Preprint Review Version 1 This version is not peer-reviewed

Emergence of Universal Antiretroviral Therapy Coverage in South Africa: Applying the Advocacy Coalition Framework to Refine the Narratives and Inform Current Policy Making Processes

Version 1 : Received: 29 February 2020 / Approved: 4 March 2020 / Online: 4 March 2020 (10:59:44 CET)

How to cite: Momo Kadia, B.; Akem Dimala, C.; Pene Njefi, K. Emergence of Universal Antiretroviral Therapy Coverage in South Africa: Applying the Advocacy Coalition Framework to Refine the Narratives and Inform Current Policy Making Processes. Preprints 2020, 2020030064 (doi: 10.20944/preprints202003.0064.v1). Momo Kadia, B.; Akem Dimala, C.; Pene Njefi, K. Emergence of Universal Antiretroviral Therapy Coverage in South Africa: Applying the Advocacy Coalition Framework to Refine the Narratives and Inform Current Policy Making Processes. Preprints 2020, 2020030064 (doi: 10.20944/preprints202003.0064.v1).

Abstract

South Africa possesses the largest anti-retroviral therapy (ART) program in the world but the path to this record was dramatic. There is scarce literature employing a comprehensive framework to explain this ART policy change and inform current policy making processes. This paper applies the Advocacy Coalition Framework (ACF) to analyse the interactions among diverse actors, institutions and networks that were associated with the ART policy change in South Africa. Post-apartheid, HIV/AIDS and AIDS-related mortality were serious public health problems. At the time, the discernible coalitions in the AIDS policy subsystem were the prescience coalition and AIDS dissidents. In view of the availability of compelling scientific evidence on the pathogenesis of HIV/AIDS, the clinical usefulness of ART, the availability of funding for national ART roll-out, strong global advocacy to reduce the cost of ART, all of these in an era when access to adequate HIV care was increasingly considered a human right, the environment to establish an appropriate ART policy for the country was conducive. However, AIDS dissidents dominated the policy agenda via their control over key institutions, the use of various dimensions of power, biasing evidence to inform policy, and promoting the activities of strong interest groups that were not in support of ART. National ART roll-out ultimately emerged as a political priority as a result of external shocks (on the ART policy subsystem) which disfavoured the dominant coalition. Failure to supplement this application of the ACF with key pubic policy concepts such as power dimensions, evidence use in policy, governance and emergence of global health networks would have led to suboptimal appraisal of the ART policy change and misinformation of current policy making processes.

Subject Areas

advocacy coalition; policy; antiretroviral therapy; emergence; South Africa

Comments (0)

We encourage comments and feedback from a broad range of readers. See criteria for comments and our diversity statement.

Leave a public comment
Send a private comment to the author(s)
Views 0
Downloads 0
Comments 0
Metrics 0


×
Alerts
Notify me about updates to this article or when a peer-reviewed version is published.