CHALLENGES FACED BY THE HIV HEALTH-SERVICES PLANNING COUNCIL IN OAKLAND, CALIFORNIA, 1991-1994

This study reports the findings of a case study of the health services planning council established in the Oakland, California, eligible met ropolitan area (the Oakland EMA) under Title I of the Ryan White Compr ehensive AIDS Resources Emergency Act of 1990 (the CARE Act). We gathe red primary data through observation of planning council meetings, exa mination of documentary evidence, and in-depth interviews with key par ticipants. An important finding of this study was the inconsistency ob served between the rational, linear planning model embedded in the CAR E Act legislation and the politicized, emergent, and, at times, chaoti c planning process actually observed in the Oakland EMA. The primary r easons for this inconsistency included confusion among council members about the planning council's responsibilities and authority, as well as its relationship with the local health department; limitations on a dministrative support at the local level; reluctance of program admini strators at the federal level to provide advice concerning development of the council; allegations of conflict of interest among members of the council; pre-existing societal tensions and divisions; concerns ab out the representativeness of the council's membership; competition am ong providers of services for funding; conflicting demands for service s by persons affected by HIV disease; disagreements between the counci l and providers of services over policies and procedures for administe ring the services contracts; and concerns about the council's involvem ent in the selection of specific agencies for funding, its lapses in c ompliance with rules of order, and its failure to accurately record mi nutes of all of its meetings. Despite the challenges faced by the Oakl and planning council, it was able to meet its Title I obligations, whi ch resulted in significant increases in the availability of medical an d social services for persons affected by HIV disease. However, dealin g with the confusion and conflicts described above consumed a consider able amount of the planning council's time and energy and eventually r equired a complete reorganization of the council to assure its stabili ty and the legitimacy of the Title I program at the local level. Medic al Subject Headings (MeSH): health planning councils; health planning organizations; health care coalitions; organization and administration ; organizational innovation; models, organizational.