrative, financial, and communication mechanism; and

7) a lack of awareness of the value of collaboration.

Commuri (1995) and Fisher (1995) examined the relationship between government and NGOs. Their analysis revealed that governments’ relationships with NGOs generally ranged from supportive to facilitative, neutral, regulative, repressive, ignored, and c o-optive. Their opinion is that if the relationship between the government and NGO is facilitative, supportive, or co-optive, then the mechanism for collaboration is likely to be effective. However, if the relationship between them is repressive, neutra l, or regulative, then the mechanism for collaboration is likely to be ineffective.

On the other hand, Najam (1996) outlined three possible relationships between social partners: confrontational, complimentary, and collaborative. He explains confrontational relationships as likely to exist when the social partners’ visions, policies, goals, and objectives were different and the strategies and processes used to achieve the goals and objectives varied. Such a relationship is likely to lead to hostility. His opinion is that complimentary relationships are likely to exist in a situatio n where the social partners share similar visions, policies, goals, and objectives, but preferred different strategies and processes to achieve them. Lastly, a collaborative relationship is likely to prevail in a situation where the social partners do no t only share similar visions, policies, goals and objects, but also prefer similar strategies and processes to achieve them.

Mphinyane (1993) also writes on models of collaboration. His four models by which organisations collaborate are: 1) consultancy model; 2) shared resource model; 3) shared market model; and 4) the association model. Two of the four models, the co nsultancy model and the shared resource model, are relevant to this study. According to Mphinyane (1993), the consultancy model is characterised by the recognition that one organisation lacks expertise to run or start a program, and therefore, depends on another fully established organisation to do so. In this model, expertise is drawn from the well-established organisation to assist the less established organisation plan, set up, organise, and implement its operational activities. There may be staff e xchanges between the collaborating organisations. The shared resource model, according to Mphinyane (1993), presupposes that the collaborating organisations tend to have similar goals, practices, resources, and facilities and are willing to share them. They tend to target the same clients with similar needs. The nature of collaboration among the public, private, and NGO sectors in Swaziland is located in the conceptual frameworks reviewed in this section.

To summarise, the problems facing family health, family planning, and the prevention and control of the spread of the HIV/AIDS pandemic in developing countries like Swaziland, are enormous and should not be a responsibility of one social partne r. A single social partner, like government, is not likely to have adequate human, financial, and physical resources to tackle them. In Swaziland, for example, the government’s total health budget, as proportional to the GDP over the past four years, ha s been less than 3% (Nhlabatsi 1997). All collaborating social partners in the public, private, and NGO sectors should be concerned and actively participate in resolving health problems. Therefore, the social partners need to collaborate in the provisio n of family health education in Swaziland.

Also, it has been observed that organisations are more likely to collaborate if they have a common threat or enemy (Najam 1996). Usually, this occurs after such organisations have realised that individually, they may not overcome this common threat or enemy. The literature reviewed in the preceding section has also shown that organisations are most likely to collaborate if they have common interests, share the same vision, have common goals and objects, target the same groups, and utilise the same st rategies. Bearing in mind the preceding literature review, what is the nature of collaboration in family health education among the public, private, and NGO sector organisations in Swaziland?

In developing countries, family health, family planning, and the prevention of the spread of the HIV/AIDS/STD epidemic is a concern not only of the government, but other social partners such as those in the NGO and private sectors (Omondi et. a l. 1993). Firstly, the findings of this study will provide useful information on the nature, strength and weaknesses, and the strategies for future collaboration between the collaborating social partners who provide family health education in Swaziland. Secondly, this study will test the explanatory value of Commuri (1995), Fisher (1995), Najam (1996), and Mphinyane’s (1993) conceptual frameworks regarding the nature of collaborative relationships between social partners. Put differently, the conceptua l frameworks explained in the literature review should be able to explain whether the collaborative relationships between social partners are supportive, facilitative, neutral, regulative, repressive, ignored, co-optive, complimentary, or consultative. I t is hoped that this study will be able to indicate the strengths and weaknesses of the current mechanism for collaboration among the private, public, and NGO organisations. Also, it will point out the value of sharing and mobilising available national r esources and facilities which enables partners to avoid unnecessary duplication in efforts, unhealthy competition, and helps them to save on time and expenditures (Nhlabatsi 1997). Finally, this study will provide direction for formulating policies to su pport better mechanisms of collaboration among the social partners providing family health education in Swaziland.

Although the evidence shows that there is collaboration between the public, private, and NGO sector agencies in providing family health education, family planning, and the prevention and control of the spread of the HIV/AIDS pandemic in Swaziland, revi ew of the literature indicates that the nature, strengths, weaknesses, and difficulties of such collaboration have not yet been determined. This research study will investigate the mechanisms by which providers of family health education in Swaziland col laborate.

The purpose of this study is to determine the nature, strengths, weaknesses, and difficulties of collaboration among the public, private, and NGO sector organisations in the provision of family health education, family planning, and the prevention and control of the spread of the HIV/AIDS pandemic in Swaziland.

The research questions which guide this study are:

Terms mean different things to different people. It is often necessary to explain the context in which they are used. This section defines key concepts used in the study.

Public sector organisations refers to government agencies that are directly under the jurisdiction and control of the government such as ministries, departments, and units which provide public services. In this study, public sector organisation s refers to the government hospitals, clinics, and units which provide family health education in Swaziland.

Private sector organisations are registered organisations whose primary motive is to make a profit. They are often referred to as "private for profit organisations" (Easton, Closson & Mavima 1997 & Najam 1994). Thus, in the c ontext of this study, private sector organisations refer to company or industry medical centres which provide family health education in Swaziland.

