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HIV/AIDS and Higher Education in Lesotho – a Cultural Historical Activity Theory (CHAT) Analysis of Three Institutions’ Responses

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HIV/AIDS and Higher Education in Lesotho – a Cultural Historical Activity Theory (CHAT) Analysis of Three Institutions’ Responses HIV/AIDS and Higher Education in Lesotho – A Cultural Historical Activity Theory (CHAT) Analysis of Three Institutions’ Responses Submitted in fulfilment of the requirements of the degree of Doctor of Philosophy in Public Administration in the Faculty of Management Sciences at the Durban University of Technology Monaphathi Maraka Student No 21649309. MAY 2020 APPROVED FOR FINAL SUBMISSION Supervisor: Prof J. Preece (PhD) Date: 01 May 2020 Co-supervisor: Prof T. Mukeredzi (PhD) Date: 01 May 2020 i DECLARATION Thesis, submitted in fulfilment of the requirements for the degree of Doctor of Technology in the Faculty of Management Sciences at the Durban University of Technology. I, MONAPHATHI MARAKA, declare that: The research reported in this thesis, except where otherwise indicated, is my original research. This thesis has not been submitted for any degree or examination at any other university. This thesis does not contain other persons’ data, pictures, graphs or other information, unless specifically acknowledged as being sourced from other persons. This thesis does not contain other persons’ writing, unless specifically acknowledged as being sourced from other researchers. Where other written sources have been quoted, their words have been re-written but the general information attributed to them has been referenced. Where their exact words have been used, then their writing has been placed inside quotation marks, and referenced. This thesis does not contain text, graphics or tables copied and pasted from the Internet, unless specifically acknowledged, with the source being detailed in the thesis and in the References section. Student Name Names of Supervisors Monaphathi Maraka Prof Julia Preece Prof Tabitha Mukeredzi Signature Signature Signature ii DEDICATION To students and staff of all Institutions of Higher Education in Lesotho; To my family, ‘Maphole, Cholo, Nyebane and Seabata, and my missed son, Marble. Also to Sophie, my late friend and fellow student while at the University of Kwazulu-Natal. And to all my fellow students from UKZN to DUT, all the best. iii ACKNOWLEDGEMENTS For guiding and encouraging me through writing the nine chapters of my thesis, I thank Professor Julia Preece and Prof Tabitha Mukeredzi, who partnered over supervising my work. One of my earliest, most influential scholars of cultural historical activity theory (CHAT) is Mary van der Riet, PhD. Without her work on generating “context” in a rural community, I would not have grasped some applications of CHAT in the fight against AIDS. She filled the gaps that Mukeredzi, who studied “experiences” of teachers in professional development, left to my imagination in tackling ‘response’ in IHEs in Lesotho. In using CHAT as an analytic frame, I discovered the meaning of community. These are the actors in my selected IHEs and key people whose lived experiences I convey through the voices of my KIs, FGDs, documents and observations of my study. I thank Professor N. Mahao, Vice Chancellor of NUL; Professor Oliphant, Rector at LCE; Mr. Lebakae, Director at LP; the Executive Director of NHTC, Dr. Tarr; for their leadership and agreeing to include their IHEs in my study. I thank the senior staff of the pilot, Lerotholi Polytechnic, Mrs. N. Majara and Ms. Tsepiso. At LCE I had the inputs of Mr. Mohale, Mr. Manamolela, Dr. Mpalami, Mrs. Mabitle, Ms. Moshoeshoe. At NHTC were Mr. Nkemele, Mrs. Lehana, Mrs. Sehloho and Mrs. Manyo whose contributions equalled those of the staff of NUL, namely Dr. Ranneileng, Mrs. Khotso and Mr Mohapi. I am indebted to the three IHEs students and staff for their understanding and cooperation in providing the facts as they know them from a customer perspective of the responses. I acknowledge the contributions of my fellow students Mantsejoa, Lofafa, Noma, Selloane and many others from South Africa, Swaziland, Zimbabwe, Uganda and parts of Africa with whom I began this road. I cannot forget our untimely demised colleague, Sophie Mahloane-Tau. Without their encouragement and scholarly solidarity, I would have taken perhaps much longer to complete my work. iv ABSTRACT The purpose of this study is to interpretively analyse the fight against HIV/AIDS, referred to as ‘response’, in three of Lesotho’s institutions of higher education (IHEs). These are the Lesotho College of Education (LCE), the National Health Training College (NHTC) and the National University of Lesotho (NUL). This study uses cultural historical activity theory (CHAT) to qualitatively interpret the response in a country with the second highest HIV prevalence globally. The study applies Vygotsky’s first