Organizational Networks, Divided Policy Authority, and the Effects on Botswana's HIV Response Regime

Abstract

The UNAIDS framework for HIV response called for 3 "Ones": one strategy, one coordinating authority, and one monitoring framework. Under the direction of President Festus Mogae, Botswana established the National AIDS Coordinating Agency (NACA) to bring together and direct the various government efforts against the epidemic. The African Comprehensive HIV/AIDS Partnership — a PPP bringing together the Botswanan government, Merck Pharmaceuticals, and the Gates Foundation — brought relatively large financial resources to Botswana and became an alternative source of gravity in the Botswanan response. This paper examines how a PPP intended to assist in a national HIV program became a problem: with the advent of ACHAP, practical responsibility for the shape and direction of the national program seemed to have two loci of power. For those trying to help implement Botswana HIV policy, there appeared a division in the locus of power: NACA had the final authority, while ACHAP had the superior resources. I examine the network structure of government and PPP actors, and I analyze how the unintentional division brought about by establishing a PPP lessened anti-HIV action at a critical period in the nation’s response to the disease.

Keywords: public-private partnership, HIV, Botswana, organizational structure

JEL Classification: D23, D73, D83, I18, L33