Non-Government Organisations (NGOs) are registered, non-profit, voluntary, independent, and charitable organisations (Cernea 1988 & Willard & Copestake 1993). In the context of this study, NGOs are the above providing family health educati on in Swaziland.

Collaboration means to labour together or to work jointly with other agencies to achieve a common goal (Webster’s New Collegiate Dictionary 1981). It means two or more social partners are working together for a common purpose. This is done by, among other things, pooling resources and facilities in an effort to tackle a set of problems which neither partner can solve alone (Omondi et. al. 1993). In the context of this study, collaboration is defined by how public, private, and NGO organisati ons co-operatively work together to provide family health education in Swaziland.

Nature of collaboration refers to the pattern, form, manner, or mechanism by which organisations and institutions collaborate to achieve their intended goals (Webster’s New Collegiate Dictionary 1981). In this study, the nature of collaboration refers to the patterns, form, manner, or mechanism by which public, private, and NGO organisations collaborate to provide family health education in Swaziland.

The present study was conducted in Swaziland, a land-locked country, covering an area of 17,364 square kilometres. It is the second smallest country in Africa. Administratively, Swaziland is divided into four regions and each region has a regional ad ministrator who is a political appointee of the King and is responsible for all regional affairs. Swaziland regained her independence from the United Kingdom in 1968. Party politics were banned in 1973 and are still banned. The present system of govern ance is the "Tinkhundla System" whereby members of a parliament are "democratically" elected from some 55 constituencies. The King has executive powers, and through an advisory council, appoints a prime minister and cabinet ministers. Currently, there i s a move to redraft a new constitution. The institution of the Monarchy is regarded as a unifying factor in the Kingdom.

The population of Swaziland is approximately one million people (National Development Strategy 1997). The population growth rate in Swaziland is about 3.2% per year. This rate places Swaziland among the fastest growing population in the world. The t otal fertility rate is about 6.1 (National Census Report 1986). Youth less than 15 years of age constitutes about 47% of the total population (National Census Report 1986). In fact, 60 % of the population is under the age of 18 years. Three-quarters of the population live in rural areas. The rest live in urban areas. The total working population of ages between 12 and 65 is estimated to be 17%. The majority of the population share a common language, tradition and history. An adult literacy rate is estimated at about 72%. Swaziland has not yet developed a formal population policy (Ministry of Health 1997).

Available data indicate that there are 6 general hospitals in the country of which 4 are government-owned and 2 mission-owned (Ministry of Health 1996). There is only one government-owned speciality hospital. With respect to health care centres, 4 ar e government-owned, one is owned by a mission, and 5 are owned by industry. There are 141 health care clinics in the country. The majority are owned by the government (47), followed by private individuals (38), missions (29), industries (21), and NGOs ( 6). Similarly, there are 162 outreach sites in the country. The majority are owned by the government (93), followed by missions (47), private individuals (12), and industries (10).

This study sets out to investigate the nature, strengths, weaknesses, and difficulties of collaboration between the public, private, and NGO organisations in Swaziland. The research design used in this study is a descriptive survey. According to Ary, Chester & Razavieh (1979), a descriptive survey design is appropriate for obtaining social facts concerning the current status of phenomena and/or for describing the nature of existing conditions in a situation. On the other hand, Cohen & Manion (1980) claim that a descriptive survey design is appropriate for identifying people’s perceptions on social issues. A descriptive survey design inquires into the status quo and attempts to measure what exists, without questioning why it exists (Ary, Ches ter & Razavieh 1979). Thus, a descriptive survey design was selected because the primary purpose of this study is to determine the existing nature, strengths, weaknesses and difficulties of collaboration between public, private and NGO organisations in Swaziland. (See Appendix A for a copy of the survey used).

The target population of this study is public, private, and NGO organisations which provide family health education in Swaziland. More specifically, key people in managerial positions such as chief medical officers, senior medical officers, heads of d epartments, heads of units, senior nurses, directors, and senior government officials were surveyed. It was assumed that these people would provide the necessary basic information given their positions in the organisations. Information pertaining to the number of organisations providing family health education was obtained by the Ministry of Health.

The Ministry of Health keeps records of all the public, private, and NGO organisations providing family health education in Swaziland (Ministry of Health 1997). Invariably, this record was used to identify the list of public, private, and NGO organisa tions providing family health education in Swaziland. The records indicate that there are 6 private sector organisations, 3 NGOs, and one government unit providing family health education. the government unit is co-ordinating the provision of family hea lth education in the country on behalf of the Ministry of Health. In view of the small number of organisations providing and collaborating in family health education, it was decided to include them all in this study. However, two private sector organisat ions were not included because of time constraints and the fact that they were difficult to access. All senior medical officers, chief medical officers, heads of departments, heads of units, senior nurses, directors, and senior government officials in th e four private sectors, three NGOs, and the government unit provided data for this study. Thus, informants who provided the data for this study were 19 in total. (See Appendix B for this list)

Data for this study emanated from (a) written documents of the selected organisations and (b) from the key informants. Data from the key informants were collected using (a) a structured questionnaire (see Appendix A), (b) interviews (see Appendix C). The structured questionnaire and interview guide were designed by the researchers and piloted to a few informants who were not part of the main study. The questionnaires were delivered to the informants by the researchers. This was possible because Swa ziland is a small country, one can travel from North to South or East to West of the country in less than two hours. Most of the questionnaire items were open ended, except one which required the informants to indicate the strength of collaboration. The informants were asked to circle one option among four options. The options were: A = very weak collaboration, B = moderately weak collaboration, C = moderately strong collaboration, D = very strong collaboration. Responses of informants from ea ch organisation were combined to produce one symbol. For example, if one informant indicated that collaboration was "very weak (A) and another from the same organisation said that it was "moderately weak" (B), B was retained. (See Table 4 in the Findings section).

