By consolidating and disseminating best practices–from service models to institutional funding strategies–Duke Kaufman is strengthening the response of citizen-led organizations combating AIDS in South Africa.
The New Idea
Duke has developed a set of coordinated responses to the AIDS pandemic in South Africa. A centerpiece of his strategy is a sustainable, community-run "Sanctuary" that offers a home and a comprehensive range of services like food, clothing, and medical care for children whose parents have died of AIDS. By replicating his sanctuary model and by identifying and disseminating the best practices of the citizen sector, he is enabling an effective, coordinated, sustainable response to the AIDS epidemic. A part of his model for which he sees an especially broad application is the resource mobilization component, which includes in-kind and for-profit initiatives and engages businesses and citizens in addressing the spectrum of AIDS-related problems.
Research suggests that South Africa has one of the highest HIV infection rates in the world. The Medical Research Council of South Africa cites AIDS as the leading cause of death in the country. In 2010 the total, cumulative deaths resulting from AIDS is expected to reach five to seven million, and there will be between 3.6 and 4.8 million AIDS orphans in South Africa–children whose parents have died of AIDS but who are not necessarily infected themselves.
The response to the epidemic is not commensurate with the magnitude of the problem. National government policy, which is focused on prevention, has been particularly hesitant with regard to treatment. Citing the toxic side effects of AIDS medication and an allegedly insufficient infrastructure to provide proper counseling and monitoring of prescription regimens, the government has doggedly refused to increase public access to antiretroviral drugs in the face of overwhelming evidence demonstrating that available medicines could reduce infection rates and increase life expectancy of people living with AIDS. Nevirapine, for instance, can reduce the risk of transmitting the virus from mother to child by 50 percent. In April 2002, the government finally buckled under immense national and international pressure and agreed to expand public access to AIDS medication at a few sites.
With a few notable exceptions, private responses by citizen-led organizations, individuals, corporations, and others are weak compared to the magnitude of the problem. According to a May 2002 Deloitte and Touche evaluation of formal workplace responses to AIDS in South Africa, a statistically significant number of industry respondents developed an AIDS policy only within the past two years. Those organizations that are addressing the problem focus on less resource-intensive interventions, like awareness and education programs. However, interventions that would either provide focus for an AIDS strategy–risk assessment and monitoring and reporting–or help generate a comprehensive industry-wide response are badly deficient. In a sector employing 12 million people with a further 20 million dependents, the overall response to AIDS is startlingly limited.
Citizen groups have not delivered especially effective solutions, either, mainly because of resource constraints. For instance, to meet the needs of orphans, numerous sanctuaries have mushroomed across the country with the intention of meeting the needs of the greatest number. However, these organizations have encountered severe difficulties adequately providing for the orphans or expanding their capacity to do so. Most organizations remain beholden to the traditional practice of soliciting funding from donors; but in a crowded marketplace where multiple organizations are seeking funding support from a small pool of donors, success rates are low. Some organizations have attempted to respond to the funding crunch by diversifying their fundraising strategies and engaging in income-generating projects. A lack of business acumen, especially the ability to market and differentiate products, often dooms such ventures. In short, organizations providing for orphans are failing to meet their goals.
Duke's strategy flows from the stark truth that given the severity of the pandemic that threatens to undermine South Africa's future, adequate responses should not delay scaling-up until the effects are much more visible. Duke's organization offers a comprehensive range of services to those affected and infected by AIDS, primarily children. The Sanctuary, which he built on an abandoned mining site, serves as the operational base for in-house care, home-based care, and other community outreach programs. Resident children who come to the Sanctuary–when they no longer have sufficient support at home or within their own communities–receive basic provisions (food, shelter, clothing), as well as treatment and care at no charge. With a capacity of 2,000 children and 350 staff, it is the largest sanctuary for AIDS orphans in Africa.
In the home-based care program, a resident doctor trains local residents at the center to identify families in need who are not necessarily HIV infected, and to provide care, AIDS awareness, counseling, and other services. He trains locals to become social workers and offers other services–ballroom dancing classes, a daycare center, and a library–as part of a conscious effort both to ensure that the center is integrated into the community and thereby to secure "buy-in" from the community. The strategy has worked: the home-based care workers are engaged in three surrounding provinces–Gauteng, Mpumulanga, and the Free State–where they regularly serve over 6,000 families.
