Boundary workers and the management of frustration: a case study of two Healthy City partnerships.

Partnerships between local governments, health districts and non-governmental and community-based organiza-tions are an increasingly important part of health promotion practice, as well as other policy and programme areas. Two inherent tensions in partnership working have been widely described. First, partnerships are generally set up as 'top down' initiatives, which advocate a 'bottom up' approach, with the inevitable power imbalances that this implies. Secondly, the gains made by partnerships tend to be limited compared with the claims made for them. Despite these tensions, individuals and organizations continue to devote considerable effort to making partnerships 'work'. This paper describes a study, which explored the implications of these apparent contradictions of power imbalance and potential disillusionment within partnerships. The study explored partnership working between community and statutory organizations within two very different Healthy Cities initiatives, one in the UK and the other in South Africa. This paper focuses on why the partners contributed continued effort and energy into maintaining the partnerships, despite their awareness of the constraints. Findings suggest that partners dealt with the tensions first by assuming a discrete identity as an 'entity of boundary people' that operates at the interface between the statutory sector authorities and the communities in question; and secondly, by reducing their activities to specific 'boundary' issues that do not threaten the main agenda of the authorities.