Written documents (policy documents, annual reports, strategic plans, handbooks, pamphlets, etc.) were collected while delivering and/or collecting the questionnaire. All of the informants were very co-operative and willing to provide the researchers with relevant documents. Tape-recorded interviews, using an interview guide, were conducted with informants who felt that they would not have the time to complete the questionnaire. (See Appendix C for the interview guide). Interviews were conducted th e same day as the informants were asked to complete the questionnaire. Interviews were conducted in the informants’ offices, and normally took between 30 minutes and one hour. Telephone interviews were conducted as follow up on certain leads and/or to c larify certain issues.

In view of the type of data collected for this study, qualitative methods were use to analysis the data. The data analysis methods included documentary analysis as guided by the research questions and descriptive statistics (frequencies) where necessa ry. Specifically, information that was extracted from the written documents included: organisations’ programs, goals and objectives, their target groups, strategies used, the nature and extent of collaboration, strengths and weaknesses of collaboration, and how they perceived it best to move forward with collaboration efforts. Matrix tables, based on the above categories, were used to analyse the data (these are in the Findings section). All efforts were made to write as accurately as possible (verbat im) the informants’ words during the interviews. Where necessary, frequencies were used to summarise the informants’ responses. The next section presents the findings of this study.

In order to appreciate the nature or mechanisms of collaboration between the organisations, it is important for the reader to have an understanding of each organisation, the program it was engaged in, its goals and objectives, its target group, and the strategies it used to deliver its services. The following section briefly describes each organisation, its program, the goals of the program, whom it was targeted for, and the strategies used to deliver it. (See Table 1 for a summary of all of the prog rams).

The Family Life Association of Swaziland is a private non-profit making NGO whose goal is to ensure that the people of Swaziland are educated about family health education, family planning and the prevention and control of HIV/AIDS. The main objective s of FLAS are to: 1) assist and supplement the activities of the Ministry of Health and other government agencies in the promotion of healthy family life and in the creation of a sense of awareness of the importance of family health in all respects so t hat it becomes a way of life; 2) assist and supplement the activities of the Ministry of Health and other government agencies in education for the acceptance of child spacing as a basic human right; 3) work with other organisations, and governmental age ncies in the implementation of community schemes in family health so that the quality of life for the individual person, the family and the community may be improved; 4) assist in informing and educating the public about the causes and effects of rapid p opulation growth at the national and international level; 5) assist in the distribution of information concerning all aspects of family health education; and 6) to adhere to the policies and principles of the International Planned Parental Federation (I PPF) (FLAS Annual Report 1995). the target groups of FLAS include the youth, men, and women.

FLAS runs four family health programs: the Community-Based Distribution of Contraceptives Program, the Industry-Based Family Planning and AIDS Program, the Family Life Education for Youth Program, and the Promotion of Responsible Sexual Behaviour Amon g Men Program. The Community-Based Distribution of Contraceptives Program targets women in rural areas. The main goal of the program is to increase the accessibility and availability of non-prescriptive contraceptives (foam, jelly, and condoms) to rural women. The distribution of non-prescriptive contraceptives is done by trained community-based distributors (CBD) who are also members of the community. Each CBD covers about 10 to 30 homesteads and FLAS pays him or her a monthly honorarium of E20.00 (ab out US$4.00).

The goal of the Industry-Based Family Planning and AIDS Program is to reduce unwanted fertility and improve maternal and child health in industries. FLAS’ strategy is to increase the prevalence of modern contraceptives and practice of child-spacing th rough industry clinics and medical centres. The objectives of the program are to: 1) contribute towards the national goal of increasing contraceptive prevalence rates in Swaziland; 2) improve the health status of employees and their families in indust ries; and 3) prevent and control the spread of HIV/AIDS between industry employees and their dependants.

The goal of the Family Life Education Program for Youth is to strengthen family life education among youth throughout the country by changing their attitudes towards responsible parenthood. The specific objectives of the program are to: 1) increase the youth’s knowledge on family life education; 2) increase the average age of first sexual encounters from the present 15 years to 16 years; 3) decrease teenage pregnancy; 4) increase youth participation in family life education; and 5) increase comm unication between parents and their children about reproductive health. The strategies used to implement the program include: peer education, material development, radio production, and formation of youth peer educators.

The Promotion of Responsible Sexual Behaviour Program is targeting men in the security forces (police, army, prison guards), prisoners, and in rural communities. The goal of the program is to educate them about family planning, sexually transmitted in fections, and HIV/AIDS prevention. The specific objectives of the program are to educate men about family planning methods, encourage them to talk to their partners about reproductive health issues, and sensitise them of their role in family planning. T he strategies used by FLAS to promote responsible sexual behaviour among men include lectures, promotional shows, folk media performances, and video, films, and slide shows.

The Swaziland National AIDs Program (SNAP) is a government program under the Ministry of Health. The goal of SNAP is to prevent the spread of HIV/AIDS epidemic among the youth (below 20 years), women and men of childbearing age, engaged couples, marri ed persons, commercial sex workers and their clients, prison inmates, homosexuals, long distance drivers, bus drivers, and conductors. The function of SNAP is to co-ordinate all HIV/AIDS programs in Swaziland through technical working groups whose compos ition includes people from organisations running HIV/AIDS programs throughout the country.

The operational activities of SNAP include: 1) developing and updating the National Strategic Planning Instrument and the national policy program of action; 2) mobilising resources; 3) conducting national advocacy against HIV/AIDS; 4) testing and screening donated blood; 5) collecting and analysis HIV/AIDS data; 6) developing and distributing information, education, and communication (IEC) materials; 7) facilitating the establishment of walk-in counselling services; 8) monitoring work place ba sed HIV/AIDS projects; 9) establishing and supervising community home-based HIV/AIDS care projects; 10) lobbying government to budget for HIV/AIDS/STD programs; and 11) conducting an annual HIV/AIDS sentinel survey. All these activities are executed i n collaboration with all organisations involved in HIV/AIDS prevention and control program.

