Towards understanding the drivers of policy change: a case study of infection control policies for multi-drug resistant tuberculosis in South Africa
| dc.contributor.author | Saidi, Trust | |
| dc.contributor.author | Salie, Faatiema | |
| dc.contributor.author | Douglas, Tania S | |
| dc.date.accessioned | 2017-06-13T09:29:22Z | |
| dc.date.available | 2017-06-13T09:29:22Z | |
| dc.date.issued | 2017-05-30 | |
| dc.date.updated | 2017-06-04T03:38:13Z | |
| dc.description.abstract | 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. | |
| dc.identifier.apacitation | Saidi, 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>, http://hdl.handle.net/11427/24573 | en_ZA |
| dc.identifier.chicagocitation | Saidi, 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> (2017) http://hdl.handle.net/11427/24573 | en_ZA |
| dc.identifier.citation | Saidi, 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. Health Research Policy and Systems, 15(1), 41. | |
| 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 - 2017-05-30 DB - OpenUCT DO - 10.1186/s12961-017-0203-y DP - University of Cape Town J1 - Health Research Policy and Systems LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 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/11427/24573 ER - | en_ZA |
| dc.identifier.uri | http://dx.doi.org/10.1186/s12961-017-0203-y | |
| dc.identifier.uri | http://hdl.handle.net/11427/24573 | |
| dc.identifier.vancouvercitation | Saidi 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; http://hdl.handle.net/11427/24573. | en_ZA |
| dc.language.iso | en | |
| dc.publisher | BioMed Central | |
| dc.publisher.department | Department of Human Biology | en_ZA |
| dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| dc.rights.holder | The Author(s). | |
| dc.source | Health Research Policy and Systems | |
| dc.source.uri | http://www.springer.com/public+health/journal/12961 | |
| dc.subject.other | Multi-drug resistant tuberculosis | |
| dc.subject.other | Policy changes | |
| dc.subject.other | Infection control | |
| dc.subject.other | Policy streams | |
| dc.title | Towards understanding the drivers of policy change: a case study of infection control policies for multi-drug resistant tuberculosis in South Africa | |
| dc.type | Journal Article | |
| uct.type.filetype | Text | |
| uct.type.filetype | Image | |
| uct.type.publication | Research | en_ZA |
| uct.type.resource | Article | en_ZA |