Abstract
Global health organizations frequently set disease-specific targets with the goal of eliciting adoption at the national-level; consideration of the influence of target setting on national policies, programme and health budgets is of benefit to those setting targets and those intended to respond. In 2014, the Joint United Nations Programme on HIV/AIDS set ‘ambitious’ treatment targets for country adoption: 90% of HIV-positive persons should know their status; 90% of those on treatment; 90% of those achieving viral suppression. Using case studies from Ghana and Uganda, we explore how the target and its associated policy content have been adopted at the national level. That is whether adoption is in rhetoric only or supported by programme, policy or budgetary changes. We review 23 (14 from Ghana, 9 from Uganda) national policy, operational and strategic documents for the HIV response and assess commitments to ‘90–90–90’. In-person semi-structured interviews were conducted with purposively sampled key informants (17 in Ghana, 20 in Uganda) involved in programme-planning and resource allocation within HIV to gain insight into factors facilitating adoption of 90–90–90. Interviews were transcribed and analysed thematically, inductively and deductively, guided by pre-existing policy theories, including Dolowitz and Marsh’s policy transfer framework to describe features of the transfer and the Global Health Advocacy and Policy Project framework to explain observations. Regardless of notable resource constraints, transfer of the 90–90–90 targets was evident beyond rhetoric with substantial shifts in policy and programme activities. In both countries, there was evidence of attempts to minimize resource constraints by seeking programme efficiencies, prioritization of programme activities and devising domestic financing mechanisms; however, significant resource gaps persist. An effective health network, comprised of global and local actors, mediated the adoption and adaptation, facilitating a shift in the HIV programme from ‘business as usual’ to approaches targeting geographies and populations.
Highlights
The establishment of global health targets, intended for adoption at the national level, seeks to focus the attention of funders, implementers and national-level policy-makers
In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set the ‘90– 90–90’ targets that operationalize what countries need to do, and what programme coverage targets need to be attained at certain time points, to achieve the policy goal of ending the AIDS epidemic by 2030, as advocated for in the Sustainable Development Goals (SDGs) (UNAIDS 2014; Stover et al 2016) (Box 1)
Many key informants in Uganda commented on the alignment of the latest National Strategic Plan (NSP) to 90–90–90; the targets were only mentioned once on page 64
Summary
The establishment of global health targets, intended for adoption at the national level, seeks to focus the attention of funders, implementers and national-level policy-makers. In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set the ‘90– 90–90’ targets that operationalize what countries need to do, and what programme coverage targets need to be attained at certain time points, to achieve the policy goal of ending the AIDS epidemic by 2030, as advocated for in the SDGs (UNAIDS 2014; Stover et al 2016) (Box 1). The 90–90–90 targets differ from previous targets, such as 3 by 5; rather than being set arbitrarily, mathematical modelling has accompanied the 90–90–90 targets, utilized to derive the programme coverage levels and estimate the resource needs for achieving the policy goal of ending the AIDS epidemic by 2030 (Stover et al 2016). Similar strategies have been developed using modelling for the epidemics of malaria and tuberculosis (TB) (Stop TB Partnership 2015; World Health Organization 2015)
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