Area of policymaking

The third reason make-up the platform for many cooperative agreements that influence policymaking on health at the national level. This is also a good way of encouraging state governments to adopt willingly international agenda for cooperation into their national policies (Ogden et al. , 2003). In the interest of collective development, the millennium development goals, which comprise the focus of the present study, emerged as the outcome of international cooperation with influence on national policymaking.

Relative to health, the millennium development created the opportunity for the promotion and incorporation of health priorities into national development policies (WHO, 2009b). These goals, which specified combating HIV/AIDS as a priority, pose a challenge to national governments to take these goals and convert these into policies that would build institutional competencies in implementing these policies.

The goal on combating HIV/AIDS challenges national governments to make this goal the outcome of policies on health. The millennium development goals emerged from the common problems experienced by countries so that the influence of these goals on the development national health policies such as on HIV/AIDS strengthens the effectiveness and functioning of health systems and achievement of the intended outcomes at the national and international level.

With international influence on national policymaking by encouraging the national integration of common goals and strengthening efforts in developing policymaking mechanisms at the national level, policy analysis becomes an important tool in evaluating the effect of international influence on national policymaking in the health sector and the impact of policies in achieving the goals for international cooperation. 2. 5 Health Policy Analysis

Health policy analysis constitutes a multi-disciplinary model of public policy addressing the derivation of explanations of the interaction of ideas, institutions and interest groups in the process of making policies. Health policy analysis has a dual purpose. One is retrospection by evaluating past or existing policies to consider policymaking and outcomes. The other is prospect development by drawing insights on successes and failures in policymaking and incorporating these insights into the development of policies in the future.

(McLaughlin & McLaughlin, 2008) This approach also offers a wide range of function areas. This could provide a model for assessing national policymaking, international policymaking, international influence on national policymaking, and international impact of national policymaking. Due to its wide application, health policy analysis utilises a number of measures or points of reference for the analysis. Three general frameworks apply to health policy analysis. First framework is stages heuristic (Lasswell, 1956).

This directs policy analysis by breaking down public policymaking into four stages, which are 1) agenda determination, 2) formulation, 3) implementation, and 4) evaluation. Agenda determination involves the sorting of issues when the range of problems faced by the nation catch the attention of decision makers. Understanding of issues and prioritisation are important in this stage. The formulation stage involves the design and formalisation of policies. The selection from various policy options forms part of this stage.

The implementation phase moves towards government action of the strategies designed to fulfil the policies. The evaluation stage covers the assessment of the impact of the policies. While the framework provides a process on which to evaluate the policymaking of governments, this received criticism for assuming linearity of the policymaking process and clear lines separating the different stages, when in practice, policymaking could be cyclical or repetitive and the different stages overlap (Sabatier, 2007).

Second framework is the policy triangle (Walt & Gilson, 1994), which applies particularly to health policy analysis. This emerged from the political economy approach and considers the four elements—object of the policy, actors, context and processes—that interact during policymaking. These four elements comprise the focus of the assessment in terms of the importance to the process and the specific contribution to policymaking.

This has a diverse application in health policymaking such as tuberculosis, antenatal syphilis, mental health, and health management reforms (Gilson & Raphaely, 2007). This could apply to the health policy analysis of South Africa, particularly on the issue of HIV/AIDS. Third model is network frameworks (Thatcher, 1998), which works by describing interactive systems and inter-linkages among various actors. The assumption of this framework is the existence of networks of inter-linkages, whether closely knit or loose, that support the engagement of the actors involved in collective action.

In application to policy analysis, networks refer to groups of actors holding interests in an area of policymaking and carry the ability to influence the success or downfall of policies (Marsh, 1998). The strength of the network determines the influence on policymaking and the influence of various policy groups reflecting greater representation in policymaking. This framework captures the concept of shared decision-making and utilises this to assess health policymaking (Rhodes, 1992). There are many specific factors for consideration in health policy analysis.

Some of these factors also coincide with the components in recognising health policies. These factors include the types and scope of health services delivered with the guidance of health policies, resource allocation to support the implementation of policies, collection of information to support decisions, and interaction of interest groups and institutional actors. (WHO, 2009a) A specific area of focus in policy analysis is priority setting (Tenbensel, 2000) by considering the bases of prioritisation, the process of selection, and the impact of the selected area of policymaking.