The institutionalization of AIDS orphan policy in South Africa

This dissertation examines the organization of primary health care for children in South Africa. The study is founded on a central research question: how has the injection of global humanitarian funding directed toward mitigating AIDS reshaped the organization of care for children in South Africa? Social science scholarship on global AIDS policy has largely focused on patients or service recipients; limited work, however, has been directed at the interface between care-workers and service recipients. In focusing on care-worker and service recipient interactions in local settings in South Africa, this dissertation contributes to scholarship concerned with the quality of care provision in the midst of widespread suffering as a result of the AIDS epidemic. The investigation is based on a twenty-one-month ethnographic field study, from August 2007 to June 2009, undertaken in the province of KwaZulu-Natal, South Africa. Data collection methods included interviews with policymakers and policy implementers; participant-observation in English and Zulu of local groups engaged in orphan projects; document analysis of policy texts; and historical archival research. The results of the study are threefold: First, document analysis on orphan policy reveals how in South Africa it is based on a standardized package of interventions imported from global policy. This standard package adopts market-based forms of governance that transfer the responsibility for orphan health and welfare service delivery from the state to the community or the family. A second finding, derived from ethnographic observations, is that humanitarian policy designed to improve the life conditions of South African children is undermined by initiatives to ensure program efficiency through the reliance on unpaid community care-workers, which leads to conflict, competition, and the reproduction of racial inequality in care-work organizations. Third and finally, participant-observation in a rural village and an urban township reveal how orphan became a productive category for an array of groups involved in the implementation of AIDS orphan policy. However, the dissertation argues that orphan policy produces new forms of social exclusion amongst families, devastated by apartheid and AIDS, who do not qualify for orphan health and welfare support