The potential and perils of partnership: Christian religious entities and collaborative stakeholders responding to HIV and AIDS in Kenya, Malawi and the DRC An ARHAP Report July 2008 This study was made possible with the generous support of Tearfund and UNAIDS REPORT Reporting on a participatory collaborative process Suggested Reference Haddad B, Olivier J, De Gruchy S. 2008. The potential and perils of partnership: Christian religious entities and collaborative stakeholders responding to HIV and AIDS in Kenya, Malawi and the DRC. Study commissioned by Tearfund and UNAIDS. African Religious Health Assets Programme, Cape Town, South Africa. Contact Information African Religious Health Assets Programme Dept. of Religious Studies School of Religion and Theology University of Cape Town University of KwaZulu-Natal Private Bag Private Bag X01 7701 3201 Rondebosch Scottsville South Africa South Africa Email: [email protected] Phone: +27 33 260 5540 Phone: +27 -21 650 3457/8 www.arhap.uct.ac.za The potential and perils of partnership Interim report for a collaborative process 2008 Acknowledgements This research would not have been possible without the contributions made by many people. First of all, we express our gratitude to the many respondents in Kenya, Malawi and the DRC who were willing to give of their valuable time to meet with us and share their knowledge and wisdom. (There are too many to list here, but all participants appear in Appendix 5.) Further, thanks to those who responded with questionnaires and the draft report feedback promptly and, more generally, for the continued enthusiasm that was shown for collaboration and action against the HIV and AIDS epidemic. Others helped by providing preliminary country information and opened doors for the invitation process - in particular: Jacinta Maingi, Peter Okaalet, Jacqueline Makokha, Gladys Wathanga, Mike Mugweru, Hendrew Lusey, Frank Baer, Sadiki Byombuka, Mendo Chirume, Pierre Somse, Badibanga Makambo, Sue Parry, Frank Dimmock, Emebet Admassu, Robert Ngaiyaye, Francis Gondwe and Rachel Mash. The advisory group who reviewed the draft report and gave us valuable feedback, we thank them for their generosity of time and insight: Jim Cochrane, Barbara Schmid, Deborah McFarland, and Mary Baich. Our team was extended by assistants in each of the three countries, who gave of their local expertise. We are grateful to Leah and Johnson Gatuma in Kenya, Stella Kasirye in Malawi, and Joseph Mavinga and Hendrew Lusey in the DRC. This study was made possible with financial support from Tearfund and UNAIDS - who entrusted us with this opportunity for engagement, and in all three countries, provided valuable in-country assistance. Thanks are also due to the Universities of KwaZulu-Natal and Cape Town where the authors are based, for the in kind contribution which provided the environment for this work to be undertaken. Finally, appreciation must be given to the larger network of colleagues that make up the African Religious Health Assets Programme (ARHAP) - on whose previous efforts and thinking much of this research is based. The authors of this report gratefully acknowledge all those who contributed to it. They take the responsibility for its writing, the judgments made and conclusions drawn. Beverley Haddad, Jill Olivier and Steve de Gruchy The potential and perils of partnership Interim report for a collaborative process 2008 Table of contents List of Appendices List of tables, figures and text boxes Executive summary 1. Background 2. Research overview 3. Findings about collaboration 4. Recommendations 5. Structure of the report Chapter 1: Introduction and aims of the study Chapter overview 1.1 Introduction 01 1.1.1 Purpose 01 1.1.2 How the study came about 01 1.1.3 Objectives of the study 03 1.2 Research approach 03 1.2.1 Theoretical fundamentals 04 1.2.2 Ethics clearance 07 1.2.3 Research team 07 1.3 Country selection 07 1.4 Focus on Christian religious entities 08 Chapter 2: Approach and methodology Chapter overview 09 2.1 Desk review: method and process 09 2.2 Participatory workshops: method 10 2.2.1 A selection of the study population and workshop preparation 10 2.2.2 Participatory workshops: Workshop method 11 2.2.3 Participatory workshops: logic 11 2.3 Self-administered questionnaires 13 2.4 Participatory workshops and questionnaire: process 14 2.4.1 Kenya research process 14 2.4.2 Malawi research process 15 2.4.3 DRC research process 16 2.5 Report writing and review 17 2.6 Limitations 17 The potential and perils of partnership Interim report for a collaborative process 2008 Chapter 3: The context of partnership Chapter overview 19 3.1 Surveying secondary literature at the intersection of religion, health and HIV and AIDS 19 3.2 HIV and AIDS in sub-Saharan Africa 