1. Dealing with the impact of HIV & AIDS on their own workforce
HIV & AIDS is affecting not only beneficiaries of partner organisations, but also their own staff. A lot of partner organisations face growing direct organisational costs for sick and compassionate leave, medical expenses, funeral expenses and management time. At the same time, work performance is inhibited by emotional stress, stigma and sickness; and knowledge, learning and experience are lost when staff members stop working or pass away. These challenges are driving organisations to strengthen such responses as HIV & AIDS workplace programmes, the training of additional staff, adjustments to medical care packages or the addressing of stigma and denial within their own institutional set-up and in its core businesses. At the same time, the nature of and opportunity for capacity building comes into question.

The functioning of the back office is not only challenged directly by an impact on the workforce. HIV & AIDS is also changing the scale and way of working of these partner organisations, requiring organisational change and development of the back office.

2. Ensuring that front- and back-office operations are synchronised and mutually supportive
Many rapidly expanding HIV & AIDS organisations struggle to keep their houses in order and ensure that front- and backoffice operations are synchronised and mutually supportive. As a result of the growing need for their services, many HIV & AIDS organisations experienced rapid growth in terms of their service delivery, number of staff and the funds that need to be managed. These organisations need to strengthen their finance and administration systems to keep up with the workload and the size of the organisation. The expansion of services is not sustainable if there is not a strong supporting back office.

3. Positioning and innovating
The constant pressure to deliver and expand services also brings challenges with regard to the strategic positioning of HIV & AIDS organisations. These organisations are confronted with needs and expectations beyond their capacity and capability; they are occupied with 'doing' and they struggle to find time and capacity for strategic planning, monitoring and evaluation, reflection and learning and for acting on these. Yet the capacity to position oneself strategically and to keep innovating are crucial elements if an organisation is to be strong and able to respond effectively to the pandemic. Organisations need to strengthen their capacity to face their limitations, to find their niche, to focus on certain aspects, to decide what can be done better by other organisations, to keep in phase with the pandemic and to proactively position themselves. They must develop good systems for reflection, learning, and planning to support these strategic decisions.

4. Developing, expanding, improving and/or adapting front-office services
HIV & AIDS organisations face challenges in improving, expanding and adapting their front-office services to changing and growing needs as a result of the pandemic and this is closely linked to the above-mentioned 'positioning and innovating' and 'going to scale' capacities of the back office. HIV & AIDS organisations need technical support in developing new or better services, and in developing models that have a built-in multiplier mechanism.

5. Going to scale
The impact of organisations on the pandemic depends both on the quality of interventions (and their effectiveness) and on their coverage. The challenge to organisations is to find ways to replicate models of good practice at the lowest possible cost. This can include expanding their operations, developing new models of good practice and creating multiplier mechanisms; these include sharing models of good practice (which are then adopted by other NGOs and/or by government), horizontal learning, twinning, introducing cascade models, setting up networks and influencing changes in the policies and actions of governments and donors. For 'going to scale' to be effective, it needs to be backed up by a lot of organisational and institutional capacities mentioned under points 2 and 3 above: for example a solid administrative and management system, a clear vision on the role of the organisation and the way going to scale fits in that strategy and a system for learning.