The second component of Duke's strategy is to set uniform and professional standards regarding the care and treatment of those affected and infected by the virus. Though there are many citizen sector initiatives that deal with the problem, their effectiveness is limited by ineffective, albeit well-meaning, methodologies. Duke has observed that these initiatives waste precious time as they, through trial and error, reinvent the wheel and chase after funds. To address this problem, Duke is implementing a process of consultation and information-sharing with a range of local and international organizations that will yield a best-practice toolkit and training opportunities that will be offered through his center.
Third, Duke has recognized that one of the most challenging barriers to responding to the epidemic is resource limitation. He has therefore developed a set of far-reaching financial and nonfinancial resource mobilization strategies that encourage groups to develop a sustainable resource base independent of donor funding.
Duke saw that attempts by the private sector to respond to the epidemic often had no clear or sustained value to either party. Organizations would go on to replicate services and infrastructure already present in the private sector. These observations have served Duke well when he approaches corporations. For instance, his foundation has established a long-term commitment with a leading adverting agency. The agency offers advice on strategic direction and public relations which are geared specifically to the South African population. In addition, it provides free office space, covers the office's operating expenses, and even sponsors staff salaries. The latter is particularly important for Duke since he wants to ensure that all money raised for the foundation is directed to the center where it is most needed, not to cover operational costs. In return, the advertising agency can apply lessons of the social sector and polish its public image with a demonstrated commitment to the foundation.
Another innovative resource mobilization strategy is the production and sale of high-quality items that can fetch high returns. According to Duke's observations, nonprofit organizations selling products as part of their income-generating strategy often fail to capture the market because there is a prevailing and false perception that the mass public will always purchase "goods for charity," regardless of their quality. To produce quality products, he consults with experts in a given product sector. For instance, with the assistance of a leading genetic rose specialist and a high-profile event featuring notable public personalities, Duke has launched a unique variety of rose dubbed the Topsy Rose that sells in discerning flower shops across the country. Another example is a beautiful line of ceramic vessels designed by a well-known ceramicist. It should be noted that while experts design these products, employed local residents do the bulk of the production at the Sanctuary. Apart from consultation fees, a majority of the proceeds are allocated to the Sanctuary's needs.
Duke also employs attention-grabbing marketing campaigns like piggybacking on major public events and art exhibitions. For instance, on each World AIDS Day, the Topsy Cycle Challenge draws cycling enthusiasts and others to a competitive and highly publicized event. During the 2002 London Marathon, Duke's associates convinced the British Army to run for Topsy. At the end of 2001, the organization got a major soft drink manufacturer to launch an artistic competition where the winner would be judged on creativity in designing objects out of soft drink cans. These and other marketing strategies, like a professionally designed Web site, have significantly raised Topsy's profile all over the world and generated a steady stream of financial and nonfinancial resources.
In another fundraising effort, Duke sells the naming rights to various buildings that comprise the Sanctuary village. Breaking with standard practice, individuals and companies can purchase such rights only for a limited period of time. This guarantees a constant flow of income into the Sanctuary.
These strategies have transformed Duke's organization into an effective and well-known leader in improving the citizen sector response to the AIDS epidemic. Duke intends the Sanctuary to be the flagship of excellence from which other organizations will learn and upon which other satellite sanctuaries will be modeled.
Duke has always had a strong interest in the broad theme of conserving life that is in dire threat. As a child he spent many hours in one of the dense forests of the Western Cape, observing and being fascinated by the interdependence of life; he noticed that each creature, no matter how seemingly inconsequential, played a significant role in the well-being of others. Later, as a teenager, he was horrified by the devastating impact that urban developments were having on the Knysna sea horse, and he helped found an organization to save the species from further harm.
Before launching the Topsy Foundation, Duke worked in the private sector where he developed marketing and business skills. During this period, he launched several successful restaurants that he later sold. Though he enjoyed the daily challenges of staying relevant in an unforgiving industry and satisfying his clients, the business did not always satisfy his inner aspirations. So, when he learned of the extent to which the AIDS pandemic was rendering an untold number of children destitute, and he realized the insufficient public and private response, he focused his efforts and skills on designing and implementing a solution.