Redundancy, Third-Party Government, and Consumer Choice: HIV/AIDS Nonprofit Organizations in New York City
Journal article by Susan M. Chambre; Policy Studies Journal, Vol. 27, 1999
Journal Article Excerpt
Redundancy, Third-Party Government, and Consumer Choice: HIV/AIDS Nonprofit Organizations in New York City. by Susan M. Chambre This article addresses two questions: (a) Why were so many new nonprofit organizations in New York City created to "fight AIDS?" and (b) What are some consequences of this phenomenon? Drawing on redundancy theory as a partial explanation, it also considers the role of racial and ethnic politics and the impact of government contracting on the formation and growth of community-based organizations. For clients, the effect has been paradoxical: financial support of a large number of organizations led to a complex and fragmented delivery system offering some clients a range of choices but decreasing access for those less able to navigate a complex system. In Experiment Perilous, Renee Fox (Fox, 1974) noted that terminally ill patients employ black humor to cope with stressful and difficult circumstances. A high-ranked official in a New York City agency shared such a joke with me in June of 1993: An Acquired Immune Deficiency Syndrome (AIDS) patient dies and five people come to his funeral. Exchanging small talk while waiting for the funeral to begin, they discover that all of them met him after his AIDS diagnosis. Even more surprising was the fact that they met him in the same way: All five had been his case manager. The joke points to an important issue in human service delivery that is not unique to AIDS: a lack of coordination and duplication of services. At the same time, it testifies to the patient's active stance seeking help and is closely linked to the two questions addressed in this article: (a) Why were so many nonprofit organizations founded in New York City to "fight AIDS?" and (b) What are some consequences of this phenomenon? Redundancy in Human Services Since the founding of Charity Organization Societies in the late nineteenth century, public officials and social reformers have sought to create more efficient human service delivery systems (Lubove, 1969). A half century ago, a major study pointed out that there were too many health charities in the United States (Gunn & Platt, 1945). Each major disease had its own organization, with the exception of polio, where there were two national organizations (Cohn, 1975; Sills, 1957). A comparison between this situation and the organizational response to the Human Immunodeficiency Virus (IIIV)/AIDS epidemic is striking. Rather than one or two national organizations with local affiliates, the terrain is far more complex. About 45 new organizations were involved in AIDS-related work by the end of 1983 (Kessler, 1986), when there were about 3,700 AIDS cases. With 641,086 AIDS cases diagnosed by the end of 1997 (Centers for Disease Control, 1998), there were more than a dozen national AIDS organizations, and the number of local organizations and programs defies estimation. The most common explanation for the creation of voluntary groups is cultural. Discussions of the voluntary sector in the United States invariably refer to the work of Alexis DeTocqueville (1966), who noted that Americans have a "tendency to form associations" that is shaped by central values in American culture and the absence of an aristocracy. Recent research suggests that the roots of association building and civic engagement are more complex. There are considerable historical, regional, and neighborhood differences in when, where, and why voluntary and nonprofit organization are founded (Winkle, 1991) and levels of support for charitable work both with respect to giving money (Wolpert, 1993) and volunteering (Chambre, 1991, 1993). Social change events stimulate the mobilization of volunteers and the formation of new nonprofits (Chambre, 1995). Preliminary findings of Theda Skocpol's study of national voluntary associations suggest that government policies and programs, like the Postal Service and subsidi es to railroads, facilitated a major period of national association building in the late nineteenth century (Skocpol, 1997). A similar effect probably occurred between 1960 and 1980 when federal programs encouraged an expansion of volunteerism, particularly among older persons (Chambre, 1989, 1993).Like social reformers, organizational theorists traditionally have stressed the benefits of streamlined organizations and organizational systems. A clear division of labor among personnel and organizational units, with minimal overlap and duplication, is assumed to increase efficiency and effectiveness. Several scholars have challenged this view and offer a counterintuitive idea: that redundancy has positive functions for public and nonprofit organizations (Bendor, 1985; Landau, 1969; Streeter, 1992). Redundancy theorists contend that overlapping and duplicative parts--both within organizations and organizational systems--are particularly important in the face of ambiguous and uncertain conditions. Indeed, redundancy "provides safety factors, permits flexible ... |
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