Towards understanding the drivers of policy change: a case study of infection control policies for multi-drug resistant tuberculosis in South Africa

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dc.contributor.authorSaidi, Trust
dc.contributor.authorSalie, Faatiema
dc.contributor.authorDouglas, Tania S
dc.date.accessioned2021-10-08T07:04:12Z
dc.date.available2021-10-08T07:04:12Z
dc.date.issued2017
dc.description.abstractBACKGROUND: Explaining policy change is one of the central tasks of contemporary policy analysis. In this article, we examine the changes in infection control policies for multi-drug resistant tuberculosis (MDR-TB) in South Africa from the time the country made the transition to democracy in 1994, until 2015. We focus on MDR-TB infection control and refer to decentralised management as a form of infection control. Using Kingdon's theoretical framework of policy streams, we explore the temporal ordering of policy framework changes. We also consider the role of research in motivating policy changes. METHODS: Policy documents addressing MDR-TB in South Africa over the period 1994 to 2014 were extracted. Literature on MDR-TB infection control in South Africa was extracted from PubMed using key search terms. The documents were analysed to identify the changes that occurred and the factors driving them. RESULTS: During the period under study, five different policy frameworks were implemented. The policies were meant to address the overwhelming challenge of MDR-TB in South Africa, contextualised by high prevalence of HIV infection, that threatened to undermine public health programmes and the success of antiretroviral therapy rollouts. Policy changes in MDR-TB infection control were supported by research evidence and driven by the high incidence and complexity of the disease, increasing levels of dissatisfaction among patients, challenges of physical, human and financial resources in public hospitals, and the ideologies of the political leadership. Activists and people living with HIV played an important role in highlighting the importance of MDR-TB as well as exerting pressure on policymakers, while the mass media drew public attention to infection control as both a cause of and a solution to MDR-TB. CONCLUSION: The critical factors for policy change for infection control of MDR-TB in South Africa were rooted in the socioeconomic and political environment, were supported by extensive research, and can be framed using Kingdon's policy streams approach as an interplay of the problem of the disease, political forces that prevailed and alternative proposals.
dc.identifier.apacitationSaidi, T., Salie, F., & Douglas, T. S. (2017). Towards understanding the drivers of policy change: a case study of infection control policies for multi-drug resistant tuberculosis in South Africa. <i>Health Research Policy and Systems</i>, 15(1), 174 - 177. http://hdl.handle.net/11427/34453en_ZA
dc.identifier.chicagocitationSaidi, Trust, Faatiema Salie, and Tania S Douglas "Towards understanding the drivers of policy change: a case study of infection control policies for multi-drug resistant tuberculosis in South Africa." <i>Health Research Policy and Systems</i> 15, 1. (2017): 174 - 177. http://hdl.handle.net/11427/34453en_ZA
dc.identifier.citationSaidi, T., Salie, F. & Douglas, T.S. 2017. Towards understanding the drivers of policy change: a case study of infection control policies for multi-drug resistant tuberculosis in South Africa. <i>Health Research Policy and Systems.</i> 15(1):174 - 177. http://hdl.handle.net/11427/34453en_ZA
dc.identifier.issn1478-4505
dc.identifier.ris TY - Journal Article AU - Saidi, Trust AU - Salie, Faatiema AU - Douglas, Tania S AB - BACKGROUND: Explaining policy change is one of the central tasks of contemporary policy analysis. In this article, we examine the changes in infection control policies for multi-drug resistant tuberculosis (MDR-TB) in South Africa from the time the country made the transition to democracy in 1994, until 2015. We focus on MDR-TB infection control and refer to decentralised management as a form of infection control. Using Kingdon's theoretical framework of policy streams, we explore the temporal ordering of policy framework changes. We also consider the role of research in motivating policy changes. METHODS: Policy documents addressing MDR-TB in South Africa over the period 1994 to 2014 were extracted. Literature on MDR-TB infection control in South Africa was extracted from PubMed using key search terms. The documents were analysed to identify the changes that occurred and the factors driving them. RESULTS: During the period under study, five different policy frameworks were implemented. The policies were meant to address the overwhelming challenge of MDR-TB in South Africa, contextualised by high prevalence of HIV infection, that threatened to undermine public health programmes and the success of antiretroviral therapy rollouts. Policy changes in MDR-TB infection control were supported by research evidence and driven by the high incidence and complexity of the disease, increasing levels of dissatisfaction among patients, challenges of physical, human and financial resources in public hospitals, and the ideologies of the political leadership. Activists and people living with HIV played an important role in highlighting the importance of MDR-TB as well as exerting pressure on policymakers, while the mass media drew public attention to infection control as both a cause of and a solution to MDR-TB. CONCLUSION: The critical factors for policy change for infection control of MDR-TB in South Africa were rooted in the socioeconomic and political environment, were supported by extensive research, and can be framed using Kingdon's policy streams approach as an interplay of the problem of the disease, political forces that prevailed and alternative proposals. DA - 2017 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - Health Research Policy and Systems LK - https://open.uct.ac.za PY - 2017 SM - 1478-4505 T1 - Towards understanding the drivers of policy change: a case study of infection control policies for multi-drug resistant tuberculosis in South Africa TI - Towards understanding the drivers of policy change: a case study of infection control policies for multi-drug resistant tuberculosis in South Africa UR - http://hdl.handle.net/11427/34453 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34453
dc.identifier.vancouvercitationSaidi T, Salie F, Douglas TS. Towards understanding the drivers of policy change: a case study of infection control policies for multi-drug resistant tuberculosis in South Africa. Health Research Policy and Systems. 2017;15(1):174 - 177. http://hdl.handle.net/11427/34453.en_ZA
dc.publisher.departmentDepartment of Human Biology
dc.publisher.facultyFaculty of Health Sciences
dc.sourceHealth Research Policy and Systems
dc.source.journalissue1
dc.source.journalvolume15
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12961-017-0203-y
dc.subject.otherInfection control
dc.subject.otherMulti-drug resistant tuberculosis
dc.subject.otherPolicy changes
dc.subject.otherPolicy streams
dc.subject.otherAntitubercular Agents
dc.subject.otherHIV Infections
dc.subject.otherHealth Policy
dc.subject.otherHumans
dc.subject.otherInfection Control
dc.subject.otherPrevalence
dc.subject.otherSouth Africa
dc.subject.otherTuberculosis, Multidrug-Resistant
dc.subject.otherAntitubercular Agents
dc.titleTowards understanding the drivers of policy change: a case study of infection control policies for multi-drug resistant tuberculosis in South Africa
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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