南非三个地区与健康相关的非营利部门的规模、特征及伙伴关系网络：初级卫生保健政策变化对社区护理的影响

The size, characteristics and partnership networks of the health-related non-profit sector in three regions of South Africa: implications of changing primary health care policy for community-based care.

作者信息

van Pletzen Ermien, Zulliger R, Moshabela M, Schneider H

机构信息

Centre for Higher Education Development, University of Cape Town, Rondebosch, 7701, South Africa, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, School of Public Health, University of Witwatersrand, Johannesburg and Earth Institute, Columbia University, NYC and School of Public Health, University of the Western Cape, South Africa

出版信息

Health Policy Plan. 2014 Sep;29(6):742-52. doi: 10.1093/heapol/czt058. Epub 2013 Aug 16.

DOI:10.1093/heapol/czt058

PMID:23955608

Abstract

BACKGROUND

Health-related community-based care in South Africa is mostly provided through non-profit organizations (NPOs), but little is known about the sector. In the light of emerging government policy on greater formalization of community-based care in South Africa, this article assesses the size, characteristics and partnership networks of health-related NPOs in three South African communities and explores implications of changing primary health care policy for this sector.

METHODS

Data were collected (2009-11) from three sites: Khayelitsha (urban), Botshabelo (semi-rural) and Bushbuckridge (semi/deep rural). Separate data sources were used to identify all health-related NPOs in the sites. Key characteristics of identified NPOs were gathered using a standardized tool. A typology of NPOs was developed combining level of resources (well, moderate, poor) and orientation of activities ('Direct service', 'Developmental' and/or 'Activist'). Network analysis was performed to establish degree and density of partnerships among NPOs.

RESULTS

The 138 NPOs (n = 56 in Khayelitsha, n = 47 in Bushbuckridge; n = 35 in Botshabelo) were mostly local community-based organizations (CBOs). The main NPO orientation was 'Direct service' (n = 120, 87%). Well- and moderately resourced NPOs were successful at combining orientations. Most organizations with an 'Activist' orientation were urban. No poorly resourced organizations had this orientation. Well-resourced organizations with an 'Activist' orientation were highly connected in Khayelitsha NPO networks, while poorly resourced CBOs were marginalized. A contrasting picture emerged in Botshabelo where CBOs were highly connected. Networks in Bushbuckridge were fragmented and linear.

CONCLUSIONS

The NPO sector varies geographically in numbers, resources, orientation of activities and partnership networks. NPOs may perform important developmental roles and strong potential for social capital may reside in organizational networks operating in otherwise impoverished environments. A uniform approach to policy implementation may not accommodate variations in the NPO sector. Considerations for adaptation may be necessary in light of the observed differences between urban and rural settings.

摘要

背景

在南非，与健康相关的社区护理主要通过非营利组织（NPO）提供，但对该领域了解甚少。鉴于南非政府出台了关于社区护理进一步正规化的新政策，本文评估了南非三个社区中与健康相关的非营利组织的规模、特征和伙伴关系网络，并探讨了初级卫生保健政策变化对该领域的影响。

方法

于2009年至2011年从三个地点收集数据：开普敦凯伊利沙镇（城市地区）、博察贝洛（半农村地区）和布什布克里奇（半/深农村地区）。使用不同的数据来源来确定各地点所有与健康相关的非营利组织。使用标准化工具收集已确定的非营利组织的关键特征。通过结合资源水平（丰富、中等、匮乏）和活动方向（“直接服务”、“发展型”和/或“激进型”）制定了非营利组织的类型。进行网络分析以确定非营利组织之间伙伴关系的程度和密度。

结果

这138个非营利组织（开普敦凯伊利沙镇56个，布什布克里奇47个；博察贝洛35个）大多是当地社区组织（CBO）。非营利组织的主要方向是“直接服务”（120个，占87%）。资源丰富和中等的非营利组织成功地结合了不同方向。大多数具有“激进型”方向的组织位于城市。没有资源匮乏的组织具有这种方向。在开普敦凯伊利沙镇的非营利组织网络中，资源丰富且具有“激进型”方向的组织联系紧密，而资源匮乏的社区组织则被边缘化。在博察贝洛出现了相反的情况，那里的社区组织联系紧密。布什布克里奇的网络分散且呈线性。