Many reasons account for international influence on public policymaking on health issues. These reasons can fall under the limitations or weaknesses of national policymaking processes or the necessity for international cooperation involving policy influences on national policy development. One rationale for the internationalisation of national health policymaking is that the traditional methods of national policymaking are insufficient to support an international policy agenda (Portman & Burzynski, 1996).
In many African countries, the machinery for policymaking is weak because of influencing factors such as political instability and severe government inefficiencies due to corruption. Inexperience in governance, especially for newly formed democratic governments or new administrations also results in poor policymaking performance. Due to poor policymaking, communities suffer lack of health services and worsening health conditions support international intervention in policymaking in the form of policy-based agreements and cooperation-based commitments monitored by international agencies and institutions.
(Gilbert & Gilbert, 2004) Another rationale for the international influence on national policymaking is limited national resources leading to limited resource allocation for health services. This creates dependence on some countries on international resources to support government programs. Often, available resources from the international community come in the form of policy-dependent aid or loans that identifies policy direction as a condition of the aid. The policy direction, which comes with the approval of aid or grants comprise international influence on national policymaking.
(Okuonzi & Macrae, 1995) There are opposing views on this context of international influence on policymaking. One view provides the rationality of incorporating policy direction with aid or grants to ensure accountability in terms of the consistency between the reason cited for seeking aid or loans and the programs on which the money and capital resources were allocated (Samoff, 2003). Another view provides that policy-based help from the international community prevent the development of the capability for national policymaking by creating perpetual dependence (Okuonzi & Macrae, 1995).
Both perspectives have merit based on the experiences of countries that are recipients of foreign aid or grants. Reconciling these views entails the recognition of the help that foreign aid provides in the short-term but the target in the long-term should be the strengthening of the policymaking mechanisms of national governments. A third rationale for international influence on national policymaking is to facilitate cooperative actions toward the achievement of common goals.
International cooperation emerged as a mechanism for collective guidance in policymaking on certain issues for a number of reasons. (Ogden et al. , 2003) One, the issues involved crosses national borders so that the solution to the problem requires cooperation. An example is HIV/AIDS. This makes up a health issue that crosses national borders because this condition is communicable and the impact is global. The primary reason for the spread of HIV across national borders is lack of information and limited health support.
Many people may not be aware that they have HIV and tests are not available or accessible for the immediate determination of people with HIV. Another, the issues covered by international cooperation transcend the respective political agendas of countries. This means that politics aside, no country can deny its responsibility to contribute to the resolution of the problems. In the example of HIV/AIDS, many if not all countries, industrialised and developing, have citizens living with HIV. (Gilbert & Gilbert, 2004)