The consideration of the three streams influencing policymaking on health issues has important contributions to the development of the framework for the study. One is the role of interest groups in policymaking (Tenbensel, 2000), especially the international community such as the development of the millennium development goals to encourage national policymaking on health to address the health targets identified such as combating HIV/AIDS.
Another is the political context of health policymaking since the policies on health largely depends on the perception of decision-makers and prioritisation of problems (Collins, 1999). The development of policies and impact of policies on health issues such as HIV/AIDS strongly depends on the perception of the government on this issue. The interaction of the three streams creates change depending on the nature and impact of the interaction. Another perspective on public policymaking over health issues is the existence of various influences in making policies.
One influencing factor comprises ideas, which encompass norms, values and research (Daniels & Lewin, 2008). In health care, ideas reflect the understanding of the health problem such as HIV/AIDS, including its causes, alternative treatment, and government support in addressing the health problem. Another influencing factor encompasses interests, similar to the interest groups under the politics stream (Kingdon, 1995), forwarded by actors holding interests in policy development because of the likely benefit or harm of resulting policies.
Last influencing factor is the events or occurrences in government or the political government that influences health policymaking. A change in government could change health policy priorities and expand or close opportunities for policy changes. (Lavis et al. , 2002) The influence perspective coincides with the three-stream model. Similarly, the three influences also inform the research on the factors influencing public policymaking on health and the relative strength of influence on policymaking.
These factors also comprise points of reference in assessing the effectiveness of health policies in capturing the realities of health problems and priority health targets. In the case of HIV/AIDS as a health policy issue, the influences could also explain the selection of particular policies by national governments. Health policies have the tendency to change over time. This is inevitable because of changes in the health situation or issues of countries and the factors influencing health policymaking.
Multiple pressures change policies (WHO, 2009a) leading to continuous policymaking even for a single health issues such as HIV/AIDS. The condition and state of governance creates pressures on health policymaking. In the consideration of different countries with various political situations, long-term crisis and co-occurring factors hamper effective policymaking (WHO, 2009a). Political instability adversely affects effective health policies and health policymaking. A reason is that change in administration leading to the removal and change of top leadership including department heads could cripple policymaking.
Uncertainty in governance is a disincentive for the pursuit of long-term initiatives through policymaking. (Singh et al. , 2007) Instability also weakens communication networks and information flows resulting to ineffective policies or lack of policies (Ghobarah et al. , 2004). In unstable political conditions, policymaking on health would always have political undertones, making the politic stream of stronger influence on policy development (Zwi, 2004). Enforcement of accountability and transparency in policymaking also suffers (Ellman et al. , 2005).