Are service-delivery NGOs building state capacity in the global South? Experiences from HIV/AIDS programmes in rural Uganda
Working paper 22
Service-delivery NGOs are often attacked for abandoning the pursuit of ‘alternative development’ in favour of ‘technocratic’ and ‘depoliticised’ forms of development. Yet some commentators argue that these organisations, through their ‘technocratic’ interventions, can in fact have progressive impacts on political forms and processes. In this paper we investigate this debate through the lens of state capacity building in the global South. Primary research into the ‘Mini-TASO Project’, a programme by Ugandan NGO TASO to support government health workers and hospitals in improving HIV/AIDS service delivery, reveals that NGOs can have a constructive impact on four aspects of state capacity – bureaucratic capacity, embeddedness, territorial reach, and legitimacy. The paper finds that within its project areas TASO strengthened the bureaucratic ability of government hospitals to deliver HIV/AIDS services, made people living with HIV (PLHIV) visible to the state, increased the state’s embeddedness within society through co-production, and enhanced state legitimacy in the eyes of beneficiaries, due to increased accessibility to life-saving services and improved patient–provider relationships. However, the impact of the programme on the infrastructural reach of the state in rural Uganda was not sustained beyond its implementation. The overall conclusion of this paper is that service delivery by NGOs is not merely a technical activity: it can actually be an avenue for building more effective states.