The School HIV/AIDS/STD, Population and Education Unit (SHAPE) is an NGO whose main goal is to prevent and control the spread of HIV/AIDS/STDs among youth in schools. The specific objectives of the program are to: encourage responsible sexual behaviou r among school youth, help prevent and control the spread of HIV/AIDS/STDs infection among school youth, and to reduce unplanned and unwanted pregnancies among school youth. The strategies of SHAPE are to: 1) train teachers on how to provide technical information on HIV/AIDS and how to counsel students infected with HIV/AIDS; 2) develop an HIV/AIDS/STD curriculum and integrate it into the school system; 3) train teachers in secondary schools on HIV/AIDS/STDs infection; and 4) identify education mater ials for teaching, and establish anti-AIDS Clubs in all the schools.

Most of the big industries in Swaziland have medical centres or clinics for their employees which provide health services to their employees and their dependants on the basis of an employee benefit scheme which is largely subsidised by industry. The i ndustry health facilities that participated in this study included: the Sumunye Clinic (SC), The Ubombo Ranches Clinic (URC), the Usuthu Pulp Clinic (UPC), and the Mananga Medical Clinic (MMC). These centres or clinics provide health services to people in the surrounding communities on a cost recovery basis. They run family health education, family planning and the prevention and control of the spread of HIV/AIDS programs in collaboration with NGOs and the Ministry of Health.

The AIDS Information and Support Centre (TASC) is an NGO whose goal is to provide support services to people who are: 1) infected with the HIV/AIDS; 2) live with HIV/AIDS infected persons; 3) counsel HIV/AIDS infected persons; 4) wish to test wheth er or not they have the HIV virus; and 5) wish to learn about the HIV/AIDS epidemic. The objectives of TASC are: 1) to promote HIV/AIDS education through information and communication activities; 2) inform the public about support services available at the Centre; 3) motivate and promote collaboration between TASC and other collaborating organisations (public, NGO, and private); and 4) facilitate and promote counselling services. TASC’s services and strategies include counselling before and after a blood test, on-going counselling for HIV/AIDS infected people and their immediate families, training AIDS counsellors, peer educators, and peer counsellor for other organisations, providing a counselling and information help-line service on HIV/AIDS, d eveloping and distributing information, education, and communication materials, and facilitating the formation of support groups for people living with HIV/AIDS.

Table 1 below summarises the organisations’ programmes, goals of the programmes, groups for whom they are targeted for, and the strategies used to deliver the health services. Two important conclusions can be drawn Table 2. The first one is that the health programmes are similar in the sense that they focus either on the prevention and control of the HIV/AIDS/STDs epidemic or on family health (life) education and family planning or both. Invariably, their goals are bound to be similar if not the sam e. The second conclusion is that the target groups for most of the organisations are the same. For example, most organisations target people of all ages (e.g. SNAP, FLAS, TASC and Industry Clinics), except one (SHAPE) which has targeted the youth in sc hools. However, some organisations, like FLAS and Industry Clinics, have several health programmes which are specifically targeted to the various sections of the population. FLAS and the Industry Clinics, for example, have specific health programmes targe ted for the youth, men, and women. Although SNAP seems to have different target groups, there is no evidence of existing programmes targeted to these groups. The third conclusion is that almost all the organisations use similar strategies to delivery th eir services such education, counselling, and provision of commodities.

Three important conclusions can be drawn from Table 1. The first one is that the health programs are similar in the sense that they focus either on the prevention and control of HIV/AIDS/STDs epidemic or on family health (life) education and famil y planning or both. Invariably, their goals are bound to be similar if not the same. The second conclusion is that the target groups for most of the organisations are the same. For example, all of the above organisations target people of all ages except for SHAPE, which targets youths in schools. However, some organisations, like FLAS and the industry clinics, have several health programs which are specifically targeted to the various sections of the population such as youth, men, and women. Although, SNAP seems to have a different target group, there is no evidence of existing programs targeted to these groups. Lastly, all of the organisations use similar strategies to deliver their services such as education, counselling, and the provision of co mmodities.

Collaborating Organisations

The first research question of this study inquired into the organisations which collaborated in the provision of family health education, family planning, and the prevention and control of the spread of the HIV/AIDS pandemic in Swaziland. Collabora tion was defined as labouring or working together for a common purpose and goal. Therefore, in the context of this study, collaboration referred to the health activities which the organisations providing family health education co-operated and worked together. The data from the interviews and the documents indicates that all eight organisations collaborated, in one way or another, to deliver the health services to their clients. However, the nature and the extent of collaboration differed among org anisations (see section below on the "strengths and weaknesses of collaboration"). This is not surprising considering the fact that the programs, the program objectives, the target groups, and the strategies used to deliver the health services were similar if not the same. What seems to vary, though, was the nature and extent of collaboration between the organisations. Table 2 shows the pattern that emerged as the data were plotted to find out which organisations collaborated with which ones. This data came from the informant interviews and questionnaires.

The second research question of this study inquired into the nature of collaboration between the organisations providing family health education, family planning, and the prevention and control of the spread of the HIV/AIDS/STD pandemic in Swaziland. In this study, the nature of collaboration was defined as the patterns, forms, or manner of co-operation or partnerships between the organisations. The data from the interviews, questionnaires and the documents showed that most of the areas in which the organisations collaborated were: 1) training; 2) production and delivery of IEC materials; 3) message delivery; 4) distribution of commodities to clients; 5) transport; 6) facilities and funding; and 7) advocacy for policy formulatio n on population control and the spread of the HIV/AIDS pandemic. Organisations collaborated on the basis of their programs. This following section describes the nature of collaboration between the organisations by the type of program.

