North–South partnerships for health aim to link resources, expertise and local knowledge to create synergy. The literature on such partnerships presents an optimistic view of the promise of partnership on one hand, contrasted by pessimistic depictions of practice on the other. Case studies are called for to provide a more intricate understanding of partnership functioning, especially viewed from the Southern perspective. This case study examined the experience of the Tanzanian women's NGO, KIWAKKUKI, based on its long history of partnerships with Northern organizations, all addressing HIV/AIDS in the Kilimanjaro region. KIWAKKUKI has provided education and other services since its inception in 1990 and has grown to include a grassroots network of >6000 local members. Using the Bergen Model of Collaborative Functioning, the experience of KIWAKKUKI's partnership successes and failures was mapped. The findings demonstrate that even in effective partnerships, both positive and negative processes are evident. It was also observed that KIWAKKUKI's partnership breakdowns were not strictly negative, as they provided lessons which the organization took into account when entering subsequent partnerships. The study highlights the importance of acknowledging and reporting on both positive and negative processes to maximize learning in North–South partnerships.

BackgroundHealth worker motivation can potentially affect the provision of health services. The HIV pandemic has placed additional strain on health service provision through the extra burden of increased testing and counselling, treating opportunistic infections and providing antiretroviral treatment. The aim of this paper is to explore the challenges generated by HIV care and treatment and their impact on health worker motivation in Mbeya Region, Tanzania.MethodsThirty in-depth interviews were conducted with health workers across the range of health care professions in health facilities in two high HIV-prevalence districts of Mbeya Region, Tanzania. A qualitative framework analysis was adopted for data analysis.ResultsThe negative impact of HIV-related challenges on health worker motivation was confirmed by this study. Training seminars and workshops related to HIV contributed to the shortage of health workers in the facilities. Lower status workers were frequently excluded from training and were more severely affected by the consequent increase in workload as seminars were usually attended by higher status professionals who controlled access. Constant and consistent complaints by clients have undermined health workers' expectations of trust and recognition. Health workers were forced to take responsibility for dealing with problems arising from organisational inefficiencies within the health system.ConclusionHIV-related challenges undermine motivation among health workers in Mbeya, Tanzania with the burden falling most heavily on lower status workers. Strained relations between health workers and the community they serve, further undermine motivation of health workers.

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Coping in Ugandan Orphans 445-456This article explores the coping strategies of orphaned children and their caregivers supported by a community-based organization in a Ugandan slum area. In-depth qualitative interviews were conducted with eight orphans (aged 12 to 16 years) and their caregivers selected by the community-based organization. The children had experienced several co-occurring risk factors such as loss and separation, poverty, disease, and an unsafe environment. Most caregivers were extended family members. One caregiver was an unrelated foster carer. Three of the households were child-headed. Data were analysed using an adapted approach of Giorgio's (Hafting, 1995; Malterud, 2001) psychological-phenomenological method. Participating children from child-headed households lacked protective factors associated with closeness (i.e., supportive dyadic relationships). All the children in the study experienced competence in the arenas of school and household chores. Cultural advice on handling adversity, including 'forgetting', 'accepting' and 'adjusting', appears to contradict Western theories of coping. Sommerschild's theoretical model on the conditions for coping was effective in identifying conditions in children's lives that may impair their coping, self-worth, and resilience.

Many nongovernmental organizations in Africa rely on grassroots volunteers to provide critical health services. Considering context and the interplay of individual, organizational, and societal influences on the experience of volunteers, this paper addresses three questions: What do grassroots volunteers contribute? What organizational processes promote volunteer engagement? What are the positive and negative consequences of volunteering? Eighteen members and staff of the Tanzanian HIV and AIDS NGO, KIWAKKUKI, were selected from 6000+ women volunteers to be interviewed. The interviews were recorded, transcribed, and analyzed for themes. Within KIWAKKUKI, volunteers contributed time and local knowledge, leading to an indigenous educational approach building on local norms and customs. Volunteers' engagement was motivated by the desire to support family members, reverse stigma, and work/socialize with other women. Benefits to volunteers included skills acquisition and community recognition; yet some volunteers also reported negative experiences including burnout, conferred stigma, and domestic violence. Positive organizational processes built on cultural practices such as collective decision-making and singing. The findings point to important considerations about context, including the synergistic effect training can have on local traditions of caring, complications of gender inequity, and how community health planning processes may need to be modified in extremely poor settings. This research also suggests good utility of the research framework (the Bergen Model of Collaborative Functioning) that was used to analyze volunteer engagement for service delivery in sub-Saharan contexts.