Collaborative Governance of HIV Health ServicesPlanning Councils in Broward and Palm BeachCounties of South Florida

James K. Agbodzakey

Published online: 21 May 2011# Springer Science+Business Media, LLC 2011

Abstract This study uses the collaborative governance concept to examine efforts ofHIV Health Services Planning Councils in two South Florida Counties. The studyemploys qualitative methods such as interviews and document reviews in collecting datafrom various relevant sources. The results reveal more similarities than differences in theCouncils’ efforts toward addressing the HIV/AIDS problem. The Councils are similar inall variables of collaborative governance with few exceptions relative to facilitativeleadership and institutional design. Collaborative governance of stakeholders therebyenhances efforts in effectively managing and/or addressing complex problems.

Keywords Collaborative governance . RyanWhite CAREAct . Target populations .

People with AIDS (PWAs) . HIV/AIDS . Stakeholders

Introduction

Collaborative governance is a type of governance that encourages joint efforts of stateand non-state stakeholders to work together to address complex problems throughcollective decision making and/or implementation (Gray 1989; Bingham and O’Leary2008; Farazmand 2004; Huxham and Vangen 2000). The inclusion of relevantstakeholders in collaborative governance promotes collective decision making ineffectively addressing complex problems (Bryson et al. 2006; Allison and Allison2004). Collaborative governance thereby fosters collective problem solving byengaging key stakeholders and is a viable alternative to top-down management,policy making and implementation.

Ansell and Gash (2007) explicate the concept of collaborative governance bydescribing collaborative governance as “a type of governance in which public andprivate actors work in distinctive ways, using particular processes to establish laws

Public Organiz Rev (2012) 12:107–126DOI 10.1007/s11115-011-0162-7

J. K. Agbodzakey (*)340 Park Street Apt 6A, Hackensack, NJ 07601, USAe-mail: dzakey@hotmail.com

and rules for the provision of public goods” (p.3). Collaborative governance is thus aprocess of engagement and consists of critical variables such as facilitative leadershipand institutional design; collaborative process variables such as trust building,commitment to the process and shared understanding, as well as outputs such asallocation priorities among others. The interaction between these variables is nonlinearand is essential to understanding the use of collaborative governance in addressing thecomplex HIV/AIDS problem in two South Florida counties.

The study uses the collaborative governance concept to examine the functionalityof collective decisions by HIV Health Services Planning Councils (hereinafterreferenced as the Councils) in Broward County and Palm Beach County as part ofthe implementation of the Ryan White Comprehensive AIDS Resources Emergency(CARE) Act (hereinafter referred to as CARE Act) in addressing the HIV/AIDSproblem. The study relies on qualitative methods such as interviews and documentreviews in garnering data from various relevant sources and focuses on 2000–2006periods. Combined findings from the data are essential to knowledge andunderstanding of collaborative governance of the respective Councils.

The what and why of collaborative governance

Complexities of the contemporary era encourage joint efforts of state and non-stakeholders as a conduit to addressing common challenges and/or problems. Eventhough state and non-state stakeholders have collaborated in the past, current trends andissues in governance and administration have increased the impetus for collectiveengagement. Scholars such as Gray 1989; McGuire 2006; Farazmand 2004, 2006;Bryson et al. 2006; Freeman 1997; Healey 1997; O’Leary et al. 2006; Huxham andVangen 2000; Allison and Allison 2004 have referenced the historical and modernaspects of collaborative governance. For instance, Farazmand (2004, p.11,77) writingon “Sound Governance…” highlighted state and non-state actors partnerships foreffective and efficient administration of the Persian Empire and how collaboration isutilized nowadays in dealing with challenges associated with governance. Similarly,McGuire (2006 p.34) on “Collaborative Public Management…” cited collaborativeproblem solving as it relates to governance in the United States from the verybeginning to this current era (also see Agranoff and McGuire 2003).

Collaborative governance has become such a viable model of governance in thiscontemporary era because of “qualitative changes” brought by globalization alterfunctions and responsibilities of states and governments to a large extent (Farazmand2006, p.1140). The mandate to govern effectively requires fundamental and practicalchanges that broaden participation of stakeholders at the various levels ofengagement. The changes in mode of governance and administration is seen asessential to tackling complex and interconnected challenges (Bingham and O’Leary2008; Cooper et al. 2006; Farazmand 2007; Friedrichsen 2006; Anonymous 2006).

Collaborative governance gains currency as an effective model because itpromotes broad participation in decision making and implementation. The broadparticipation of relevant state and non-state stakeholders in decision making andimplementation promotes collective resolve to address the problem and increasesresponsibility for outputs and/or outcomes. Various international, national, state, and

108 J.K. Agbodzakey

local governments embrace collaborative governance as a viable model in addressingcomplex or “wicked problems” such as HIV and AIDS (Gray 1989; Rittel andWebber 1973; Freeman 1997; English 2000; Healey 1997).

Collaborative governance has “governance” as an essential element. Governance is aconvoluted concept and has been applied in diverse ways. Michalski et al. (2001) intheir work on “Governance in the 21st Century”, conceptualized governance as “thegeneral exercise of authority” (p.9). The exercise of authority connotes some elementof control or top-down management of public affairs on a wide spectrum. Lynn et al.(2000, p.3) defined governance as “regime of laws, administrative rules, judicialrulings and practices that constrain, prescribe, and enable government activity, wheresuch activity is broadly defined as the production and delivery of publicly supportedgoods and services” (also see Frederickson and Smith 2003, p.210; Ansell and Gash2007, p.3). The definition by Lynn et al. (2000) suggests some extent of joint publicand private sector participation in service delivery in line with some established rules,and is emblematic of collaborative governance. Collaborative governance is moreinclusive of all relevant stakeholders in the policy process.

Scholars use the terms collaboration, participatory management, participatorygovernance, collaborative democracy, collaborative governance, sound governanceand collaborative management to describe collective efforts of state and non-statestakeholders in addressing complex problems through joint decision making and/orimplementation. These terms are sometimes used interchangeable in the literaturebut Ansell and Gash (2007) prefer “collaborative governance” to “management”because governance is “broader and encompasses various aspects of governing”, andthe term “collaborative” is “more indicative of the deliberative and consensus-oriented approach” to decision making (p.6). This study embraces the termcollaborative governance. The frequent use of collaborative governance in thiscontemporary era thereby warrants examining what collaborative governance is andwhy it used, as in this case, in addressing challenges posed by the AIDS epidemic.

Gray (1989) in her book on “Collaborating: Finding Common Ground forMultiparty Problems” defines collaborative governance as “a process through whichparties who see different aspects of a problem can constructively explore theirdifferences and search for solutions that go beyond their own limited vision of whatis possible” (p.5). This definition highlights how stakeholders with divergentinterests, strengths, and weaknesses, engage each other for the purposes of achievingcommon goals or objectives. Working collectively is not devoid of potential oractual conflicts. Conflict is likely to occur especially when there is the need for“authoritative allocation” of resources to service providers by the Councils as part ofimplementation efforts (Lasswell 1936). Nonetheless, the commitment to achieve acommon purpose is critical for collaborative governance. Other definitions equallyhighlight collaborative governance as involving stakeholders in collective decisionmaking and action for the benefit of society (Healey 1997; Bingham and O’Leary2008; Chrislip and Larson 1994; Echeverria 2001; Coggins 1999; Beierle 2000;René and Tharsi 2004).

