HIV and local community

The first strength of the intervention policy is the central position of key stakeholders in the intervention policy, since people with HIV and local community, the private sector, local community and traditional leaders are direct benefits of the policy providing public access to antiretroviral drugs. Moreover, the other stakeholders at the centre of the policy were necessary in developing and implementing the policy and in allowing the distribution of generic antiretroviral drugs to communities. This implies that the policy likely reflected the interests of the key stakeholders.

The second strength is the achievement of a general support from the stakeholders, although the government was unable to establish its position on antiretroviral drugs in the initial stages of policy implementation. The extent of support for a policy is one determinant of its successful implementation. However, there are also core weaknesses. One is the lack or limited consultation of the key stakeholders in policymaking, particularly the people living with HIV and their families, community and traditional leaders, and other sectors.

An explanation could be a struggling civil society and even with many non-government and faith organisations involved in community organisation, the stigma of HIV/AIDS and lack of information scattered the community. The other is limited coordination of the different stakeholders because of corresponding struggles on the part of government. The government leaned towards studies showing the lack of link between HIV and AIDS and questioned the antiretroviral drugs as treatment for AIDS.

This affected the implementation of the biomedical response as the core component of the intervention policy. In terms of progress, the initial years met with minimal impact on the health condition of people living with HIV/AIDS and other community impact. With regard to the comprehensive treatment policy, there are marked improvements relative to the intervention policy in terms of the coordination of the roles and influences of the different stakeholders. Nevertheless, there are strengths as well as weaknesses.

The first strength is the placement of all the stakeholders at the centre of the policy and policymaking process. Even the stakeholders positioned at the periphery now took the centre stage in the comprehensive policy. This has positive and wide implications on the responsiveness and effectiveness of the policy. By being at the centre of the policy, the interests of different stakeholder are likely considered. Although different interests could complicate the policy, the support of these stakeholders to the policy is a determinant of its success.

The second strength is the greater power of the stakeholders, especially the advocate groups in influencing policies and supporting in the determination of policy options. This aligned with the active involvement of most of the stakeholders in the policy. However, there remain weaknesses. First is the poor consultation of some of the key stakeholders, particularly the people living with HIV and community leaders or traditional leaders.

The strategic plan called for focus on the provision of public access to antiretroviral treatment, the establishment of one health care centre in every district, the expansion in the number and skills of health workers, and improved cooperation across sectors. Yet, the people living with HIV and community leaders remain passive recipients of the services provided by the implementation of the policy. This could affect the effective representation of the interests of the party most affected by the policy.

The people living with HIV are likely to provide important insights into their needs and the manner of responding to these needs. The second weakness is the weak link between the national government and its constituency that highlights the role of local community and traditional leaders. The success of policies depends on how well needs are translated into plans and plans executed to activities that respond to needs. The limitations in coordinating the determination of policy options, selection and implementation remain an area for improvement.

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