20 3.3 The religious-health landscape in sub-Saharan Africa 20 3.3.1 Religious entities working in health 21 3.3.2 The strengths and weaknesses of religious entities 25 3.4 The nature of religious responses to HIV and AIDS in Africa 28 3.5 Multisectoral collaboration in the context of HIV and AIDS 29 3.5.1 Collaboration with governments 29 3.5.2 Interfaith collaboration 30 3.5.3 Ecumenical collaboration 32 3.5.4 Collaboration with donors or ‘partners’ 32 3.5.5 Collaboration with secular civil society 33 Chapter 4: Kenya Chapter overview 34 4.1 Kenya country context 34 4.1.1 Religious-health landscape in Kenya 35 4.1.2 The HIV and AIDS epidemic in Kenya 36 4.1.3 A brief survey of the state of collaboration in Kenya 41 4.1.4 A brief survey of the state of funding in Kenya 43 4.1.5 The key players in the Kenyan HIV and AIDS context 45 4.2 The findings of the research in Kenya 46 4.2.1 Findings concerning the context in which Christian religious entities are 48 working 50 4.2.2 Findings concerning the work of Christian religious entities in the promotion of Universal Access 4.2.3 Findings concerning the strengths and weaknesses of current collaboration 55 between Christian religious entities and other role player 4.2.4. Findings concerning the challenges and potential of collaborative 60 partnerships between Christian religious entities and other role players 4.3 Recommendations arising from the research findings in Kenya 64 4.3.1 For the attention of the Christian religious entities 64 4.3.2 For the attention of government 64 4.3.3 For the attention of donors 64 4.3.4. For the attention of all 64 Chapter 5: Malawi Chapter overview 65 The potential and perils of partnership Interim report for a collaborative process 2008 5.1 Malawi country context 65 5.1.1 Religious-health landscape in Malawi 66 5.1.2 The HIV and AIDS epidemic in Malawi 68 5.1.3 A brief survey of the state of collaboration in Malawi 75 5.1.4 A brief survey of the state of funding in Malawi 76 5.1.5 The key players in the Malawian HIV and AIDS context 78 5.2 The findings of the research in Malawi 80 5.2.1 Findings concerning the context in which Christian religious entities are 81 working 83 5.2.2 Findings concerning the work of Christian religious entities in the promotion of Universal Access 5.2.3 Findings concerning the strengths and weaknesses of current collaboration 87 between Christian religious entities and other role players 5.2.4 Findings concerning the challenges and potential of collaborative 92 partnerships between Christian religious entities and other role players 5.3 Recommendations arising from the research findings in Malawi 96 5.3.1 For the attention of the Christian religious entities 96 5.3.2 For the attention of government 96 5.3.3 For the attention of donors 96 5.3.4 For the attention of all 96 Chapter 6: Democratic Republic of Congo Chapter overview 97 6.1 DRC country context 97 6.1.1 Religious-health landscape in the DRC 98 6.1.2 The HIV and AIDS epidemic in DRC 100 6.1.3 A brief survey of the state of collaboration in DRC 105 6.1.4 A brief survey of the state of funding in DRC 106 6.1.5 The key players in the DRC HIV and AIDS context 107 6.2 The findings of the research in DRC 108 6.2.1 Findings concerning the context in which Christian religious entities are 109 working 111 6.2.2 Findings concerning the work of Christian religious entities in the promotion of Universal Access 6.2.3 Findings concerning the strengths and weaknesses of current collaboration 114 between Christian religious entities and other role players 6.2.4 Findings concerning the challenges and potential of collaborative 119 partnerships between Christian religious entities and other role players 6.3 Recommendations arising from the research findings in DRC 122 6.3.1 For the attention of the Christian religious entities 122 6.3.2 For the attention of government 122 The potential and perils of partnership Interim report for a collaborative process 2008 6.3.3 For the attention of donors 122 6.3.4 For the attention of all 122 Chapter 7: Reflection and Recommendations Chapter overview 123 7.1 Introduction: similarities 124 7.2 Findings from the country chapters 127 7.3 Multi-sectoral collaboration in the context of HIV and AIDS 127 7.4 Recommendations for improved collaboration 132 References List of Appendices Appendix 1 Acronyms and abbreviations Appendix 2 Glossary of selected terms Appendix 3 The African Religious Health Assets Programme - ARHAP Appendix 4.1 Questionnaire for Christian religious entities Appendix 4.2 Questionnaire for collaborative stakeholders Appendix 4.3 Covering letter and consent form Appendix 5.1 Invitees and participants - Kenya Christian religious entities Appendix 5.2 Invitees and participants - Kenya collaborative stakeholders