Bryson et al. (2006) define collaborative governance “as the linking or sharing ofinformation, resources, activities and capabilities by organizations from two or moresectors to achieve jointly an outcome that could not be achieved by organization inone sector separately” (p.44). Padgett et al. (2004, p.252) conceptualize collaborative

Collaborative Governance of HIV Health Services Planning Councils… 109

governance as “the practice of cooperative work among government and nonprofitservice agencies, community organizations and leaders, academics, and otherpartners working together” (also see Nicola 2006, p. 335). Thus, stakeholders worktogether to achieve a common purpose and society stands to benefit fromcollaborative governance, especially when it focuses on addressing a complexproblem such as HIV/AIDS.

The emergent collaborative governance approach, as is the case for the Councils, is amuch more viable option for addressing the numerous challenges posed by HIV/AIDS.The Councils consist of relevant state and non-state stakeholders including the otherwisepowerless and “deviant” target populations (CARE Act 1990, 1996, 2000, 2006, 2009;Schneider and Ingram 1993). The inclusion of target populations alongside otherstakeholders in decision making through regular face-to-face interaction strengthensthe resolve among the Council members to act collectively. Also, broad participationand regular face-to-face interaction relative to decision making at the Councilsdifferentiate collaborative governance from networks, agency-interest interactions, andpublic-private partnerships (Ansell and Gash 2007, pp. 4–5; Freeman 1997).

The comparative advantage of collaborative governance relative to other forms ofgovernance does not make it immune to challenges. Challenges such as time constraints,turf battles, trust issues, delayed decisions, and politics of the collaborative processamong others, are inevitable (Hageman and Bogue 1998; Aubrey 1997; Booher 2004).For instance, the divergent interests that are represented in decision making,particularly, in making allocation priorities are likely to experience conflicts relativeto participation in the collaborative process. Nonetheless, collaborative governance is amuch more viable option for collective decisions, actions, and solutions to problemsbecause of the extensive inclusion of relevant stakeholders and knowledge of theconsequences of inaction on the health and well-being of PWAs. Collaborativegovernance thus fosters common resolve, creativity and innovation of stakeholders intackling complex problems for the common good (Bryson and Crosby 2005;Farazmand 2004; Gray 1989; Rittel and Webber 1973).

Collaborative governance as a consequence of legislative mandate has not been asubject of intense research in public management. How the legislation shapescollaborative governance, how critical variables such as facilitative leadership andinstitutional design impact the collaborative process and outputs relative toaddressing HIV/AIDS in South Florida is yet to be explored. Research has so farcentered on “antecedents and enhancing collaborative performance” relative to somecollaborative efforts while at the same time creating a “missing link” in some aspectsof collaborative governance, for instance, the collaborative process (Thomson andPerry 2006, p.30). Understanding how collaborative governance works and theoutputs within the context of HIV/AIDS at the county level will provide publicmanagers information on collaborative governance and foster its use as a conduit toaddressing other pertinent health, social, and environmental problems.

The few attempts at examining use of collaborative governance in collective problemsolving were limited in scope and fall short of needed insights on some of its keyvariables. Dukay’s (1995) research on collaborative governance and the HIV/AIDSepidemic in Colorado focuses on decision making without addressing constituentissues such as commitment to the process and its relevance to decision making, andthe outputs and/or outcomes of collaborative governance. Kwi-Hee’s (2004) study

110 J.K. Agbodzakey

explores the collaborative process relative to social capital formation in communitydevelopment, but falls short of addressing the critical role that leadership andinstitutional design play in collaborative governance. This comparative case studyfocuses on collaborative governance as it relates to addressing the HIV/AIDSconundrum in Broward County and Palm Beach County by drawing on the criticalvariables (facilitative leadership and institutional design), collaborative processvariables (trust building, commitment to the process and shared understanding) andoutputs i.e. allocation priorities (Ansell and Gash 2007). The discussion ofcollaborative process variables includes consensus and empowerment which lendscredence to the communicative and collaborative nature of the Councils.

Collaborative governance in South Florida

This section discusses collaborative governance model relative to efforts towardaddressing the HIV/AIDS problem in Broward County and Palm Beach County. Thediscussion starts with the CARE Act and politics of social construction of targetpopulations. In addition, the discussion includes collaborative process variables, thecritical variables and ends with outputs, but with emphasis on allocation priorities.Overall, the model depicts HIV/AIDS collaborative governance via the experience ofthe two Councils in South Florida as part of the implementation of the CARE Act inaddressing challenges associated with the AIDS epidemic.

HIV/AIDS Collaborative Governance Model

Facilitative Leadership

Institutional Design

Allocation Priorities

Compre -hensive Plans

Needs Assessment Reports

Health Care Providers

Community-based Org

AIDS Services Org

Social Service

Providers

Health Care Planning

Agencies

Local Health Agencies

Affected Communities

Individuals with AIDS

(social construction/

deviants)

Non-elected Community

Leaders

State Government

Grantee Part A

Grantees under II of

part C

Grantees under Section

2671

Lead Agency of HRSA

Other

Collaborative GovernanceSocial Construction of Target populationsDeliberative DemocracyLeadership TheoriesStructure Theories

Theoretical Framework

Ryan WhiteCARE Act

1990

1996

2000

2006

2009

Legislation

Collaborative Governance Process

Outputs

Council/Target Populations

Collaborative Governance of HIV Health Services Planning Councils… 111

Adapted from: Schneider and Ingram (1993); Ansell and Gash (2007) and RyanWhite CARE Act (1990)

The Ryan White CARE Act

The CAREAct laid the foundation for participatory decisionmaking involving state andnon-state stakeholders, as in this case, HIV infected and affected and community leadersin collaborative governance at EMAs that were hardest hit by the AIDS epidemic. Thelegislation facilitates shared understanding of the problem and the need to actcollaboratively and sets the standards, modes of operation, tasks and outputs forcollaborative governance of the Councils and thereby fosters making decisions byconsensus for the “common good” (CARE Act 1990, 2006; Bryson and Crosby 1992).The legislation became the “ultimate variable” for collective response to the HIV/AIDS problem in the respective counties. Nonetheless, the legislation was shaped bypolitics of AIDS at the onset of the AIDS epidemic (Theodoulou 1996, Donovan2001). Also, how collaborative governance works at the local level is partly contingenton local arrangements and commitment of the stakeholders in working as a team. Overtime, the legislation and efforts of stakeholders with interest in the HIV/AIDS problemhelp modify the social construction of PWAs from undeserving to deserving ofgovernment assistance (Schneider and Ingram 1993). Furthermore, target populations,thus PWAs became key stakeholders in the policy process, especially in makingdecisions at the county level as part of implementation of the CARE Act.

Case of the councils

This study compares collaborative governance of two Councils in South Florida,specifically in Broward County and Palm Beach County as part of theimplementation of the CARE Act. The study examines how collaborativegovernance works in addressing the HIV/AIDS problem in the respective counties.The two Councils were chosen because they exist in adjoining counties with similardemographics (ethnic composition); have similar collaborative processes, andinstitutional designs, were accessible to the researcher because of proximity andcost savings, have existing structures of collaborative engagement relative tomulticultural culture discourse, have been recipients of Minority AIDS Initiative(MAI) since 2001 and were established in the early 1990s (U.S. Census 2009;Stanisevski 2006; HRSA 2009).

