Megan Hershey

Introduction:

The HIV/AIDS pandemic claimed the lives of 2.4 million Africans in 2005. Last year’s 3.2 million new infections brought the number of people living with HIV in sub-Saharan Africa to an overwhelming 25.8 million (see: www.unaids.org). On a continent where most states are unable to provide sufficient social services, numerous non-governmental organizations (NGOs), both international and local, have aggressively launched education and treatment programs in response to the HIV/AIDS crisis. Despite being heavily hit by HIV/AIDS, one African country, Kenya, has actually seen its adult HIV prevalence rate drop dramatically from 13.5 percent in 2001 to 7.5 percent in 2004 (see: www.who.org).[1] However, the precise reasons for this decline remain unclear. My project seeks to provide insights into this puzzle. I will study a sample of NGOs in Nairobi which conduct HIV/AIDS prevention education programs in an effort to answer the research question: what factors lead to NGO program success?

My comparative research design and ethnographic methods will produce case studies of eight NGOs which conduct HIV/AIDS education programs. Using program reach as a measure of success, I will determine which factors contribute to NGO program success. I will consider the role of state and local government as well as other civil society actors in this process. But because program success can only be partially defined by people reached, it is important to understand what happens to HIV/AIDS messages after they leave the doors of the NGOs. Therefore, I will trace HIV/AIDS messages as they trickle down from the NGO, through formal and informal social networks, to ultimately affect behavioral change. Understanding how NGOs and communities disseminate HIV/AIDS message will demonstrate effective methods of fighting HIV/AIDS to scholars, policymakers and granting agencies. This project will reach beyond a general understanding of Nairobi’s NGOs to provide a nuanced analysis of the political and relational factors which lead to success. It also has implications for the long-term role of local networks in promoting sustainable, participatory development.

Literature and Hypotheses:

My project focuses on NGOs and local, participatory networks (informal groups such as church and community groups), which constitute a large part of Kenya’s civil society. I draw on Edwards’ writings to define civil society as the non-governmental, formal or informal, associational sector of a society (Edwards 2004). Scholars have linked a robust civil society with both increased democracy and development (Putnam 1994, Ritchey-Vance 2002, Howell and Pearce 2001, Therkildsen and Semboja 1995). In this study I further explore the developmental value of civil society, particularly its ability to distribute and sustain HIV/AIDS messages.

NGOs, arguably the most central civil society actors, have been widely understudied by social scientists. NGOs have rapidly proliferated throughout East Africa over the past 25 years, constructing a politicized development space due to their ability to provide services the government cannot (Kanyinga 1995, Therkildsen and Semboja 1995). Their central position in civil society, and their essential role in fighting HIV/AIDS in Kenya, makes them worthy of study. Practitioners and scholars who do write about NGOs often fail to include important factors (such as the role of local, participatory networks) in their studies of NGO program success. It is common for scholars to focus too narrowly on the NGO itself, confusing service sustainability with sustainability of the organization (Lewis 2001, Edwards and Fowler 2002, Cannon 1999).

In order to thoroughly analyze my case studies, I will explore seven factors which may explain NGO success. The first two factors I consider are especially important because they have not yet been rigorously tested by other scholars. The first factor I consider is an NGO’s utilization of local, participatory networks (such as informal church and community groups) to reach people and bring them to HIV/AIDS education sessions (Howell and Pearce 2001, Aubrey 1997, Therkildsen and Semboja 1995, Kanyinga 1995). The dynamic relationships between NGOs and local, participatory networks have not been thoroughly explored as a key to NGO program success, thus this project will hypothesize that local participatory networks are valuable in both advertising and facilitating NGO HIV/AIDS education programs.

The second factor I will test for is the role of faith in an NGO. An increasing amount of rhetoric on the effectiveness of faith-based NGOs has emerged from both the United States and abroad, but no systematic study of NGOs has been conducted to compare the success of faith-based with non-faith-based NGOs. Sparse literature on faith-based NGOs has implied that the faith aspect of an NGO does matter and can affect its effectiveness (Kniss and Campbell 2004, Liebowitz 2002, Reinikka and Svensson 2002, Jeavons 1994). Therefore, I have chosen to include four faith-based NGO case studies in my project. Departing from the literature, I hypothesize that it is not necessarily faith itself that matters, but the position of faith-based NGOs in relation to the community that provides these NGOs with direct access to social networks through which they can widely distribute HIV/AIDS messages and attain success.

In order to understand what the above factors contribute to NGO success, I will include five other explanatory factors which are more commonly thought to lead to success. The third factor I will observe is the source and amount of NGO funding (measured in dollars). The fourth factor is the expertise of the NGO staff (measured in years of formal education and informal trainings). My fifth factor is the level of non-financial support received from international ties (i.e. an NGO’s New York headquarters or connections with a Western church). Size and age of the NGO constitute my sixth factor. The final factor to be tested is the presence and type of non-financial support from local and national government actors.

But there is more to NGO program success than training people about HIV/AIDS. These education messages only have value if they are passed on to others and actually affect behavioral change. The second part of my study will trace the HIV/AIDS education messages after they leave the doors of the NGOs to determine whether or not they ultimately change people’s lives.

My hypotheses in this section address the spread of HIV/AIDS education messages through grassroots level relationships which sustain or reject these messages after they leave the NGO. Granovetter argues that personal relationships are strongly embedded within society and that they are vital generators of trust (Granovetter 1985). Drawing on Granovetter’s argument for the value of trust in relationships, I hypothesize that individuals receiving HIV/AIDS prevention messages second hand are more likely to accept the information and change their behavior if they have a close, personal relationship with the person from whom they received the message.