In the School Youth HIV/AIDS Program, FLAS, SHAPE, SNAP, and the Ministry of Education collaborate in the following manner. The Ministry of Education collaborates by (a) allowing FLAS, SNAP and SHAPE to teach about youth family planning and HIV/AIDS/S TDs syndrome to the head teachers, teachers, parents and the youth in schools, and (b) permitting the three organisations to produce an AIDS Handbook for Teachers in Swaziland and the School Health Education to Prevent STDs, HIV/AIDS Training Gu ide. Schools also collaborated by providing time and facilities for the three organisations to deliver their services (i.e. teach and distribute the IEC materials). FLAS and SHAPE collaborate in developing and producing IEC materials. The three org anisations also collaborate in pressuring the Ministry of Education to include family life education and lessons on the prevention and control of the spread of HIV/AIDS/STDs pandemic in the school curriculum. Although both SHAPE and FLAS are involved in organising and running training workshops and seminars for head teachers, teachers, parents, and youth counsellors, they have not yet collaborated in doing this. Each organisation plans and facilitates its own training workshops and seminars.

The explanation given for not collaborating was that each organisation had a different approach. FLAS’s approach is to teach the pupils in schools without first appraising the parents about the content of the program. SHAPE’s strategy is to first ap praise the parents about the content of the program before teaching the pupils. SHAPE is sensitive to the parents’ position on family life education (especially on the topic on sex education). Some parents, especially from traditional families and some extremely religious families were strongly opposed to the idea of teaching family life education to their school children. One church organisation is reported to have actually distributed pamphlets which were against the teaching of family life education and planning, not only to school children but to the parents in general (FLAS 1996). FLAS and SHAPE have, however, collaborate, to a lesser extent, in IEC material development and distribution. FLAS, for example, trains SHAPE’s staff on IEC material de velopment, while SHAPE distributes FLAS’ IEC materials in the schools.

There has been a bilateral collaboration between SHAPE and the Ministry of Education. The Ministry of Education, for example, has appointed a teacher to SHAPE to facilitate the co-ordination of the youth program in the schools. This person is paid by the Ministry of Education. Also, the Ministry of Education provides SHAPE with transport to travel to the schools. It also provides funding to SHAPE to run the In-School HIV/AIDS Program as well as for producing and distributing the IEC materials to sc hools. SHAPE collaborates with the Ministry of Education by providing an office and secretarial services to the appointed teacher. Also, SHAPE provides technical assistance to the program.

TASC’s contribution in the In-School Youth Program is to provide resource persons during the training and teaching of teacher-and-peer counsellors on HIV/AIDS/STDs as well as to provide IEC materials. In most instances, TASC’s staff is either invited by FLAS or SHAPE to be resource persons in the training workshops or seminars. In return, the two organisations train TASC’s staff on how to develop IEC materials on HIV/AIDS/STDs.

In promoting family life education, family planning, and the prevention of the HIV/AIDS among youth, men, and women, FLAS has collaborated with the National Radio Station to air its messages. The radio messages are produced by FLAS. The programs are both in the local language and English. The youth participate in the production of the radio programs which are usually in the form of talk shows, drama, and citation of poems. They air twice a week for 15 minutes. In order to get messages across r ural communities, FLAS collaborates with rural community centres. The local drama societies, well-known music groups, talk shows, and citation of poems are held in rural community centres free of charge. The shows are performed by popular, well known lo cal music groups and drama societies. The shows and drama feature an assortment of entertainment activities mixed with clear short educative messages. The messages include partners’ communication about the use of condoms and the risk of having too many partners. FLAS provides the groups with transport and token money.

In the National AIDS Program, FLAS and SNAP collaborate in training government nurses on planning and interpersonal communication skills. FLAS provides the expertise (resource persons), while SNAP provides funding for the training. SNAP and FLAS join tly work on the projections, procurement, distribution, monitoring and evaluation of family planning commodities. They collaborate in planning and organising national campaigns on HIV/AIDS. They assist industries to organise their own HIV/AIDS campaigns for their employees as well as take part in the celebrations.

In return, the industries provide funding and facilities for the campaigns. SNAP also collaborates with FLAS in distributing health commodities which are provided free of charge by the Ministry of Health to all organisations that are involved in fami ly life education, family planning and the prevention and control of the HIV/AIDS epidemic (i.e. TASC, SHAPE, Industry Clinics, public and private clinics). Industry clinics reciprocate by providing SNAP with data on HIV/AID cases. After SNAP completes the analysis of the data, it shares the information with all the health providers in Swaziland.

TASC collaborates in this program by training nurses and peer counsellors from FLAS, the Ministry of Health, hospitals, industry clinics, and private clinics on how to test clients for HIV/AIDS, counsel them, and provide them with IEC materials. TASC’ s personnel have also been invited by the other collaborating organisations to be resource persons in their training workshops and seminars. In return, SNAP, SHAPE, and FLAS have distributed TASC’s IEC materials to the industry clinics, public, and priva te clinics, hospitals, and schools. SNAP has gone to the extent of assisting TASC develop its Immediate and Long Term Plan 1996 - 2000 at not cost.