The literature supports focusing on similar or dissimilar cases to provide knowledgeand understanding of a phenomenon (Stake 1998; Yin 1984, 1994). Broward Countyand Palm Beach County fall within the federal government designated EligibleMetropolitan Areas (EMAs) because of the high incidences of HIV infections andhave been recipients of Ryan White funds since the 1990s (Broward County HIVPCComprehensive Plan 2006–2009; Palm Beach County HIVCC Comprehensive Plans2006). By comparing collaborative governance of the Councils in line with thelegislative mandates and based on variables such as facilitative leadership, institutionaldesign, collaborative process variables and outputs help establish how collaborativegovernance works in the respective counties in meeting the needs of PWAs. The nextsection focuses on collaborative process variables.

112 J.K. Agbodzakey

Trust building

Trust building is essential for working together to address complex problems such asHIV/AIDS. The complex nature of the problem demands collective response fromstate and non-state stakeholders with a common resolve to alleviate the devastatingimpacts of the AIDS epidemic on infected and affected individuals and the rest ofsociety. The resolve to make a difference can best be realized when the stakeholderslearn to trust each other. Trust plays an important role in collaborative governanceand conscious attempt at trust building takes time and effort (Huxham and Vangen2005; Holton 2001).

Trust is a principal dimension of the confidence building variable of thecollaborative process because of the value it adds to collaborative governance. Trustbolsters cooperation among the collaborative partners and task performance (Chilesand McMacken 1996; Smith 1995). Nonetheless, trust is not the only dimensionassociated with trust building. Other dimensions identified in this study werecommunication, working together as a team, the Sunshine law, facilitation, respectfor the opinion of other members, equality in representation and participation, time,consensus, and voting. Together, these dimensions enhance the possibility ofachieving the objectives of addressing the HIV/AIDS problem in Broward Countyand Palm Beach County.

Members of both Councils acknowledged trust is essential to working togetherand stated it takes collective effort of stakeholders in collaborative governance tobuild trust over time (Vangen and Huxham 2003; Kramer and Tyler 1995). Amajority of the members admitted there is at least trust to get the job done and trustin the collaborative process. The CARE Act, Council Bylaws, policies andprocedures played a role in helping members build trust over time. Consequently,trust among members of the Councils fosters working together and has facilitatedefforts towards addressing the HIV/AIDS problem in the respective counties.

Commitment to the process

Commitment to the collaborative process, as is the case with HIV Health ServicesPlanning Councils in Broward and Palm Beach counties is essential for success inaddressing the problem. Commitment focuses on the willingness of the state andnon-state stakeholders, in this case, members of the respective Councils, to worktogether to achieve the objectives of collaborative governance (Ring and Van de Ven1994, p. 98). By commitment to the collaborative process, the members consented toabide by the protocols, embrace the challenges associated with collaborativegovernance and derive mutual gains (Burger et al. 2001; Walters et al. 2000;Hudson et al. 1999). Based on the data, members of both Councils were committedto promoting the health and well being of PWAs in the respective counties.

The dimensions synthesized from responses relative to the commitment to theprocess variable were commitment, knowledge/expertise, consensus, and facilitate.Both Councils shared similar perspectives on commitment to collaborativegovernance. Members of both Councils were committed to making a difference inthe lives of people with AIDS through regular participation in decision making,performing assigned tasks in various committees, participating in community forums

Collaborative Governance of HIV Health Services Planning Councils… 113

and advocating for the community of the infected and affected population.Furthermore, members demonstrated their commitment by sharing knowledge/expertise and experience to collaboratively make allocation priorities to best addressPWAs needs.

Members of both Councils demonstrated commitment to the collaborative processby the collective efforts to advance the interests of PWAs. Members’ volunteeredtime, incurred personal costs and expended other resources as part of participation inthe collaborative process. Members’ commitment was bolstered by awareness of thedifference allocation priorities to various services have made in the health and wellbeing of PWAs.

Shared understanding

Shared understanding of the HIV/AIDS problem and the CARE Act’s intentions andpurposes by members of the HIV Health Services Planning Councils in bothcounties is essential for collective response to the problem. Shared understandingimpresses upon the members to work as a team to provide needed services to meetvarious PWAs needs (Theodoulou 1996; Davies and Boruch 2001; Milbourne et al.2003). Based on the data, the members of the respective Councils have demonstratedan understanding of the AIDS problem and have endeavored to fulfill various tasks,as necessary to addressing challenges associated with the AIDS epidemic.

It appeared that shared understanding of the AIDS problem by members of theCouncils provided the impetus to reach consensus on various subjects ofdeliberations, i.e. as reflected in resource allocation for various categories ofservices to meet PWAs needs. The resolve to make a decision by consensus waspartly attributed to members’ access to epidemiology data and the unique experiencethat PWAs bring to the collaborative process which created collective urgency forremedial action. Consequently, reaching consensus on subjects of deliberation atboth Councils have become a common practice. Even in instances where all themembers cannot agree on a specific subject of deliberation, final decisions weremade via a simple majority vote.

Shared understanding of members of the Councils to act on the AIDS conundrumwas partly attributed to facilitative leaders’ role in stimulating debate, steeringdeliberations and fairly applying rules governing deliberations. The facilitativeleaders (chairs) drew attention to the rationale for collaborative governance at thevarious meetings and urged members to work together as a team in order to advancethe health and well being of PWAs. The chairs of committee and general Councilmeetings were catalysts for shared understanding which aided producing outputssuch as allocation priorities for the benefit of PWAs.

The CARE Act facilitated knowledge and understanding of the AIDS problemand the need for collective action by state and non-state stakeholders. The Councils’bylaws complemented the rationale for remedial action and teamwork of themembers to address the problem. The legislation encapsulated governmentunderstanding and response to the AIDS problem and outlined specific actionsrequired of Councils in the respective EMAs. Shared understanding of members waspartly attributed to membership orientation and other training programs for membersby the respective Councils. Collectively members learned to comprehend the gravity

114 J.K. Agbodzakey

of the AIDS problem, trust the collaborative process and grow commitment overtime to help address the problem, as is the case at Broward County’s and PalmBeach County’s Councils. The next section discusses the critical variables.

Facilitative leadership

The facilitative leaders (reference to chairs at the committee and general Councilmeetings) are critical to the success of collaborative governance. The facilitativeleaders play a key role in the collaborative process by their efforts in facilitatingdeliberations at committee and general Council meetings, in promoting representa-tion and participation of relevant state and non-state stakeholders and in helpingproduce outputs such as allocation priorities to meet the needs of PWAs in therespective counties. The facilitative leaders’ efforts alongside that of rest of themembers of the Councils are essential to ensuring collaborative governance works asa conduit to addressing the HIV/AIDS problems in South Florida.

The invaluable efforts of the facilitative leaders in collaborative governancecannot be over stated. Based on the data, it is apparent the facilitative leaders atBroward County’s and Palm Beach County’s Councils are making efforts tofacilitate the collaborative process in a way that enhance achieving the legislativeintents of the CARE Act. The facilitative leaders chair the general and committeemeetings of the respective Councils and spend more time doing so. For example theBroward County’s Council usually has nine (9) meetings in a year and averages aminimum of two (2) hours per meeting session while Palm Beach County’s Councilusually has six (6) meetings in a year and averages one (1) hour per meeting session.

