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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 ...

AIM : There are currently debates about why South Africa integrates global health into its foreign policy agendas. This study aimed at exploring motivation and interests' South African policy actors pursue to advance global health and the processes that lead to such integration. METHODS : The study utilized a mixed-method design from a sample of state policy actors at the National Department of Health of South Africa. Participants were selected purposively and had experience of more than three years participating in various international health activities. All participants completed semi-structured questionnaires. Quantitative data was analysed to determine frequencies and transcribed text was analyzed using qualitative content analysis. RESULTS : A total of 40 people were invited, of whom 35 agreed to participate. Of the respondents, 89.7% (n=32) strongly argued that health should facilitate 'free movement of people, goods and services'. Majority (79.0%, n= 29) agreed that 'development and equality' are the main elements of foreign policy. Of the respondents, majority 77.1% (n=27) agreed that 'moral and human rights' are the main elements of foreign policy. Furthermore, 82.8% (n=29) agreed that the country should advance 'Africa regionalism and south-south cooperation' and 85.7% (n=30) strongly argued for a 'whole-government approach' in addressing global health challenges. 'HIV/AIDS' and 'access to medicines agenda' were the main policy issues advanced. The main domestic factors shaping South Africa's involvement in global health were its 'political leadership' and 'capacity of negotiators'. CONCLUSION : It is evident that within South Africa, state policy actors are largely concerned with promoting global health interest as a normative value and a goal of foreign policy, namely, human dignity and development cooperation. Furthermore, South Africa drives its global health through building coalition with other state and non-state actors such as civil society. HIV/AIDS, as a policy issue, presents a potential ...

BACKGROUND : The need to retain health personnel is a policy challenge undermining health system reform of the 21st century. The need to resolve this global health workforce crisis resulted in the First Global Forum on Human Resources for Health in 2008 from which the Kampala Declaration and Agenda for Global Action was formulated. However, whilst there have been several studies exploring the retention of health personnel towards this end, available literature does not provide a detailed narrative on strategies used in peri-urban communities. The aim of this study was to explore retention strategies implemented in a Zimbabwean peri-urban community between 2009 and 2014 and implications for peri-urban communities towards the health system reform agenda. METHODS : The study was carried out in Epworth, a peri-urban community in Harare, Zimbabwe. The research design was a cross-sectional survey, in which qualitative methods were used in sampling, data collection, reporting and analysis. Qualitative tools were used to collect data through in-depth interviews with purposively selected health personnel managers at 10 local clinics and sample interviews with purposively selected healthcare workers who included registered general nurses, state-certified nurses, midwives, environmental health technicians, nurse aids and community health volunteers at each clinic. Two focus group discussions were carried out with community health volunteers. Qualitative data was subjected to thematic analysis, with coding being performed manually. RESULTS : A programme-specific strategic partnership between the government and donor community contributed towards the mobilisation of more health personnel, health facilities, worker development and remuneration. To complement this, the Ministry of Health intervened through the review and payment of salaries, support towards post-basic training and development, and protection. The local board, mission and donors contributed through the payment of top-up allowances and provision of non-monetary ...

BACKGROUND : The indigenous health care system continues in the postcolonial era to be perceived by antagonists as a threat to Western medicine. It has been associated with 'witchcraft', actively discouraged and repressed through official government prohibition laws. Despite that, human immunodeficiency virus and acquired immunodeficiency syndrome (HIV and AIDS) patients consult both allopathic and indigenous health practitioners. AIM : The study explored a collaboration model between allopathic and traditional health practitioners in the management of patients living with HIV and AIDS in postcolonial South Africa. SETTING : We conducted six combined focus group discussions and four separate group discussions with each category of co-researchers. Methods: Combined and separate focus group discussions were conducted with community members, allopathic and indigenous health practitioners, applying the cyclical method in the decolonisation process. Their perceptions and experiences in the management of HIV and AIDS patients were explored, and finally decolonisation strategies suitable for collaboration in their context were identified. RESULTS : The two health systems were rendering services to the same HIV and AIDS communities. Lack of communication created confusion. Collaboration was long overdue. A change in mindsets, attitudes and practices among practitioners was critical, with an acknowledgement that 'neither health system is better than the other, but the two should be complementary, recognising that the culture and beliefs of patients influence their health-seeking behaviour'. CONCLUSION : Co-researchers were committed to working together in the fight against HIV and AIDS infections. Their model for collaboration addresses the challenges of patients' secrecy, treatment overdose and the abandonment of antiretroviral treatment. Through the application of a decolonisation process, their mindsets, attitudes and practices towards each other were changed, enabling the joint development of a custom model for ...

The transfer of authority and responsibility for some public functions from one level of government, especially national government, to a second sphere (provincial) or a third sphere (local governments) has been adopted by many countries with the understanding that such health system decentralisation can help to address political, managerial and operational issues in terms of systemic efficiency and cost-effectiveness. While South Africa's health system is already structured with a certain degree of decentralisation, the implementation of National Health Insurance (National Health Insurance) and the proposed creation of District Health Authorities as outlined in the Green Paper on NHI, implies that the country will now have to undertake several further steps in decentralising its health system. If poorly designed or ineffectively implemented , decentralisation can exacerbate existing inequalities and inefficiencies and create new challenges and problems. This chapter explores several possibilities for the implementation of a coherent decentralisation system which addresses the health needs of the population. The authors also provide an extensive overview of the various forms and decentralisation and then offer some lessons, caveats and important issues that must be taken into account in the country's journey to further decentralisation. The potential role of the National Department of Health in a new decentralised system is considered, and several criteria to guide and stagger the decentralisation process are offered. The authors conclude that while decentralisation is not without its disadvantages, decentralisation of health care services in South Africa can make a phenomenal impact on the quality and access to much-needed health services for the most vulnerable populations, particularly women and children and further note that ongoing monitoring and evaluation against set targets will be needed in order to achieve successful implementation of the envisaged NHI-funded health system. ...