SOUTHERN AFRICA: Small AIDS organisations lost in funding maze

Photo: Kristy Siegfried/IRIN
Johannesburg, 21 February 2007 (PlusNews) - Millions of donor dollars earmarked for HIV/AIDS prevention, care and treatment pour into Africa every year. The lion's share is channelled through governments and the well-known, international NGOs that are assumed to have the capacity to manage large sums of money; but countless smaller, home-grown initiatives, many of them started by local people in response to an urgent need in their communities, battle for a piece of the pie.

Flora Modiba has been the sole provider of home-based care to HIV/AIDS patients in her neighbourhood of Tembisa, a Johannesburg township, since 2000. A full-time professional nurse, she began by visiting patients on her days off.

It took three years to secure a donation that allowed her to quit her job and devote herself to the project full-time, but the donation was a once-off and the funding she now receives is insufficient and, she feels, overly prescriptive. "I think a lot of funders don't really understand what we're doing," she said.

Modiba's core business is palliative care because Tembisa's only hospital cannot cater for its estimated 500,000 residents, and the 90 percent of patients suffering from AIDS-related illnesses must be cared for at home, yet neither of her two funders will pay for pain medication or the salaries of professional staff to administer them.

Instead, she relies mainly on volunteers whom she can pay only a minimal monthly stipend to care for her organisation's 170 patients.

She estimates that she has applied for more than 50 grants, with little success. "It's just a question of pressing the right buttons, but we don't know which are those right buttons," she said.

Lack of Capacity

Modiba is actually better off than many other community-based organisations (CBOs) providing essential HIV/AIDS services, many of which lack the skills or resources to access funding even for basic supplies or stipends for their care-workers.

"I spent the whole of January writing proposals," said Elizabeth Rapuleng, who has fruitlessly been trying to raise funds for her orphan-care project in South Africa's rural Limpopo Province for the past two years.

She has eight years of experience in mobilising and managing funds for a similar project in the Johannesburg township of Soweto, but many others who start home-based and orphan-care projects have no experience of running an organisation, let alone writing funding proposals or reporting to donors.

"Most organisations around here start up and then they die because they don't have the capacity to manage funding," said Rapuleng.

Umbrella organisations like the AIDS Consortium provide their affiliate organisations, mostly small CBOs, with training in resource mobilisation and capacity-building.

"Oftentimes the programme output is there, but if you're a 'gogo' [grandmother] who is caring for 60 orphans, and hasn't even had the benefit of decent schooling, the sustainability opportunity is minimal," said Denise Hunt, the AIDS Consortium's executive director. "That gogo is going to need a lot of hand-holding to run an organisation, to get funding, and to know how to use it."

Rather than pulling the plug on organisations that fail to properly manage or account for funding, donors are also starting to wake up to the need to provide technical support to their grant recipients. The European Union (EU), in partnership with the African Medical and Research Foundation (AMREF), the Department of Health and the South African Red Cross Society, is piloting a project aimed at building the organisational capacity of the CBOs it funds in South Africa's Limpopo Province.

Mapela Home-Based Care is one of 23 organisations in Makopane District participating in the initiative. The founders, Kedibome Sebelebele and Salome Sekhu, began providing home-based care to a handful of patients in their community in 2002. Five years later they had 117 patients on their books and 17 care-workers, but little idea of how to manage an organisation that had grown according to need rather than design.

With help from the Red Cross, they had successfully applied for funding from the EU and the Department of Health but were struggling to meet their reporting obligations. "Sometimes when we report to funders, they say it's not the right format," complained Sebelebele.

The first stage of the capacity building initiative consisted of a series of workshops on financial management, governance, administration and human resources, among others, where Sebelebele and Sekhu were introduced to concepts like having a board of directors, human resource policies and strategic plans.

In the second stage, a Red Cross 'mentor' visited regularly to provide hands-on help in implementing those concepts. "We've got a board now, but we need help defining roles," Sekhu told her mentor during a recent visit. Sebelebele, who now has the title of finance officer, said she needed training in how to use the computer, paid for by the EU, to do the organisation's accounting.

According to Jon Siburi, who is coordinating the Red Cross arm of the project, lack of knowledge about basic accounting procedures was more often to blame for CBOs losing their funding than corruption or deliberate misspending. "Most of these organisations start small and expand in terms of funding, but not in terms of capacity," he commented.

If the initiative proves successful, it is likely to be replicated in other areas of the country.

Donor Unpredictability

But solving the funding puzzle does not end with a course in financial management: donors have varying expectations, requirements and funding cycles, and are not immune to their own administrative glitches.

"We're trying to manage finances that are only there on paper," said Patricia Mogale, project manager of a home-based care project in Limpopo Province. She was expecting a disbursement from their only donor in October, but by the end of January it had still not arrived. "We haven't been able to pay stipends [to our care-workers] this month," she said. "And it wasn't until last week that they told us they'd lost our contract."

Funding interruptions and delays pose a serious challenge to CBOs, and a change in donor strategy can spell the end of a small organisation.

The Botswana Network of AIDS Service Organisations (BONASO), another umbrella organisation, used to disburse funds to its affiliates on behalf of the African Comprehensive HIV/AIDS Partnerships (ACHAP), a public-private partnership between the Botswana government, the Bill & Melinda Gates Foundation, and pharmaceutical company Merck & Co. Inc.

When ACHAP decided to direct its funding via local government channels, BONASO and its affiliates were given just six months notice. According to Daniel Motsatsing, BONASO's executive director, this was not enough time to secure new donors: "Some projects that were running well have completely collapsed as a result; only those that had funding from other donors have survived."

Donors who prescribe how their dollars are to be spent create another headache for organisations trying to respond to needs as they arise. Modiba recently used donor money earmarked for home-based care to buy pain medication for terminally ill patients, who receive little more than paracetamol from their local clinic. "I'm afraid they might not renew my funding but, to me, using the money for medications is part of patient care," she said.

She understands the need for accountability - donor fears of funding programmes that exist in name only are not unfounded - but believes they should place more trust in CBO's local knowledge of gaps in HIV/AIDS services and what is needed to address them.

Hunt noted that donors were often reluctant to fund operational costs, such as salaries and administration, preferring to fund specific programmes with identifiable outcomes.

"They love OVC [orphans and vulnerable children]," she said. "Especially corporates - they don't want to look at the bigger picture, they want to see the children being fed; they want to say, 'there's our money and there's the response'. But the reality is, if you want a powerful impact, you need to employ really good staff, which means you need people to fund your core costs."

Hunt, Modiba and Mogale all spoke of the necessity of developing income-generating schemes that would lessen their dependence on donors, but whether such schemes would be enough to sustain their organisations is an open question.

Modiba believes that a donation of a shipping container, in which she could set up a bakery, could go a long way towards funding her project in Tembisa. For now, she operates out of a shack with no electricity and, lacking a vehicle, her care-workers mostly reach their clients on foot.

see also:
AFRICA: Donors call the shots in HIV/AIDS sector


Theme (s): Aid Policy, Gender Issues, HIV/AIDS (PlusNews),

[This report does not necessarily reflect the views of the United Nations]

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