The leaders’ facilitative efforts contributed to trust building, commitment to thecollaborative process, shared understanding, reaching consensus and empowermentof target populations (Ansell and Gash 2007; Bryson and Crosby 2005; Ryan 2001;Svara 1994). The dimensions synthesized from the data relative to the facilitativeleadership variable for both Councils were to facilitate deliberations, help build trust,establish equality in representation and participation, provide much neededknowledge and expertise, promote consensus, help resolve conflicts, empower,provide feedback, be neutral and fair, treat with respect and dignity, enforce rules,and create an environment conducive for deliberations. The dimensions relate withother variables of the collaborative governance process, thus lend credence to thecritical role of the facilitative leaders in collaborative governance (Chrislip andLarson 1994; Ryan 2001; Lasker et al. 2001).

The facilitative leaders’ major role was to facilitate deliberations and thatappeared to be the case at the Broward County’s and Palm Beach County’s Councils.The leaders’ facilitative efforts in the collaborative process were not only essential intrust building, commitment to the process and shared understanding but were criticalin producing outputs such as allocation priorities. The members of both Councilsadmitted the important role the facilitative leaders play in helping make allocationpriorities and other outputs as necessary to providing various categories of servicesto PWAs. The facilitative leaders in all intents and purposes were the custodians ofthe collaborative process because they serve as servant and transforming leaders ofthe Councils, and are hence critical in the success of collaborative governance inaddressing the HIV/AIDS problem (Greenleaf 1977; Cunningham 2004; Burns

Collaborative Governance of HIV Health Services Planning Councils… 115

1978; Bryson et al. 2006; Svara 1994; Thomson and Perry 2006). The facilitativeleaders at both Councils enjoyed overwhelming support from the rest of themembers.

The facilitative leaders’ contribution to the success of collaborative governance ispartly contingent on knowledge and experience in steering the collaborative process.Based on the data, knowledge and experience are essential to encouragingparticipation in deliberation by stimulating debate on agenda items, enforcing therules, keeping to the agenda for the day, placing time limits on items of deliberation,providing equal opportunity to members to participate in deliberations, establishingprofessional and working relationship with members, reframing issues to promoteunderstanding, and helping make final decisions that best meet needs of PWAs. Thefacilitative leaders at the respective Councils possessed a unique set of knowledgeand experience that aided in fulfilling the required duties.

Institutional design

Institutional design is one of the critical variables of collaborative governancebecause of the contribution to the collaborative process. The way an institution isdesigned plays an important role in the function and eventual success ofcollaborative governance. Ansell and Gash (2007) conceptualized institutionaldesign as the “basic protocols and ground rules of collaboration” (p.13). Institutionaldesign within the context of the Councils includes the structure of the Councils andis the focus of one of the subsidiary research questions of the study. Both Councilshave adopted flexible structures as part of collaborative governance towardsaddressing the HIV/AIDS conundrum. The efforts of both Councils complementlocal efforts in promoting health and well being of residents in the respectivecounties.

The institutional design of the Councils promotes inclusion of relevant state andnon-state stakeholders in collaborative governance, the operation of the Councils andefforts of the facilitative leaders. The CARE Act alongside the bylaws, policies andprocedures, and Robert’s Rules of Order form the basis for design of the respectiveCouncils. The design of the Councils is unique in that it includes target populations(HIV infected and affected) as key stakeholders in making decisions as part of theimplementation of the CARE Act. The mandated inclusion of target populations indecision making marks a new trend in the policy process and fosters proactiveresponse to addressing challenges posed by the AIDS epidemic in the respectivecounties. The design of the Councils enhances influence of target populations indecision making through chairing meetings and even the Councils and thus helpsmake allocation priorities to address PWAs needs.

Based on the data, dimensions such as rules, specific task, consensus, diversity,empowerment, facilitation, trust, communication, conducive environment, informa-tion session/forum, and voting were synthesized relative to the institutional designvariable. These dimensions point to the relentless efforts of the Councils to makedecisions that help meet needs of PWAs and by doing so attempt to fulfill thelegislative intents of the CARE Act. Both Councils share similar dimensions butwith some differences in areas such as number of members, committees, meetings,and duration of meetings, meeting structure, and allocation priorities.

116 J.K. Agbodzakey

The Broward County’s Council has thirty-three (33) fulltime members whereasthe Palm Beach County’s Council has twenty-one (21) fulltime members (BrowardCounty HIVPC Bylaw 2006b and Palm Beach County HIVCC Bylaw 2005.Regardless of the number of fulltime members, each Council is constituted of at least33% HIV infected members. Both Councils have some service providers that belongto various committees but are not fulltime members of the Councils. Nonetheless,the members, guests, staff responsible for the meetings and service providers that arenot fulltime members are part of the Councils’ decision-making process, but onlyfulltime members of the Councils vote on the various issues of deliberation at thecommittee and general Council meetings. Members vote “yes” or “no” based onwhat they perceived to be in the best interest of PWAs.

The Councils are made up of committees. The Broward County’s Council hasseven (7) committees and meets at least nine (9) times in a year. Each meeting lastedfor a minimum of two (2) hours. The Palm Beach County’s Council has nine (9)committees and each committee meets at least six (6) times in a year. Each meetinglasted for a minimum of one (1) hour but the agenda for discussion is sent tomembers in advance. Most of Broward County’s Council committees are joined byPart A and B members. The members at both Councils belong to various committeesbased on interest and expertise. In addition, both Councils created ad-hoccommittees based on contingencies and relevance to making judicious allocations(Broward HIVPC Bylaw 2006b; Palm Beach HIVCC Bylaw 2005). The sittingarrangement for committee meetings at Palm Beach County’s Council is close-knit(members sit close to each other and face each other while sharing the same table).Sitting arrangement at the general Council meeting is not that close-knit. Memberssit in a circular format. The sitting arrangement at the Palm Beach County’s Councilis similar to Broward County’s Council’s sitting arrangements at the committee andgeneral Council meetings. Overall, the sitting arrangement enhances dialogue amongthe members.

The Councils’ deliberations are guided by rules and based on the data, rules areone of the key dimensions of institutional design relative to collaborativegovernance, and members asserted the rules are clear enough. The rules (CouncilBylaws, policies and procedures, Robert Rules of Order, Florida Sunshine Law) areessential to creating environment conducive for participation, facilitation, taskperformance, communication, conflict resolution and reaching consensus on varioussubjects of deliberation. The rules guide all aspects of collaborative governance andimpact the outputs (Dedekorkut 2004; Glasbergen and Driessen 2005). BothCouncils endeavor to consistently apply the rules to respective efforts which helpbuild trust and commitment to collaborative governance, especially in view of thecomposition of the Councils. It is not an overstatement to point out that the CAREAct is the principal rule for collaborative governance, thus emphasizing howprotocols and ground rules shape collaborative governance for the “common good”and is aided by local arrangements to collectively make decisions to address theHIV/AIDS problem.

Institutional design, as is the case with Councils in Broward County and PalmBeach County also promotes consensus and empowerment of members. Members ofthe Councils understand the need to work together as a team in order to produceoutputs to address the problem. The commitment to reaching consensus among the

Collaborative Governance of HIV Health Services Planning Councils… 117

members is evidenced by thoughtful and inclusive deliberations at the committeeand general Council meetings and the various allocation priorities between the2000–2006 periods. In addition, the common resolve to work as a team entailsembracing the perspective of target populations as key stakeholders in addressing theproblem. The Councils in their respective capacities observed the guiding protocolsand hence complied with the legislative mandates regarding representation andparticipation. In addition, the members for the most part work as a team.Consequently, members that are PWAs feel they belong and feel empowered bybeing part of the collaborative process. The next section focuses on empowermentand consensus.

