Public policymaking is usually oriented towards action. The policies could create change in the processes of policymaking, the behaviour of the decision-makers, or change in the action of executors. (Kraft & Furlong, 2006) Development policies such as those on health result in action because of the necessity for change. Public policymaking is future oriented. This explains the general terms used in setting out policies. The future involves uncertainties so that guidelines developed today should provide best actions to achieve a desired future outcome and minimise uncertainty.
As such, policymaking employs information and methods that reflect an understanding of uncertainty and best practices to ensure expected results. (Kraft & Furlong, 2006) The government and its organs engage in public policymaking (Bardach, 2008). The policies serve as guidelines for execution by government departments so that policies on health guide actions and programs of the health and social welfare department. There is also a formal aim to achieve in public policymaking (Anderson, 2005).
All policies intend to guide the achievement of outcomes or results so that in health, the achievement of improvements in health condition or health services could be the target. Public policymaking considers public interest. The consideration or regard of policymakers of public interest determines the direction of policies. (Birkland, 2005) In health, policies reflect the understanding of policymakers of the problems faced by their constituency and the consideration of the best course of action. Policymaking seeks to identify the best available means of achieving outcomes.
After understanding needs or issues, identification of all options and consideration of all factors follows to determine the best means of addressing these issues. (Kingdon, 2002) This implies knowledge on options and skills in policy option selection of policymakers. Overall, policymaking links means and ends through a process involving the components mentioned. Understanding policymaking is important because this provides a basis for investigating the policymaking of governments, particularly South Africa, on the health issue of HIV/AIDS.
The elements of policymaking by the government sectors explain the factors involved in the development of policies on health issues and why certain policies emerge. The components of the policymaking process also provide the points of reference or tools in the analysis of the policies of South Africa addressing HIV/AIDS in relation to the millennium development goals. Policymaking on health is dependent on three streams that influence the agenda on health issues, which are the problem, politics and policy streams.
The problem stream involves the health issues that policymakers recognise and the prioritisation of the health problems. (Kingdon, 1995) Concurrently, in the context of limited resources, the health issues deemed of high priority would be the focus of policymaking (Pradilla et al. , 2007). In the specific health issue of HIV/AIDS, the level of recognition and priority of this problem determines the extent of policymaking on this issue. The politics stream involves the different interest groups forwarding their respective perspectives (Kingdon, 1995).
Interest groups could be non-government or private sector health advocacy groups, state partners, and members of the international community involved in providing foreign aid or hosting international cooperation commitments (Court & Maxwell, 2005). The machinery of these interest groups determines the extent of influence on health policymaking at the national level (Tenbensel, 2000). The policy stream involves the consideration of the health problems and interest groups to develop policies based on considerations such as feasibility, acceptability, and responsiveness (Kingdon, 1995).