Transcript Scaling-up ART in Thailand: the roles of policy networks

Scaling-up ART in Thailand:
the role of policy networks
Sripen Tantivess
International Health Policy Program, Thailand
CREHS Data Analysis Workshop, Chennai, 29 March 2007
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ART recipients under public programmes, 1992-2006
90,000
80,000
No. of PHA on ART
70,000
60,000
50,000
Universal
ART policy
40,000
30,000
20,000
Clinical
Research
Network
AZT
monotherapy
Access to
care
programme
10,000
0
92
93
94
95
96
97
98
99 2000 01
02
03
04
05
06
Source: Bureau of AIDS, Tuberculosis and Sexually-transmitted Infections
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Specific objectives:
Conceptual framework:
1.
Actors
Policy
networks
To explain the shift in the agenda
towards universal ART access and
Context
the processes of policy adoption,
formulation and implementation.
2.
Process
To analyse actor involvement in
each policy stage.
Agenda setting
3.
To assess the context that
influenced policy development and
Formulation
implementation.
4.
Implementation
Policy
outcomes
To identify networks of actors and
examine their roles in treatment
policy.
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Agenda setting & policy adoption
• Local production of generic ARVs
• Drug price reduction
• Campaigns run by NGOs
• Instigation of universal health coverage (UC) programme
• Global mainstream to promote ART access
• Changes in actor networks
• 1992-2000: MOPH officials (Disease Control Department) and HIV specialists
• 2001: new Health Minister, MOPH officials (health economists and financing
reformists), NGOs/PHA groups
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Policy formulation
• New programme configurations and preparation required
• MOPH appointed administration and technical panels
• Policy network members:
•
STATE: Disease Control Department, HIV experts, health workers, health
financing researchers
•
NON-STATE: NGOs and PHA groups
• Resource exchange
• STATE: authority, technical expertise, management skills
• NON-STATE: experience on HIV care (and expected collaboration in the
next stage)
• Common interest: rapid ART expansion, increased access to
treatment
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General context of policy implementation
1. Parallel reforms:
•
•
•
Universal Health Coverage Scheme  increased workload
Health promotion programme  HP services in community
Public administration reforms  reallocation and early retirement
of health officials/workers
2. Inadequate experienced health workers
3. HIV-related stigma  impediments in treatment & care delivery
4. ART extension as priority, urgent policy  pressures on
implementers
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Policy implementation
•
Activities: patient enrollment; counseling; drug information; laboratory; ARV
prescribing; follow-up; home visits; psychological support
•
Influence of general/local context (obstacles)
•
Coping strategies:
• Treatment networks of provincial and district providers
• Public-civic partnerships
• Nurse and pharmacist prescribing in uncomplicated cases
• Exchanging information – sharing experience
• Drawing lessons on clinical research and existing ART programmes
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Policy implementation networks
• Policy network members:
•
STATE: health officials; health professionals; lab. scientists; social
workers
•
NON-STATE: local HIV NGOs and patient groups
• Resource exchange
• STATE: authority, clinical & technical expertise, management skills
• NON-STATE: capacity and experience on HIV care
• Common interest: rapid ART expansion, increased access to
treatment
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Province A
Province B
Local context:
Local context:
• Strong NGOs and PHA networks
• Weak NGOs and PHA networks
• Existing public-civic collaboration
• Existing public-civic collaboration
• well-accepted by hospitals
• self-funded ART
Strong participation of NGOs/PHA
in ART extension
• hospital-led PHA groups
• Rapid turnover of district hospital GPs
Provincial-district professional networks for
training and consultations
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Lessons learned:
Extended policy network
Policy community
• Impediments
• small number
• Increased demands
• professional members
• Changes in objectives
• consistent relationship
• common values & background
• hierarchical  some actors
dominated the policy
More resources needed
(issue network?)
• relatively large number
• different values & background
• imbalanced relationship
• different capacity & power
• common purpose & interests
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