Empowerment

Empowerment emerged as one of the process variables of collaborative governance.Empowerment fosters consensus and commitment to collaborative governance.Bryson and Crosby (2005) conceptualized empowerment as “helping each groupmember claim and develop his or her power in service of the group’s mission andpromoting a sense of shared leadership in the group” (p.70). For members ofcollaborative governance to be empowered, the authors point out the “need forshared understanding of the team’s mission, goals, decision making procedures,rules, norms, work plans and evaluation methods” (p.70). The CARE Act mandateof inclusion, especially including PWAs in collaborative governance, and with fairapplication of policies and procedures, bylaws and facilitative leadership by therespective Councils, plays an essential role in enabling affiliated PWAs to feelempowered by being part of the collaborative process.

Empowerment of target populations is a key dimension of institutional design andfair application of the rules contributed to empowerment of members of theCouncils, especially members that were PWAs. All the PWAs interviewed at bothCouncils asserted being empowered by being part of collaborative governancegeared towards addressing the challenges posed by the AIDS epidemic. A PWAmember of each Council is expected to be present at each meeting beforeproceedings can commence and votes are taken on subjects of deliberation. Thus,without a PWA at a committee or general Council meeting, there is no quorum. Inaddition, the required thirty-three percent (33%) PWA membership of each Councilregardless of whether the maximum membership quota is met ensures PWAs havevoice in all issues that impact meeting various needs (CARE Act 1990, 2006).Consequently, PWA members of the Councils feel perceptions are being modifiedabout who they are partly because of contributions to collaborative governance,expertise and experience, and relentless efforts to advance the interests of otherPWAs in the respective communities. Nonetheless, some of the PWA members wishthe membership quota could be increased in order to bolster participation andempowerment.

The feeling of empowerment as a consequence of participation in collaborativegovernance is a testament to the impact of the CARE Act. The mandate of PWAsinclusion fosters modification in the perception of target populations, at least, at theCouncil. In addition, efforts in the treatment of AIDS that enables some PWAs tolive longer and become active in various endeavors coupled with incessant education

118 J.K. Agbodzakey

and awareness creation have shifted negative social perception of PWAs amongsome segments of the population. Thus, a case can be made for “management ofstigma” (Goffman 1986) on the part of some segments of the population that haveinteracted with the AIDS infected and affected, and have benefitted from AIDSawareness programs. Furthermore, the modification supports Lieberman’s (1995,p.437) contestation of “how social and political institutions adjudicate amongcontending definitions of group identity in making public policy” and Keeler’s(2007, pp.627–628) observation which questioned institutionalization of the existingcategory of HIV transmission and proposed conceptualizing HIV/AIDS “as a seriousviral infection similar to hepatitis B” to help reduce the stigma of PWAs.

Consensus

In conceptualizing collaborative governance, Ansell and Gash (2007) mentionedconsensus-oriented and/or achieves consensus as essential to collaborative governancefor collective problem solving (p.3). The experience of the Broward County’s andPalm Beach County’s Councils shows state and non-state stakeholders work togetherin addressing the HIV/AIDS problem, and thus supports Ansell and Gash’scontestation on collaborative governance. Consensus emerged as one of the variablesof collaborative governance. It implies the Councils are not just consensus-oriented butmake decisions by consensus unlike other collaborative engagements that might bejust consensus-oriented without achieving consensus in practice. Consensus on varioussubjects of deliberation at the committee and general Council meetings is essential formaking judicious allocation priorities to address various PWAs needs. Scholars such asMcClosky (1964), and Prothro and Griggs (1960) conceptualized consensus as “anagreement.” Consensus does not necessarily connote 100% agreement on varioussubjects of deliberation but represents a majority position on the subject.

Making decisions by consensus is essential for collaborative governance becauseof the diverse interests that are represented at the Councils. The state and non-statestakeholders need to explore the various interests in order to find a common groundfor collective action (Innes 2004, p.7). Consensus among the stakeholders to actcollectively on the problem “facilitates collaboration: it reinforces the cooperationwhich arises from coincidence of interests, limits the range of the divergence ofinterests by defining ends in a way which renders them more compatible, andcircumscribes the actions injurious to cooperation which might arise from thedivergent interests” (Sills 1968, p.264). The experience of the Councils in BrowardCounty’s and Palm Beach County’s revealed a strong sense of team work among themembers to advance the interests of PWAs.

The drive to reach consensus by the members of the Councils is partly attributedto the shared understanding of the problem and the need to work together as a team,regular face-to-face dialogue, the commitment to making a difference in the lives ofPWAs, the value placed on each member’s contributions, and the resolve to bearresponsibility for outputs. The data revealed members reaching consensus on amajority of issues but there were instances of disagreements, even deadlocks. Thus,members have learned to appreciate disagreement as part of the decision-makingprocess and accepted as helpful to making decisions to advance the interest of PWAsin the respective jurisdictions.

Collaborative Governance of HIV Health Services Planning Councils… 119

The resolve to reach consensus is further enhanced by the representation andparticipation of PWAs. A third of each Council (33% of membership) is made ofPWAs who draw attention to the AIDS epidemic on a consistent basis, share theexperience with the rest of the members, provide information on which services areeffective and make a case for a continuum of care. Although it will be difficult toaccount for PWAs active representation on all issues, PWAs have made some effortsto translate passive representation into active representation (Krislov 1974; Selden1997).

The essence of consensus to collaborative governance is evident by itsrelatedness to other collaborative process and critical variables. Reachingconsensus sometimes takes time and effort because of tensions associated withdeliberations (Donohue 2004; Coglianese and Allen 2003; Andranovich 1995).Nonetheless, the established mode of operation by the CARE Act, Council Bylaws,policies and procedures and Robert’s Rules of Order and facilitative leadershipwere helpful in stemming unproductive tensions associated with deliberations. Inaddition, trust that developed among the members over time helped channelenergies to making decisions as a consequent of productive deliberation andconsensus by members of the Councils. The next section discusses outputs,especially, allocation priorities of the Councils.

Allocation priorities

Broward County’s and Palm Beach County’s Councils have committed efforts inmaking allocation priorities to address various categories of PWAs needs. TheCouncils have consistently made allocations to various core medical services (75%of allocations) annually and in compliance with the legislation while at the samepromoting team work in producing the outputs. The Councils in their respectivecapacities exercised discretion in funding the various categories of services. The coremedical services were ambulatory/outpatient services, drug/medication assistance,oral/dental health, mental health, nutritional services, substance abuse, food bank,outreach, transportation, home health, other program support. Some of theallocations were for administrative purposes. The allocations within the 2000–2006 periods, like previous allocations helped meet various categories of PWAsneeds.

The allocation for the 2000–2006 periods is unique in that it included funds forMAI. Each EMA with high incidences of minority HIV infections receives MAI onyearly basis. The Broward County’s and Palm Beach County’s Councils have beenbeneficiaries since 2001 and have utilized the funds to support allocation for thevarious medical categories. The allocation priorities for the various categories differper Council as does the amount received from the federal administrative agency.