generation of CHAT, Leontiev’s multifaceted second generation, and Engeström’s third generation, which features a minimum of two interacting activity systems. Its multimodal methodology draws from Mukeredzi’s (2009, p.56) critique of CHAT and its problem of not getting “in” deep into dimensions of an activity. Thus, this study incorporates closely matching theories, models and concepts around CHAT; mainly the World Health Organisation’s (2004b) health standards, Zeithaml and Bitner’s (2000) services marketing mix and Checkland and Holwell’s (1998) information systems. The findings reveal that conceptual tools - human skills and policies, do not mediate material processes such as planning, financing and reporting, resulting in a poor response. Gaps in human agency across critical elements of activity in the three IHEs result in conceptual, functional and material contradictions, and poor use of mediating artefacts adversely affects all interventions, including HIV testing and services (HTS), anti-retroviral (ARV) treatment and viral load suppression (VLS) envisaged in the UNAIDS (2014a and 2015) guidelines. This study teased out ‘expanded contradictions’ and tensions in the IHEs response, which invoked expansion, transformations, opportunities and new implications. Despite the IHEs leadership awareness of need for change, an historical embeddedness in unchanging cultures and functional contradictions due to poor agency (by subjects), lack of policies (rules), finance, (tools), hamper the response. The study found opportunities for IHEs against HIV/AIDS. This study recommends two new agency models. One is ‘knit-working’, which aims to improve responses by identifying key, specific, and rapidly doable ‘nitty-gritty’ inter-college activities. The second model aims to strengthen IHEs leadership agency through 3-Cs of commitment at top management, improved resources and capacity at middle management, in order to enable operational level services to evidence the concern over AIDS. This study will alleviate a dearth of literature in the nexus of Lesotho’s IHEs, HIV/AIDS and services. v ABBREVIATIONS AAU - Association of African Universities ABMP - African Broadcast Media Partnership against HIV/AIDS AIDS - Acquired Immunodeficiency Syndrome ARVs - Anti-Retrovirals AU/C - African Union / Commission CATDWR - Center for Activity Theory and Developmental Work Research CHAT - Cultural Historical Activity theory CHE - Council on Higher Education COP - Country Operational Plan FGD - Focus Group Discussion GDP - Gross Domestic Product GoL - Government of Lesotho HEAIDS - Higher Education AIDS Programme HIV - Human-Immunodeficiency Virus HTC - HIV Testing and Counselling HTS - HIV Testing Services ICT - Information and Communication Technology IDU - Injecting Drug Use IEC - Information, Education and Communication IHE(s) - Institution(s) of Higher Education IS/D - Information System/Design JEAPP - The Joint Economic, AIDS, Poverty Programme KI/I - Key Informant/Interview KYS - Know Your Status LCE - Lesotho College of Education LENEPWA - Lesotho Network of People Living With HIV/AIDS LENASO - Lesotho Network of AIDS Service Organisations LHDS - Lesotho Health and Demographic Survey LP - Lerotholi Polytechnic LPPA - Lesotho Planned Parenthood Association MCP - Multiple Concurrent Partnerships MDGs - Millennium Development Goals vi MMR - Maternal Mortality Rate MoET - Ministry of Education and Training MoH - Ministry of Health MoT - Modes of Transmission MSM - Men who have sex with men NAC - National AIDS Commission NGO - Non-Governmental Organisation NHTC - National Health Training College NTI - Nurse Training Institute NUL - National University of Lesotho OI - Opportunistic Infections PEPFAR - President’s Emergency Plan for AIDS Relief PLWH/A - People Living With HIV/AIDS PMTCT - Prevention of Mother to Child Transmission PrEP - Pre-Exposure Prophylaxis PSI - Population Services International QCA Qualitative Comparative Analysis QMMH - Queen ‘Mamohato Memorial Hospital SADC - Southern African Development Community SARUA - Southern African Regional Universities Association SDGs - Sustainable Development Goals SIDA - Swedish International Development Agency SSA - Sub-Saharan Africa UN - United Nations UNAIDS - United Nations Joint Programme on HIV/AIDS UNDP - United Nations Development Program UNFPA - United Nations Population Fund US/G - United States/Government VC - Vice Chancellor VMMC - Voluntary Male Medical Circumcision/MC WHO - World Health Organisation ZPD - Zone of Proximal Development vii TERMS USED HIV/AIDS - used interchangeably with AIDS, and as used in specific reference; IHE - used interchangeably with ‘college’, ‘university’ or as per source; Health services- used to generalise and is interchangeable with ‘health care’, ‘clinic(s)’. Response - used to mean the activity of fighting HIV/AIDS in IHEs, and comprises the three main components of IHEs, HIV/AIDS and services.
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