The Brazilian Government HIV/AIDS Programme: an example of Civil Society participation?

Dissertation submitted to the Faculty of Technology of The Open University in fulfilment of the requirements for the degree of Master of Science in Development Management in October 2004. This information-based research seeks to contribute to the growing body of literature on the evolving relationships between the State and Civil Society Organisations (CSOs) and between CSOs themselves in the context of HIV/AIDS in Brazil. As in many other parts of the world, State-led development in Brazil has given room to a very different way of working where multiple actors can and are encouraged to be involved from a 'public action' perspective. These actors bring conflicting goals, interests, values and perspectives into the new inter-organisational relationships that have been formed. Inevitably, new challenges, risks, benefits and opportunities have to be managed. In this report it is argued that the management of interactions between organisations, groups and individuals occupies an extremely important place in development management as these interactions directly influence how development is shaped and takes place. This is one of the main reasons why this 'real-world' topic is focused on. CSOs are considered essential contributors to the construction of strong civil societies, especially in developing countries, as they enable civil society to participate more fully and equitably in governance and development processes (Clark, 1990). This emphasises the great importance of building the capacity of CSOs so that they can manage inter-organisational relationships effectively. In the context of HIV/AIDS in Brazil, CSOs are considered by the World Bank as having a flexible, innovative and cost-effective approach which enables them to reach and work effectively with the most vulnerable segments of society (Boyd et al., 1999). This comparative advantage of CSOs is particularly well suited to addressing the multi-faceted needs of people who live with, and are affected by, HIV/AIDS. Over twenty years of the HIV/AIDS pandemic has shown the need for action on all fronts, mobilising both government and civil society to address issues of prevention and care (Tearfund, 2004). The Brazilian Government HIV/AIDS Programme (BGHAP) is now entering its third decade and it is considered by UNAIDS (2003) as an example of good practice. Much of its success is attributed to the participation and contribution of CSOs (World Bank, 2004). This research examines how CSOs participate in BGHAP and how inter-organisational relationships are outworked in and through it. The 3 Cs analytical framework (Robinson et al., 1998) is widely used as a way of appreciating and understanding how 'co-ordination, competition and co-operation' are expressed. Other development and development management concepts are also used. This research seeks to learn from the BGHAP experience and proposes ways of enhancing the inter-organisational relationships that exist between BGHAP and the CSOs involved with it. Several links between development theory and practice are made in this report from a 'learning and action' perspective. A number of key findings are discussed and recommendations made. This research has involved three methods of data collection (focused interviews of key informants, questionnaire-based survey and literature study) due to the diversity of actors and the wealth of primary and secondary sources of information available.