We present a longitudinal case study of lay women's participation in a project seeking to facilitate home-based care of people dying of AIDS in a rural community in South Africa, drawing on four sets of interviews conducted with volunteers over a five-year period. We link participation in the project to three dimensions of women's agency: their knowledge and skills, their confidence; and their personal experiences of efficacy. We show that whilst the experience of participation enhanced each of these dimensions of volunteers’ agency at various stages of the project, the empowerment that did take place appeared to be limited to women's project-related roles, rather than generalising to other areas of their lives beyond the project. The project had limited impact on women's ability to negotiate condom use with husbands, to assert themselves in relation to male project leaders and to become more involved in wider community decision-making and leadership. We discuss three possible interpretations of our findings: (i) that greater empowerment might have occurred had the project run for a longer time period; (ii) that whilst such projects play a vital role in providing services, the more general ‘empowerment via participation’ agenda is a false promise in highly marginalised communities; or (iii) that whilst generalised positive impacts of such projects on volunteers are hard to track, such projects do open up glimpses of increased agency for many women. These might have positive but unpredictable results in ways that defy formulation in linear conceptualisations of social transformation and development, understood in terms of clearly observable and measurable inputs and outputs.
Journal of Health Management (2009) 11 (2) 315-336 [DOI: 10.1177/097206340901100204]