title: Delivering HIV services in partnership: factors affecting collaborative working in a South African HIV programme.
abstract: The involvement of Global Health Initiatives (GHIs) in delivering health services in low and middle income countries (LMICs) depends on effective collaborative working at scales from the local to the international, and a single GHI is effectively constructed of multiple collaborations. Research is needed focusing on how collaboration functions in GHIs at the level of health service management. Here, collaboration between local implementing agencies and departments of health involves distinct power dynamics and tensions. Using qualitative data from an evaluation of a health partnership in South Africa, this article examines how organisational power dynamics affected the operation of the partnership across five dimensions of collaboration: governance, administration, organisational autonomy, mutuality, and norms of trust and reciprocity.
  
  
  
  Managing the tension between the power to provide resources held by the implementing agency and the local Departments' of Health power to access the populations in need of these resources proved critical to ensuring that the collaboration achieved its aims and shaped the way that each domain of collaboration functioned in the partnership.
  
  
  
  These findings suggest that it is important for public health practitioners to critically examine the ways in which collaboration functions across the scales in which they work and to pay particular attention to how local power dynamics between partner organisations affect programme implementation.
authors.affiliation: Anova Health Institute, 12 Sherborne Rd, Park Town, Johannesburg, 2190, South Africa. jobson@anovahealth.co.za.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Jobson
authors.affiliation: Anova Health Institute, 12 Sherborne Rd, Park Town, Johannesburg, 2190, South Africa.
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: Grobbelaar
authors.affiliation: Anova Health Institute, 12 Sherborne Rd, Park Town, Johannesburg, 2190, South Africa.
authors.forename: Moyahabo
authors.initials: M
authors.lastname: Mabitsi
authors.affiliation: Anova Health Institute, 12 Sherborne Rd, Park Town, Johannesburg, 2190, South Africa.
authors.forename: Jean
authors.initials: J
authors.lastname: Railton
authors.affiliation: Anova Health Institute, 12 Sherborne Rd, Park Town, Johannesburg, 2190, South Africa.
authors.forename: Remco P H
authors.initials: RP
authors.lastname: Peters
authors.affiliation: Anova Health Institute, 12 Sherborne Rd, Park Town, Johannesburg, 2190, South Africa.|School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: James A
authors.initials: JA
authors.lastname: McIntyre
authors.affiliation: Anova Health Institute, 12 Sherborne Rd, Park Town, Johannesburg, 2190, South Africa.|Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Helen E
authors.initials: HE
authors.lastname: Struthers
mesh_terms: D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000379:methods*; D014943:Global Health / Q000639:trends; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D055818:Public-Private Sector Partnerships / Q000191:economics*; D036301:Qualitative Research; D013019:South Africa
keywords: Collaboration; Global health initiatives; HIV; Health partnerships; Health systems strengthening; South Africa