In the Industry-based family health, family planning and HIV/AIDS programs, FLAS collaborates by (a) providing training to the industry clinic nurses and the industry-based distributors (IBDs) on family life education and family planning, and the prev ention and control of HIV/AIDS, (b) training on the appropriate use of contraceptives, distributing family planning commodities (contraceptives), IEC materials on family planning and HIV/AIDS, and (c) assisting industries identify and select appropriate IBDs. All of these services were provided free of charge until last year (1996) when FLAS and TASC decided to charge its clients on a cost recovery basis. This decision was arrived at after there was a decline of donor funding for FLAS and TASC programs . TASC’s collaboration in this program is basically on training the company nurses and the IBDs on how to test clients’ blood for HIV/AIDS infection, and how to counsel them before and after they have been tested positive. They also IEC materials on HIV /AIDS. As mentioned earlier, TASC’s IEC materials are distributed to the companies by FLAS free of charge. In return, industries have contribute to programs by (a) making available to FLAS and TASC training facilities free of charge, (b) offering FLAS and TASC training personnel free boarding and lodging facilities, (c) releasing company personnel during company time to attend FLAS and TASC’s training sessions, (d) contributing to the purchasing of capes, shoes, T-shirts, and bag which are usually giv en to the IBDs as a way of motivating them.

The third research question of this study inquired into the strength (intensity) of collaboration between organisation providing family health education, family planning and the prevention and control of HIV/AIDS in Swaziland. Table 3 indicates the re sponses of the key informants of the collaborating organisations. The first letters indicate the responses of informants in the columns section and the second letters indicate the responses of informants in the rows section. Careful examination of the re sponses in Table 4 reveals three things: (i) that the strength of collaboration between the NGOs was perceived to be weak, (ii) that the strength of collaboration between the NGO and the industry organisations was also perceived to be weak, and (iii) that the strength of collaboration between the industry organisations was perceived to be strong. In the first and second instance, the responses of the informants were either ‘A’/‘B’ meaning "very or moderately weak collaboration". In third instance, the responses of the informants were either ‘D’/‘D’ meaning "very or moderately strong collaboration." There is, however, an exception to this general trend: collaboration between FLAS and the industry organisations was very strong.

Key: A = Very Weak Collaboration

B = Moderately Weak Collaboration

C = Moderately Strong Collaboration

D = Very Strong Collaboration

GOVT = Government

UNDP = United Nations Development Program

EU = European Union

UNICEF = United Nations Children’s Emergency Fund

CONCO = Local Coca Cola Company

USAID = United States Agency for International Development

The strength of collaboration among the NGOs was perceived by the informants to be weak. These findings were collaborated with the data from the interviews where respondents were asked to state the strength of their col laboration and explain their responses. One of the explanations for the weak collaboration among NGOs was the perceived competition for donor attention. The NGOs in Swaziland depend on donor-for funding. Apparently, donors fund projects that are based on good, well-articulated proposals that have a clear mission, clear goals and objectives, and viable and realistic business, implementation, and evaluation plans. The NGOs who have developed this kind of technical expertise for project proposal developm ent are not willing to share it with the other NGOs who lack this expertise. This kind of behaviour has invariably weakened collaboration among some NGOs. As one informant pointed out, "this has created distrust among NGOs because we seem not k een to share our expertise and plans lest our competitors copy them".

The second explanation relates to the issue of accountability and claiming credit for the success of an NGO project if several donors are funding it. It was explained that some donors were not generally keen to collaborate in funding NGO projects that are already funded by other donors. The problem arose when each donor accounted for or claimed credit for its inputs to the project, especially when preparing a report to its government. In other words, there was a problem of knowing with certainty the impact of each donor intervention to the NGO project. This, the informants explained, was the reason for the duplication of efforts between NGOs’ donor-funded projects.

The third point provided by the informants explaining the weak collaboration among NGOs was the different time frames at which projects are conceived and then funded by donors. Apparently, this makes it difficult for NGOs to harmonise their project im plementation plans because each project would be at different stage or phase of implementation and progression. Harmonisation of the different stages of project implementation was problematic.

The fourth explanation, provided by at least one NGO, was that the government also caused the weak collaboration among them in the sense that it provides funding to some NGOs and not others. And yet, in some cases, especially in HIV/AIDS program, all of them were making a contribution to the community. This differential treatment appears to have soured relations among the NGOs.

Finally, NGOs pointed out that there was no policy defining the nature of collaboration among themselves, despite the existence of the Co-ordinating Assembly of Non-Organisation (CANGO) their umbrella organisation. The views of some of the NGOs were t hat CANGO has had some internal problems lately and, therefore, are unable to fulfil its role of co-ordinating NGO activities. CANGO, they argued, is not in a position to address the issue of collaboration among NGOs, especially with respect to project p lanning, implementation, costing and evaluation, and sourcing funding because an unwillingness exists among some NGOs to financially contribute to CANGO. Thus, it has no money to execute its duties. The view among the NGOs is that CANGO is an ad hoc orga nisation which is not guided by any formal organisational or financial framework.

It is natural that when organisations see themselves to be in competition, they do not collaborate, especially if collaboration will lead to sharing information which in turn may lead to copying each other’s strategies. This seems to be the case betwe en the NGOs in Swaziland. It should be realised that most NGOs depend on donor funding for their survival. They must be viewed as very effective in implementing donor funded projects to attract future moneys. It would seem then that as long as NGOs depe nd on donor funding for their survival that their collaborative efforts will remain weak and the role of CANGO will continue to be minimal. One would predict that as soon as donor funding diminishes and the degree of competition for donor-funding lessens , that CANGO’s role and collaboration among the NGOs would be strengthened. This assertion is based on Hudson’s (1987) theory that collaborative relationships are thwarted by: 1) a lack of shared visions, goals, and objectives; 2) unclear definitions of roles, responsibilities, and functions; 3) dissimilar strategies and processes; 4) unwillingness to share information and physical, human, and financial resources; 5) competition over the same target groups; 6) absence of a sound administrative, fi nancial, and communication mechanism; and 7) a lack of awareness of the value of collaboration.