Broward County’s Council consistently received more funds from the CARE Actwhen compared with the Palm Beach County’s Council. Within the 2000–2006periods, Broward County’s Council received a total of $101,244,110 and served11,708 clients, compared to $63,830,957 of Palm Beach County’s Council thatserved 5,143 clients (CARE Council Comprehensive Plan 2006; CARE CouncilCount of Clients and Service Report 2009; CARE Council Allocation 2000–2006;Broward County HIVPC Comprehensive Plan 2006–2009; Ryan White Title 1

120 J.K. Agbodzakey

Service Utilization 2006a). The allocations included MAI of $ 6,131,485 (6.05% ofallocation for the period) for Broward County’s Council and $ 4,631,621 (4.57% ofallocation for the period) for Palm Beach Council. The difference in the amountreceived from the CARE Act is partly attributed to the incidences of AIDS at therespective counties. Admittedly, funding has not kept pace with growth in infection.

The allocation priorities constituted the major outputs of the respective Councils.Other outputs such as Needs Assessments and Comprehensive Plans were helpful tomembers in making the allocation priorities. The Needs Assessment Reports drewattention to various gaps in services and the Comprehensive Plans mapped out thestrategies for action while taking into account the epidemic situation at each Council.Each Council conducted Needs Assessment on a regular basis over the 2000–2006periods. In addition, the respective Councils have completed two (2) ComprehensivePlans. The Councils occasionally conducted client satisfaction surveys to supple-ment Needs Assessment and Comprehensive Plans to help make allocation priorities.The Council outputs were a consequence of collaborative engagement of membersfrom various constituencies in deliberation and commitment by members to makingdecision by consensus. Also, facilitative leaders and institutional design of theCouncils were necessary to producing the outputs to promote the health and wellbeing of PWAs in the respective counties.

Discussion

Collaborative governance of the Councils as part of the implementation of theCARE Act in addressing HIV/AIDS problem is unique in that the CARE Act of1990 and its subsequent modifications in 1996; 2000; 2006 and 2009 established theconditions for collaborative governance. It is complemented by the willingness ofthe state and non-state stakeholders, which in this context are members of theCouncils, to work together as a team in making decisions by consensus. Thelegislation laid the bases for institutional design and facilitative leadership in thecollaborative process. Thus, legislation set the guidelines for representation,participation, rules governing the collaborative process, leaders’ facilitative roles,mechanisms for conflict resolution, and formulas for allocation of funds andcategories of services (CARE Act 1990, 2006). The Councils exercised discretion inallocating resources based on what is perceived to best serve interests of targetpopulations.

The two Councils are much similar than different in collaborative governancetoward addressing the HIV/AIDS problem. The extensive similarities are partly dueto the CARE Act setting the foundation for existence and continuous operation ofboth Councils and the willingness of the members of both Councils to workcollaboratively. The Councils are closely related in all the collaborative processvariables and the respective dimensions. In addition, the Councils are largely similarin the critical variables (facilitative leadership and institutional design) and therespective dimensions with some few exceptions. Both Councils have similaroutputs with some differences in amount of allocation priorities and number ofclients served. The differences point to the uniqueness of each Council and how eachCouncil tries to address the challenges posed by the HIV/AIDS conundrum in its

Collaborative Governance of HIV Health Services Planning Councils… 121

jurisdiction. The membership of both Councils consists of HIV infected and affected,service providers, and non-elected community leaders (Broward County HIVPCBylaw 2006; Palm Beach County HIVCC Bylaw 2005).

Collaborative Governance of the Councils, as it relates to producing outputs infunding categories of services for PWAs were partly due to consensus andempowerment of members in the collaborative process. Consensus and empower-ment emerged based on synthesis of members’ responses. Consensus andempowerment relates with collaborative process variables such as trust building,commitment to the process, shared understanding, and the critical variables such asfacilitative leadership and institutional design. Consensus highlights issues surround-ing deliberations and making allocation priorities as part of efforts to meet needs ofPWAs in line with the legislative mandate. The Councils are not just consensus-oriented as the literature suggests is the case in some instances of collaborativegovernance but the Councils strive to make decisions by consensus on regular basis(Ansell and Gash 2007; Gray 1989; Bryson et al. 2006).

The Councils in Broward County and Palm Beach County are collaborative andare making allocation priorities in addressing various needs of PWAs. For instance,the Councils allow target populations to chair the general Council and committeemeetings which are critical to making allocation priorities and producing otherrelevant outputs in providing needed treatment and intervention services. In addition,the study provides an in-depth understanding of key variables in the collaborativeprocess such as trust building, commitment to the process, shared understanding, andcritical variables such as facilitative leadership and institutional design. Thecollaborative process variables and the critical variables have respective dimensionsand are interconnected in way that helps one understand the iterative nature of thecollaborative governance model for collective decision making and implementation.Facilitative leadership and institutional design are the major contributors to thecollaborative process and in producing the outputs. Nonetheless, both Councils haveto deal with challenges of collective decision making such as occasional conflicts indeliberation and politics of resource allocation.

The study’s model highlights social constructions of target populations, withemphasis on the deviant category, how the social constructions influence theenactment of the CARE Act, how the legislation establishes inclusive Councils thatemploy collaborative governance, and how the deliberative process at the Councilscontribute to outputs. The model clearly depicts the nexus between politics,policymaking, and implementation. The implementation of the CARE Act, at thelocal level shapes the policy and vice versa (Nakamura and Smallwood 1980;Browne and Wildavsky 1983). The recurrent modifications and reauthorization ofthe legislation and expansion of participants as and when necessary is a clearmanifestation.

The model could be utilized for conceptual and practical purposes by scholars andpractitioners in developed and developing countries as a framework for understand-ing and/or explaining health, political, socio-economic, environmental and culturalcollaborative endeavors. The model could be applied to undertakings whenstructures of collaboration are established by legislation, with or without modifica-tion. The model could be used for HIV/AIDS Commissions even if the guidingframework is not necessarily a major legislation like the CARE Act. The caveat is to

122 J.K. Agbodzakey

take into consideration norms governing leadership and/or authority structures inthat, societies that promote absolute obedience to authority would have difficultypromoting facilitative leadership and integrated institutional design as a conduit toeffective deliberation. Furthermore, the model could be employed in collaborativeengagements in non-democratic regimes when expertise and people-centeredapproach is valued as a viable means to tackling complex and interconnectedproblems.

Conclusion

Collaborative governance has become such a predominant and viable model intackling complex problems that confront societies in this contemporary era eventhough existed in various forms in the past (Cooper et al. 2006; Farazmand 2004;McGuire 2006). It is a promising alternative to the traditional patterns ofadversarialism and managerialism that are associated with public decision makingand contingent implementation strategies such as networking, and public-privatepartnerships (Ansell and Gash 2007, pp.5–6;). Collaborative governance broadensrepresentation and participation in the collaborative process. It even includes thosewho were “otherwise” formally neglected or ostracized (Gray 1989; Bingham andO’Leary 2008; Schneider and Ingram 1993). Decision outputs reflect divergentinterests and have greater potential in addressing public problems as is the case withthe HIV Health Services Planning Councils in Broward and Palm Beach Counties ofSouth Florida. The collective efforts of the members of the Councils resulted inallocation priorities on an annual basis and complemented by other outputs such asneeds assessments reports and comprehensive plans. Together, these outputsfacilitated providing various categories of services to PWAs and by doing someeting various PWAs needs in various communities of the Councils.

References

Agranoff, R., & McGuire, M. (2003). Collaborative public management: New strategies for localgovernments. Washington: Georgetown University Press.

Anonymous. (2006). A call to scholars and teachers of public administration, public policy, planning,political science, and related fields. Public Administration Review, 66, 168–170.

Allison, E. W., & Allison, A. M. (2004). Creating a hearing for the listening: steps to increase theeffectiveness of new forms of public and private participation. Group Facilitation, 127(6), 127–139.

