Understanding how domestic health policy is integrated into foreign policy in South Africa: a case for accelerating access to antiretroviral medicines

ABSTRACT

Background: South Africa, as an emerging middle-income country, is becoming increasingly influential in global health diplomacy (GHD). However, little empirical research has been conducted to inform arguments for the integration of domestic health into foreign policy by state and non-state actors. This study seeks to address this knowledge gap. It takes the form of an empirical case study which analyses how South Africa integrates domestic health into its foreign policy, using the lens of access to antiretroviral (ARV) medicines.

Objective: To explore state and non-state actors’ perceptions regarding how domestic health policy is integrated into foreign policy. The ultimate goal of this study was to achieve better insights into the health and foreign policy processes at the national level.

Methods: Employing qualitative approaches, we examined changes in the South African and global AIDS policy environment. Purposive sampling was used to select key informants, a sample of state and non-state actors who participated in in-depth interviews. Secondary data were collected through a systematic literature review of documents retrieved from five electronic databases, including review of key policy documents. Qualitative data were analysed for content. This content was coded, and the codes were collated into tentative categories and sub-categories using Atlas.ti v.7 software.

Results: The findings of this work illustrate the interplay among social, political, economic and institutional conditions in determining the success of this integration process. Our study shows that a series of national and external developments, stakeholders, and advocacy efforts and collaboration created these integrative processes. South Africa’s domestic HIV/AIDS constituencies, in partnership with the global advocacy movement, catalysed the mobilization of support for universal access to ARV treatment nationally and globally, and the promotion of access to healthcare as a human right.

Conclusions: Transnational networks may influence government’s decision making by providing information and moving issues up the agenda.

KEYWORDS:

• Global health
• global health diplomacy
• policy analysis
• South Africa
• HIV/AIDS

Responsible Editor Siddhivinayak Hirve, World Health Organization, Sweden

Responsible Editor Siddhivinayak Hirve, World Health Organization, Sweden

Acknowledgments

The authors thank all the interviewees for their participation in the study, and the experts who helped to refine the manuscript. We are also grateful to the University of Pretoria for their contribution towards the wider PhD study from which this paper was drawn.

Disclosure statement

This manuscript is part of the PhD study of the first author. The views expressed in this study are those of the authors and not of the funder. The authors declare no conflict of interest.

Ethics and consent

Ethics approval was obtained from the University of Pretoria. I hereby consent to publication. Data and materials supporting the conclusions of this article can be found by contacting [email protected]

Paper context

Little empirical research has been conducted to inform arguments for the integration of global health into foreign policy by state and non-state actors. This study seeks to address this knowledge gap regarding developing an understanding of how global health is integrated into foreign policy in South Africa, using the lens of access to antiretroviral medicines. We demonstrate that South Africa has been able to move towards ‘transgovernmentalism’ and ‘denationalization’, whereby health ministries lose their authority to other sectors and non-state actors. We argue that global health diplomacy scholars may want to consider whether their analytical foci and bedrock assumptions should be amended to reflect twenty-first-century developments such as the transnationalization of health governance.

Additional information

Funding

The research leading to these results has received funding from the University of Pretoria.

Notes on contributors

Simon Moeketsi Modisenyane

All three authors conceived and designed the study and analysed and interpreted the data. SMM drafted the paper and accepted accountability for all aspects of the work. SJHH supervised fieldwork and HF edited the paper. Both SJHH and HF approved the final version of the paper.