Table 3 indicates that collaboration between the government agency (SNAP), NGOs and company clinics is relatively weak. Several reasons were provided by the three parties as to why this collaboration is weak. The main reason given is the difference i n the culture of work in government institutions and private organisations or NGOs. To be more precise, the major issue was the prevalence of red tape and bureaucracy in the government institutions. One executive member of an NGO, for example, pointed o ur that people in government did not have the sense of agency that NGOs share. "We in NGOs and the private sector, have deadlines to meet. Time is money. We cannot afford to leave our work here, travel to Mbabane, only to be told that the meeti ng has been cancelled because the chairperson had to attend an urgent meeting called by his/her seniors. We use our transport to go there. At the end of the day we loose in terms of time lost and human and financial resources".

The second point mentioned by NGOs and the private sector for the weak collaboration between the government agency and them was the tendency of government to centralise the decision making process. Government officers in SNAP did not to have the power to make important decisions in meetings with NGOs and the companies which was a great source of frustration to the NGOs and the private sector. This is because resolutions taken in such meetings had to be referred to committees higher up the government hierarchy for approval. By the time such a decision is taken, it is belated.

One particular instance that was mentioned was the issue of accessing some of the donor funds for NGOs which are channelled through the government agent, SNAP. Some donors, like the UNDP, channel their funds to NGOs through the government. NGOs compl ained that this process was very cumbersome, full of red tape and bureaucracy, and wasted time. A senior medical officer in an industry clinic had this to say: "If you want to access those donor funds, be prepared to wait for another six months. That is not the way we work in the private sector. We would rather use our own resources than suffer that red tape".

The third explanation as to why there was weak collaboration between the government agency, SNAP, and NGOs and the private sector was a lack of policy which defined the nature of the collaboration. This, according to government officers, was the reaso n for the delay in channelling funds to NGOs and the private sector. All of the stakeholders agreed that a policy was needed to guide SNAP, NGOs, and the private sector on the mechanism, criteria, and procedures for collaborating and accessing donor fund s, as well as how they will be accounted for. One senior government officer remarked that "in the absence of such a policy, it would be difficult for government to monitor the use and misuse of the donor funds and those of government. We need to put this policy in place first".

Table 3 indicates that collaboration between NGOs, with the exception of FLAS, and the private industry clinics is relatively weak. One of the reasons provided for this was inadequate capacity by some of the NGOs to provide good service to the private sector because of they had to down-scale their operations due to diminishing donor funding. Another reason provided by the informants for the weak collaboration was the fact that some of the NGOs started to charge money for their services at a cost reco very basis. Yet, in the past, such services were free. One industry clinic, for example, had stopped buying family planning commodities from an NGO because that NGO was charging the company for services rendered. The industry clinic opted to get the co mmodities free of charge from the medical stores proved by the Ministry of Health.

FLAS was the only NGO who strongly collaborates with industry clinics. The reasons provided by the industries were that FLAS: (a) is efficient in delivering its services, and (b) has the capacity to provide the services despite her down-scaling as a result of diminishing donor funding. Furthermore, the industries felt morally bound to collaborate with FLAS because for a long time it provided them with services free of charge.

Lastly, Table 3 indicates that collaboration among the industry clinics is very strong because: (a) their culture of work is very similar; (b) their set up and the nature of operations of the clinics are similar; and (c) the conditions of service o f the employees are similar. Subsequently, the senior medical officers, for example, have their own committee which frequently meets to share ideas in the medical field and also to collaborate on placing bulk orders for medical supplies out of the countr y. They collaborate in seconding or exchanging nurses among the clinics for a few days to few weeks. They also share in the organisation of training course for their nurses. One nurse training program, for example, is co-funded by the companies. One company makes its facilities available for the tutorial classes. Courses dome from a university in South Africa. The companies provide funding for their nurses and the nurses collaborate by inviting one another whenever there is a training workshop or s eminar in any of the industry clinics.

Health and socio-economic development are interrelated. In view of the current economic austerity, this study assumes that collaboration is a vital ingredient between the public, private, and NGO sector organisations. The purpose of this study is to investigate the nature, strength and weaknesses of collaboration between the public, private, and NGO sector organisations in the provision of family health education, family planning, and the prevention and control of the spread of the HIV/AIDS pande mic. Despite the limitations of this study, it can be fairly concluded that there is collaboration between the public, private, and NGO sector organisations in the provision of family health education. However, the extent to which these organisations co llaborated vary within and amongst themselves.

Collaboration between government, on the one hand, and the private sector and NGOs, on the other, is relatively weak. While collaboration among the private sector organisations is strong, it was weak among the NGOs. The strength of collaboration amon g the private sector organisations seemed to anchored on the nature of their work culture, similarities in terms of their business operations, set up of their medical centres, and the conditions of service of their employees.

The weak collaboration among the NGOs revolves around the issue of competition as a result of trying to get the attention of the donors. This, in turn, creates mistrust and ill-feelings among some NGOs. The weak collaboration among the government, pr ivate and NGO sectors is a result of the government’s red tape, bureaucracy, selective collaboration with some NGOs and not others, and the absence of national policy or mechanism for collaboration.

Since some of the donor agencies have begun to channel their funds for NGOs through government, there is need to formulate a policy which will clearly spell out the nature of collaboration between the government and NGOs. The policy should also descri be the mechanism for accessing donor-funds. Such a policy, however, should be flexible enough to allow the NGOs to get on with their jobs. In other words, such a policy should avoid the trappings of the government red tape and bureaucracy.

The government needs to consider decentralising authority to the agency (SNAP) through which donor funds are channelled to NGOs. Decentralising authority will ensure that decisions are made quickly and the work of NGOs and their efficiency are not com promised.

There is need for the donor agencies who fund NGOs to collaborate among themselves in terms of project conception, implementation, and program supervision and evaluation. This will enable them to jointly fund projects, thereby, cutting down on duplica tion of efforts and inefficient the use of human, physical, and financial resources, facilities as well as the unnecessary competition between the NGOs. In other words, donor co-operation in funding will lead to harmonisation of facilities, and resources .