Andranovich, G. (1995). Achieving consensus in public decision making: applying interest basedproblem-solving to the challenges of intergovernmental collaboration. Journal of Applied BehavioralResearch, 31, 429–445.

Ansell, C., & Gash, A. (2007). Collaborative governance theory and practice. Journal of PublicAdministration Research and Theory Advanced. Published November, 2007.

Aubrey, L. (1997). The politics of development cooperation: NGOs, gender and partnership in Kenya.New York: Routledge.

Beierle, T. C. (2000). The quality of stakeholder-based decisions: Lessons from the case study record.Discussion Paper 00-56, Resources for the Future.

Bingham, L. B., & O’Leary, R. (2008). Big Ideas in collaborative management. New York: Sharpe.Booher, D. E. (2004). Collaborative governance practices and democracy. National Civic Review, 93, 32–

46.

Collaborative Governance of HIV Health Services Planning Councils… 123

Broward County HIVPC. (2005). Ryan White Title I: Comprehensive HIV/AIDS Plan FY 2006–2009.Broward County, Florida.

Broward County HIVPC. (2006a). Analysis of Ryan White Title I service utilization. Broward CountyFlorida.

Broward County HIVPC. (2006b). Bylaws. Broward County, Florida.Browne, A., & Wildavsky, A. (1983). Should Evaluation Become Implementation? New Directions for

Program Evaluation, 20, 101–103.Bryson, J. M., & Crosby, B. (1992). Leadership for the common good: Tackling public problems in a

shared power world. San Francisco: Jossey-Bass.Bryson, J. M., & Crosby, B. (2005). Leadership for the common good: Tackling public problems in a

shared-power world (2nd ed.). San Francisco: Jossey-Bass.Bryson, J. M., Crosby, B. C., & Stone, M. M. (2006). The design and implementation of cross-sector

collaborations: propositions from the Literature. Public Administration Review, 66 Special Issue, 44–55.

Burger, J., Gochfeld, M., Powers, C. W., Warren, C., & Goldstein, B. D. (2001). Science, policy,stakeholders, and fish consumption advisories: developing a fish fact for Savannah river.Environmental Management, 27, 501–514.

Burns, J. M. (1978). Leadership. New York: Harper & Row.Chiles, T. H., & McMacken, J. F. (1996). Integrating variable risk preferences, trust and transaction cost

economics. Academy of Management Review, 21, 73–99.Chrislip, D. D., & Larson, C. E. (1994). Collaborative leadership: How citizens and civic leaders can

make a difference. San Francisco: Jossey-Bass.Coggins, G. C. (1999). Regulating federal natural resources: a summary case against devolved

collaboration. Ecology Law Quarterly, 25, 602.Coglianese, C., & Allen, L. K. (2003). Building sector-based consensus: A review of the EPA’s common

sense initiative. Working Paper RWPO3, JFK School of Government, Harvard University.Cooper, T. L., Bryer, T. A., & Meek, J. W. (2006). Citizen-centered collaborative public management.

Public Administration Review, 66, 76–88.Cunningham, R. (2004). Servant leadership—an introduction. Global Virtue Ethics Review, 5, 2–6.Davies, P., & Boruch, R. (2001). The Campbell collaboration does for public policy what Cochrane does

for health. British Medical Journal, 323, 294–295.Dedekorkut, A. (2004). Determinants of success interorganizational collaboration for natural resource

management. Ph.D. Diss., Florida State University, Tallahassee.Donohue, J. (2004). On collaborative governance. Corporate social responsibility initiative Working Paper

No. 2. Cambridge, MA: John F Kennedy School of Government, Harvard University.Donovan, M. C. (2001). Taking aim: Target populations and the wars on AIDS and drugs. Washington:

Georgetown University Press.Dukay, V. R. (1995).Using Collaboration Theory to Address the HIV/AIDS Epidemic. Dissertation

Presented to the University of Denver Proquest Publication. Retrieved April 10th, 2008.Echeverria, J. D. (2001). No success like failure: the Platte River collaborative watershed planning

process. William And Mary Environmental Law And Policy Review, 25, 559.English, M. (2000). Who are the stakeholders in environmental risk decisions? Risk: Health, Safety &

Environment, 11, 243–254.Farazmand, A. (2004). Sound governance: Policy and administrative innovations. Westport: CT Praeger.Farazmand, A. (2006). Global administrative reforms and transformation of governance and public

administration. In A. Farazmand & J. Pinkowski (Eds.), Handbook of globalization, governance, andpublic administration. Boca Raton: Taylor and Francis Group.

Farazmand, A. (2007). Learning from the Katrina crisis: a global and international perspective withimplications for future crisis management. Public Administration Review, 67, 149–159.

Frederickson, G. H., & Smith, K. B. (2003). The public administration theory primer. Boulder: Westview.Freeman, J. (1997). Collaborative governance in the administrative state. UCLA Law Review, 45, 1–98.Friedrichsen, S. (2006). Collaborative public management in San Francisco. Public Administration

Review, 66, 150–152.Glasbergen, P., & Driessen, P. J. (2005). Interactive planning of infrastructure: the changing role of Dutch

project management. Environment and Planning C: Government and Policy, 23, 263–277.Goffman, E. (1986). Stigma: Notes on the management of spoiled identity. New York: Ouchstone.Gray, B. (1989). Collaborating: Finding common ground for multiparty problems. San Francisco: Jossey-Bass.Greenleaf, R. (1977). Servant leadership: A journey into the nature of legitimate power and greatness.

New York: Paulist.

124 J.K. Agbodzakey

Hageman, W. M., & Bogue, R. J. (1998). Layers of leadership. The challenges of collaborativegovernance. Trustee, 51, 18–20.

Health Resources Services Administration. (2009). The HIV/AIDS Program: Ryan White Parts A. F.Retrieved July 12th, 2009 from http://hab.hrsa.gov/aboutus.htm#o.

Healey, P. (1997). Collaborative planning: Shaping places in fragmented societies. Vancouver: UBC.Holton, J. A. (2001). Building trust and collaboration in virtual teams. Team Performance Management:

An International Journal, 7, 37–47.Hudson, B., Hardy, B., Henwood, M., & Wistow, G. (1999). In pursuit of inter-agency collaboration in the

public sector. Public Management Review, 1, 235–260.Huxham, C., & Vangen, S. (2000). Leadership in the shaping and implementation of collaboration

agendas: how things happen in a (not quite) joined-up world. Academy of Management Journal, 43,1159–1175.

Huxham, C., & Vangen, S. (2005). Managing to collaborate: The theory and practice of collaborativeadvantage. New York: Routledge.

Innes, J. E. (2004). Consensus building: clarifications for the critics. Planning Theory, 3, 5–20.Keeler, R. L. (2007). Analysis of logic: categories of people in U.S. HIV/AIDS policy. Administration &

Society, 39, 612–630.Kramer, R. M., & Tyler, T. R. (1995). Trust in organizations: Frontiers of theory and research. Newbury

Park: Sage.Krislov, S. (1974). Representative bureaucracy. Englewood Cliffs: Prentice-Hall.Kwi-Hee, B. (2004). Process of Collaborative Governance for Community Development: Comparing LA

Empowerment Zone and Los Angeles Neighborhood Initiative. Dissertation Presented to theUniversity of Southern California. Proquest Publication. Retrieved July 10th, 2008.

