Abstract
AbstractIn this chapter I explore the dynamics of the policy development process and I examine theories of policy implementation. By focusing on narratives, I show that the policy process is not characterised by rational policymaking but by people’s views and interpretations. First, I analyse the process of policy construction. Second, I look at the aid game in Malawi. Third, I look at how these narratives have been passed on through education. Fourth, I present data from interviews I conducted with UNAIDS to present stakeholders’ responses to the question Does your organisation use evidence to inform policy and programmatic decisions on HIV/AIDS? I argue there are a wide range of stakeholders involved in policy construction and implementation. These stakeholders include large, and powerful bilateral and multilateral agencies, such as DFID, USAID and the World Bank, as well as international Non-governmental organisations, national NGOs, international and national faith-based organisations, and the organs of the Malawi government, both at the national and the district levels, each with its own vested interests and each with its own policies. Therefore I argue the evidence produced to apply policies is not objective but narratives shaped by various policy agendas and interests of the elites.
Highlights
In the 1990s we witnessed a great rush to produce global policies on AIDS: it was acknowledged that the greatest impact of the AIDS pandemic had taken place in low and middle-income countries, in sub-Saharan Africa
The model estimates the number of new HIV infections that will be acquired over the ensuing year by individuals in risk groups that have been identified in a given population using data on the size of the groups, the aggregate risk behaviour in each group, the current prevalence of HIV infection among the sexual or injecting drug partners of individuals in each group and the probability of HIV transmission associated with different risk behaviours (Case et al 2012)
When I analysed 43 funding proposals submitted by CBOs to Balaka District Council for projects on harmful cultural practices and HIV/AIDS I found that the project proposal stipulated they would be working on HIV/AIDS when I looked at the budget I discovered that the activities they wanted to fund were related to income generation which suggest these funds were being re-diverted for other projects which the CBO heads felt were of greater priority
Summary
In the 1990s we witnessed a great rush to produce global policies on AIDS (see Chapter 4 on international frameworks on AIDS): it was acknowledged that the greatest impact of the AIDS pandemic had taken place in low and middle-income countries, in sub-Saharan Africa. In the Political Declaration on HIV/AIDS, they committed to taking action to move towards universal access to HIV prevention, treatment, care and support by 2010 (UNAIDS 2008) Despite such efforts, the reaction of policymakers in the Global South has been incredibly varied. In Malawi policies and programmes on AIDS and sexual cultural practices are not informed by evidence. Another respondent working for USAID informed me that a problem was that people do not accept qualitative, ethnographic studies as evidence (P32) It is the qualitative analysis of local peoples’ perceptions and knowledge around AIDS and attitudes towards sexual behaviour that give us a much more in-depth picture of how prevalent ‘at risk’ behaviour is and offer possible ways of challenging or breaking cycles of transmission. It is hardly surprising that the resulting HIV prevention programmes are largely ineffective in curbing transmission—they do not get to the root of the problem as defined through and by the biomedical evidence
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