There is need for NGOs to consider strategies of raising their own funds so that they do not entirely depend on donor funding. This, perhaps, should be part of the proposed national policy on collaboration between NGOs and the government. Some NGOs a re already charging clients for service provided. However, some of their efforts in this direction are frustrated by government because it provides some of these services free of charge.

There is a need among the private sector organisations to strengthen their collaborative activities to have more impact on family life education, family planning, and the prevention and control of the spread of the HIV/AIDS epidemic.

In view of the declining donor funding, it is critically important that collaboration between the NGO and private sectors be strengthened because both partners stand to benefit. There is a need to create a forum which facilitates this collaboration.

In terms of the dissemination of the information contained in this report, several strategies will be used. The executive summary will be circulated among the NGOs, the government agency, and the private companies who participated in this study. Fund ing permitting, copies of the full report will be deposited in the national library and the university library. Efforts will be made to present the findings of this study in appropriate local and international seminars, workshops, and conferences. Also, efforts will be made to prepare a paper for publication in regional and international journals. Since the principal researcher is a member of a national development strategy committee in Swaziland, some of the findings of this study will be shared with the said committee.

This study zeroed in on the nature of collaboration. Time constraints and a lack of financial resources did not allow for looking at the effectiveness of the nature collaboration with respect to the impact of the programs to the clients. The question that begs an answer is: To what extent has the nature of collaboration between the public, private, and NGO sectors been effective (impact) in the delivery of health services in Swaziland?

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THE NATURE OF COLLABORATION AMONG PUBLIC, PRIVATE, AND NON-GOVERNMENTAL ORGANIZATIONS IN THE PROVISION OF FAMILY HEALTH EDUCATION IN SWAZILAND: A QUESTIONNAIRE

1.1 Your Full Name:

1.2 Your Academic Qualification(s):

1.3 Your Professional Qualification(s):

1.4 Your Position/Title in the Organization/Agency

1.5 Your Work Experience in this Job

1.6 Your Job/Duties

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2.

3.

4.

1.7 Name of the Organization You Work For Now

1.8 List the Family Health Education (FHE) Program(s) in your Organization

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2.

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(If need more space, please use the back of this page)

2.1 In the spaces provided below, list and state the family health education (FHE) programs in which your organization collaborates with other organizations to provide and deliver family health education in Swaziland.

1. a =

b =

c =

d =

2. a =

b =

c =

d =

3. a =

b = c =

d =

4. a =

b =

c =

d =

5. a =

b =

c =

d =

6. a =

b =

c =

b =

(If need more space, please use the back of this page)

Normally, the nature/form of collaboration between family health education organizations and programs include:

* collaborating in providing training for family health providers

* collaborating in providing specialized services (i.e. referral of clients to certain clinics)

* sharing counseling services for clients

* sharing costs for counseling services

* planning a training program for family health providers

* sharing or providing facilities for training family health providers

* sharing or providing facilities for teaching clients about family health education

* sharing or providing facilities for storing family health supplies

* sharing costs for training family health providers

* sharing transport costs for delivering family health supplies to regional centers

* sharing costs for paying family health providers

* sharing costs for transporting family health providers

* sharing or providing personnel when training family health providers

* sharing costs for marketing family health education programs

* using other organization’s facilities for education or marketing services

* sharing or providing family health education database

* sharing costs for procuring supplies for family health education programs

* sharing costs of producing & distributing family health education materials

2.2 For each family health education program, please state the nature/form of collaboration between your organization and the other organizations which provide family health education in Swaziland (i.e. how does your organization collaborate with the other organizations which provide family health education in Swaziland?)

1. a =

b =

c =

d =

a =

b =

c =

d =

2. a =

b = c =

d =

3. a =

b =

c =

d =

4. a =

b =

c =

d =

5. a =

b =

c =

b =

(If you need more space, please use the back of this page)

2.3 Please give reasons why it is necessary or important for your organization to collaborate with the other organizations in providing and delivering family health education in Swaziland?

1.

2.

3.

4.

5.

6.

7.

8.

9.

2.4 In your view, is the collaboration between the your organization and the others strengthening or weakening the provision and delivery of family health education in Swaziland? Tick one.

2.5 In your view, to what extent has the collaboration between your Organization and the others listed in question 2.1 above been strong or otherwise in the provision and delivery of family health education in Swaziland? Use the scale bel ow to rate the extent of collaboration.

Scale: A = Very Weak Collaboration

1. A B C D

2. A B C D

3. A B C D

4. A B C D

5. A B C D

6. A B C D

7. A B C D

8. A B C D

9. A B C D

10. A B C D

11. A B C D

12. A B C D

2.6 Usually, collaboration has some problems/difficulties/constraints. Please state the problems, difficulties, constraints which your organization may have experienced or encountered while collaborating with the other organizations in providing and d elivering family health education in Swaziland.

1.

2.

3.

4.

5.

6.

7.

8.

9.

2.7 In this section, please write the strategies which you believe should be put in place to improve or strengthen collaboration between your organization and the other collaborating partners in providing and delivering family health education in Swaziland.

1.

2.

3.

4.

5.

6.

7.

8.

9.

2.8 Please write any additional information you would like us to know about the collaboration between your organization and the other partners in providing and delivering family health education programs in Swaziland.

1.

2.

3.

4.

5.

6.

7.

8.

9.

2.9 We would like you to provide us with any documentation (sector policy papers, program evaluation reports, annual reports, any other documents) which your believe can assist us in understanding the nature/form of collaboration between your organiza tion and the other partners in providing and delivering family health education programs in Swaziland.

Thank you very much