Lasker, R. D., Weiss, E. S., & Miller, R. (2001). Partnership synergy: a practical framework for studyingand strengthening the collaborative advantage. The Milbank Quarterly, 79, 179–205.

Lasswell, H. D. (1936). Politics: Who Gets What, When, How. New York. Whittlesey House, McGraw-Hill.

Lieberman, R. C. (1995). Social construction (continued). American Political, Science Review, 89(2), 437–441.

Lynn, L., Jr., Heinrich, C., & Hill, C. (2000). Studying governance and public management: Why? How?In G. H. Frederickson & K. B. Smith (Eds.), The public administration theory primer (p. 210).Boulder: Westview.

McClosky, H. (1964). Consensus and ideology in America. American Political Science Review, 58, 361–382.McGuire, M. (2006). Collaborative public management: assessing what we know and how we know it.

Public Administration Review, 66, 33–43.Michalski, W., Miller, R., & Stevens, B. (2001). Governance in the 21st Century. Future Studies, OECD

Publication. Retrieved December, 2008 http://www.oecd.org/dataoecd/15/0/17394484.pdf.Milbourne, L., Macrae, S., & Maguire, M. (2003). Collaborative solutions or new policy problems:

exploring multi-agency partnerships in education and health work. Journal of Education Policy, 18,19–35.

Nakamura, R. T., & Smallwood, F. (1980). The Politics of Policy Implementation. New York: St. Martin'sPress.

Nicola, R. M. (2006). North American perspectives turning point: implications for collaborativegovernance. Clinical Governance: An International Journal, 11, 335–345.

O’Leary, R., Gerard, C., & Bingham, L. B. (2006). Introduction to the Symposium on CollaborativePublic Management. Public Administration Review, 66, Special Issue, 6–9.

Padgett, S. M., Bekemeier, B., & Berkowitz, B. (2004). Collaborative partnerships at the state level:promoting systems changes in public health infrastructure. (Turning Point Partnerships). Journal ofPublic Health Management and Practice, 10(3), 251–257.

Palm Beach CARE Council. (2009). Count of Clients and Service Report. Palm Beach County, FloridaPalm Beach County CARE Council. (2005). Bylaws. Palm Beach County, Florida.Palm Beach County CARE Council. (2006). Palm Beach County EMA Comprehensive Plan. Palm Beach

County, FloridaPalm Beach County CARE Council/Palm Beach EMA. (2000–2009). Allocation Priorities, 2001–2006.

Retrieved April 10th, 2009 from http://hab.hrsa.gov/reports/data2b.htm#2.Palm Beach County HIV CARE Council. (2005). CARE Council Bylaws. Retrieved July 12th, 2008.

http://www.carecouncil.org/CC_2008/Members/Bylaws%201-31-05.pdf.Prothro, J. W., & Griggs, C. W. (1960). Fundamental principles of democracy: bases of agreement and

disagreement. Journal of Politics, 22, 276–294.

Collaborative Governance of HIV Health Services Planning Councils… 125

René, B., & Tharsi, T. (2004). Multi-party collaboration as social learning for interdependence: developingrelational knowing for sustainable natural resource management. Journal of Community & AppliedSocial Psychology, 14, 137–153.

Ring, P. S., & Van de Ven, A. H. (1994). Development processes of cooperative interorganizationalrelationships. Academy of Management Review, 19(1), 90–118.

Rittel, H. W. J., & Webber, M. (1973). Dilemmas in a general theory of planning. Policy Sciences, 4, 155–169.

Ryan White Comprehensive AIDS and Resource Emergency (CARE) Act (1990). Retrieved October, 11,2007, http://hab.hrsa.gov/livinghistory/timeline\1990.html.

Ryan White Comprehensive AIDS and Resource Emergency (CARE) Act. (2000). As Amended by theRyan White Care Act of 2000, July, 2008 19Public L106-345 Retrieved http://www7.nationalacademies.org/ocga/Laws/PL106_345.asp.

Ryan White Comprehensive AIDS and Resource Emergency (CARE) Act. (1996) As Amended By TheRyan White Care Act. Amendments of 1996 Pub. L, 104–146. Retrieved December, 10, 2008 ftp://ftp.hrsa.gov/hab/amend.pdf.

Ryan White HIV/AIDS Treatment Extension Act. (2009). Retrieved November, 1, 2009 http://hab.hrsa.gov/.

Ryan White HIV/AIDS Treatment Modernization Act. (2006).Retrieved October,11, 2007 http://hab.hrsa.gov/livinghistory/timeline/2006-2006/2006.html.

Ryan, C. (2001). Leadership in collaborative policy-making: an analysis of agency roles in regulatorynegotiations. Policy Sciences, 34, 221–245.

Schneider, A., & Ingram, H. (1993). Social construction of target populations: implication for politics andpolicy. The American Political Science Review, 87(2), 334–347.

Selden, S. C. (1997). The promise of representative bureaucracy: Diversity and responsiveness ingovernment agency. Armonk: Sharpe.

Sills, D. L. (1968). International Encyclopaedia of Social Sciences. Vol. 3. Crowell Collier andMacMillan, Inc.

Smith, S. R. (1995). Social capital, community coalitions, and the role of institutions. Durham: DukeUniversity, Sanford Institute of Public Policy.

Stake, R. (1998). Cases studies. In N. K. Denzin, Y. S. Lincoln (Eds.), Strategies of qualitative inquiry (pp.86–109). Thousand Oaks, CA.

Stanisevski, D. M. (2006). Multicultural discourse: A comparative case study of government practices infacilitation of multicultural discourse in South Florida. Dissertation Presented to Florida AtlanticUniversity, Fort Lauderdale.

Svara, J. H. (1994). Facilitative leadership in local government: Lessons from successful mayors andchairpersons. San Francisco: Jossey-Bass.

Theodoulou, S. Z. (1996). AIDS equal politics. In: AIDS the politics and policy of disease (pp. 1–15).Upper Saddle River, NJ. Prentice Hall.

Thomson, A. M., & Perry, J. L. (2006). Collaboration Processes: Inside the Black Box. PublicAdministration Review, 66, Special Issue: 20–32.

U.S. Census Bureau. (2009) State of Florida and County Quick Facts. Retrieved, July 10th, 2009. http://quickfacts.census.gov/qfd/states/12000.html.

Vangen, S., & Huxham, C. (2003). Nurturing collaborative relations: building trust in interorganizationalcollaboration. The Journal of Applied Behavioral Science, 39, 5–31.

Walters, L. C., Aydelotte, J., & Miller, J. (2000). Putting more public in policy analysis. PublicAdministration Review, 60, 349–359.

Yin, R. K. (1984). “Introduction” (pp. 1–18), Selection from “Conducting Case Studies” (pp. 83–97) and“Reporting Case Studies” (pp. 141–166). In: Case study research: Design and methods. 3rd ed.Beverly Hills, CA: Sage.

Yin, R. K. (1994). Case study research: Design and methods, applied social research. Thousand Oaks:Sage.

James K. Agbodzakey earned Bachelor of Arts in Political Science from University of Ghana-Legon,Masters in International Affairs and Public Administration from Ohio University, and Ph.D. in PublicAdministration from Florida Atlantic University. James served as a Project Associate at the UN, IMF/Kelly, BSO, FAU PPRC, AMA, RI, SALVONET and Hillel at OU. James is currently unaffiliated and canbe reached at dzakey@hotmail.com

126 J.K. Agbodzakey