No.3 The Art of Policy Formulation: Experiences from Africa in Developing National HIV/AIDS Policies John Stover, Alan Johnston (August 1999)  Full Document (English)      Order for free      email to me  AIDS has presented a major challenge to African societies during the last two decades. Governments throughout the region have struggled to develop effective policies and programs to address the epidemic. This report presents case studies of the policy process in nine Anglophone African countries. Each country has employed a unique approach to policy development; the results are equally diverse. This report describes some of the country experiences and highlights areas of similarity and difference as well as major problems addressed by Anglophone African countries. The information has been distilled into a framework that captures key elements of the policymaking process. The major components of the framework are as follows: Problem identification and need recognition. Countries have passed through several stages in their response to the AIDS epidemic, including medical response, public health response, multisectoral response, and focused prevention and treatment. During the early phases, countries saw little need for a comprehensive AIDS policy. However, the need for a policy response grew as countries adopted multisectoral approaches to the epidemic and the broad impacts of AIDS on human rights, economic growth, society, and families emerged. Information collection. Once a decision to develop a policy is made, the next step usually is to obtain expert opinion—through consultant reports, interviews, or workshops. Drafting. Drafting is usually the task of small working committees. Some countries drafted policies quickly with a minimum of outside participation while others relied on a number of drafting committees that sought input and consensus from a range of interests. Review. In some cases, draft policies were debated widely and reviewed by thousands of people as a result of special regional meetings and dissemination efforts. In other cases, little outside review took place. As a consequence, policies often languished, with no champions pushing for review and approval. Approval. National AIDS policies have been approved at one of three levels: the minister of health, the cabinet, or Parliament. Implementation. Some policies have been implemented through operational or strategic plans or through the establishment of committees to develop operational guidelines. In many cases, elements of the policy can be implemented even before the full policy is adopted. Interest groups may be encouraged to take the lead in disseminating and implementing parts of the policy that are of particular interest to them. Most policies contain some components that can be implemented immediately though administrative actions; other components require efforts to develop specific legislation and to obtain funding. Each country policy addresses a large number of specific issues. Despite several cultural, social, and legal differences among the countries studied, the issues surrounding key policy topics show many similarities. The following are among the topics that were most difficult to resolve: HIV counseling and testing; pre-employment testing; orphans; AIDS education in schools; condom advertising; mandatory condom use in brothels; condom distribution in prisons; willful transmission of HIV; and HIV and abortion. In some instances when it was difficult to achieve consensus, policymakers simply eliminated issues from policy consideration. For example, most policies do not address willful transmission of HIV. In other cases, vague wording requires the issue to be addressed in national policy, with the exact meaning left to interpretation through implementation guidelines. The key lessons that have emerged from the case studies are summarized below. Identifying AIDS as a problem does not translate into recognition of the need for a comprehensive AIDS policy. The need for a comprehensive policy may become apparent only when the epidemic becomes so severe that a large portion of the population is affected or when the advocacy efforts of specific groups convince decision makers of the importance of a policy response. There are many approaches to drafting and review. Some countries rely on a high level of participation. Although greater participation lengthens the time required for drafting and review, it builds momentum for the policy and often shortens the time required for approval. As a result, highly participatory approaches may actually require less time for policy development than policies drafted rapidly by a small group of experts who then struggle for years to gain approval. The most participatory processes have produced the broadest policies covering a wide range of key issues. Such policies, it is expected, will prove to be the most effective, but the outcome remains to be demonstrated. Once approved, policies can be implemented in many ways. Some aspects of a policy (such as approval of condom advertising) may be implemented directly, in some cases even before the policy is formally approved. Other policy issues can be implemented only through enabling legislation, with the development of guidelines, or as part of a strategic plan. Countries may lack the resources to implement all facets of a policy at once. Interest groups may need to take the lead in advocating for the implementation of specific portions of the policy that most interest them.