From integrity to impact: Strengthening governance in HIV/AIDS NGOS through transparency and accountability

BACKGROUND: Weak governance in HIV/AIDS non-governmental organisations (NGOs) can undermine service delivery, erode donor confidence, and weaken community trust. Transparency and accountability are promoted as safeguards of integrity, yet their implementation often exposes tensions between donor oversight, organisational realities, and community expectations. AIM: This study examines how governance practices shape legitimacy and service delivery effectiveness in HIV/ AIDS NGOs in Gauteng Province, South Africa. METHODS: A qualitative design was employed, drawing on insights from NGO leaders engaged in donor relations and accountability processes. Twenty-eight purposively selected leaders from five HIV/AIDS NGOs participated in in-depth interviews. Data were thematically analysed to identify governance practices, accountability process contradictions, and perceived impacts on legitimacy and service delivery. RESULTS: Three themes emerged. First, negotiating donor demands and organisational realities: transparency mechanisms reassured funders but imposed administrative burdens that diverted staff time from service delivery. Second, community trust as contested legitimacy: participatory mechanisms such as social audits and monitoring committees were valued but often constrained by local hierarchies and resource limitations, risking symbolic rather than substantive accountability. Third, integrity in service delivery under pressure: ethical safeguards such as transparent procurement and confidentiality protections strengthened program reliability, but their absence led to resource misallocation and weakened trust. Across themes, participants highlighted contradictions between symbolic compliance and substantive accountability, as well as between donor oversight and community expectations. CONCLUSIONS: Transparency alone is insufficient to sustain legitimacy. Governance reforms are most effective when transparency, accountability, and integrity systems operate as interconnected components. Strengthening both donor oversight and community-based participatory mechanisms is essential to reinforcing trust, safeguarding resources, and ensuring equitable HIV/AIDS service delivery.