In addition to evaluating the types of relationships which promote HIV/AIDS message transmission, I will evaluate whether or not local participatory networks adopt these messages and then sustain them. The concept of participatory development has been hailed as the next great development theory following the decline of modernization and dependency theories and has been praised for its ability to empower people, promote sustainable development and to lead to a more democratic culture (Davids, et al. 2005, Mulwa 2004, Cannon 2002, Ritchey-Vance 2002). Participatory development defines development as “what the people want” and emphasizes the importance of community “ownership” at all stages of development (Davids, et al. 2005). This project will explore how communities can participate in development at the stage of sustainability by disseminating HIV/AIDS prevention messages. In my final hypothesis, I posit that if local participatory networks adopt HIV/AIDS messages, the messages can be sustained in the community without the continued support of NGOs.

Research Design and Methodology:

My project will test a number of factors at the NGO level and then trace HIV/AIDS messages as they trickle down to the grassroots. Because I want to determine what factors lead to NGO program success, I will use a comparative research design with success, defined as reach, as the outcome. To measure reach, I will record the number of people who attend education sessions at each NGO. Therefore, I will select eight Nairobi-based NGOs as case studies: four NGOs which operate more successful programs (two faith-based and two non-faith-based) and four NGOs which have less successful programs (again, two faith-based and two non-faith-based). I will control my sample by choosing NGOs with similar HIV/AIDS program design and content. Also, because all of my NGO case studies will be located in Nairobi, I will be able to control for the local environment and the level of local NGO competition.

I will use a combination of qualitative methods, including: participant observation, in-depth interviews and questionnaires. In order to closely observe the daily life of the NGOs, I will conduct participant observation at each NGO for four weeks. I will supplement my observations with in-depth interviews of NGO employees in order to determine which factors are relevant to success. I will conduct additional in-depth interviews with members of any local participatory groups which may work with the NGO in order to determine their role in program success. At this time I will also collect NGO financial and other reports to test my other factors.

I will spend the next four months tracing the path of HIV/AIDS messages after they leave the doors of the NGOs. My goal in this part of the project will be to determine how and through whom, messages about HIV/AIDS prevention are spread from NGOs to individuals and to what extent they have been internalized and have affected individual choices. This part of the project will allow me to track the often ignored residual reach of NGOs.

In order to gather this information, I will distribute questionnaires to a random sample of individuals who have attended NGO HIV/AIDS training sessions during the past year. Ten questionnaires will be administered per NGO, for a total of 80 questionnaires. Through these questionnaires I will determine if these attendees passed on HIV/AIDS messages to others and, if so, to whom. Then, I will conduct in-depth interviews with a sample of the individuals who received the information second hand. I will randomly choose three people who received HIV/AIDS messages from each person who filled out a questionnaire, for a total of 240 interviewees. The use of interviews will allow me to access individuals’ reactions to HIV/AIDS prevention messages. Also, these interviews will elaborate on the type of relationship the interviewee has with the person who passed information onto him or her. Capturing these nuances is vital if I am to analyze the relevance of relationship type in the dissemination of HIV/AIDS messages.

Because of the sensitive nature of HIV/AIDS I will not ask in-depth questions about the sexual behavior of my interviewees. Instead, I will measure the success of the HIV/AIDS message by whether or not an interviewee is aware of his or her HIV status. I have been advised by medical professionals at the Moi University Medical School in Eldoret, Kenya that this indicator is commonly used to determine the effectiveness of HIV/AIDS education. Identifying how and through whom HIV/AIDS messages are disseminated, and whether they affect behavioral change, will demonstrate the sustainability of educational messages outside the confines of the NGO.

Preparation and Preliminary Research:

I have already taken a number of steps to ensure the success of my project, including pursuing academic coursework, language study and a preliminary research trip to Kenya. Two years of political science coursework at Indiana University have refined my proposed project and prepared me to conduct field research. My focus on comparative politics and public policy has exposed me to a wide range of theoretical literature in these fields. I wrote a review of the political science literature on NGOs and HIV/AIDS in Africa for my African politics course, and a separate course on NGOs exposed me to the range of environments NGOs operate in. My African studies minor has allowed me to take courses in a variety of disciplines; the bibliography I created on the topic of HIV/AIDS in Kenya for my African Studies Bibliography course has proven quite useful for this project. My current work on a dissertation chapter will set up the research I plan to conduct in Kenya; it asks how and why the Kenyan government has addressed the issue of HIV/AIDS and what environment this has created for NGOs.

My methodological skills are also well-suited for this research. I have practiced interviewing, participant observation and conducting focus groups in a qualitative methods course. I have also taken a statistics sequence which will allow me to read government and NGO data on HIV infection rates. This January, I will further my methodological skills by attending an intensive two-week course at the Arizona State University Institute for Qualitative Research Methods. After finishing my coursework, taking my qualifying exams and receiving approval for my dissertation proposal next semester, I will be ready to leave for Kenya in September 2007.

In addition to my other coursework I have actively studied Swahili to prepare myself for work in Kenya. In only 13 months I have completed six semesters of Swahili. Two of these semesters were completed in summer 2006 at the intensive summer Fulbright Group Project Abroad in Tanzania. I will complete an additional three semesters worth of Swahili this year before embarking on field research. I plan to conduct my interviews in either Swahili or English, allowing the interviewees to choose the language they prefer to speak. Finally, I am in the process of creating Swahili interview guides with my Swahili professor for use in the field.