The influence of the MDGs on national policymaking on HIV/AIDS in South Africa and the impact of the two key policies reflected the shift from a single-issue policy with limited impact only on HIV/AIDS to a comprehensive policy with wider impact not only on HIV/AIDS but also on the other development goals. The ability to move from a single to a multi-issue policy constitutes not only a development in policies but also in policymaking because of the influence of the MDGs.
This could be described this shift as the movement from a ‘mobilisation/biomedical’ paradigm to a ‘nationalist/ameliorative’ paradigm (Butler, 2005). The shift is due and is reflective of the political and social context of South Africa during the development of the policies and international influence through the setting of expectations and comprehensive development plan for the long-term. The World Health Organization identified twelve stakeholders of policies on HIV/AIDS based on the recognition that this health problem has political, economic, social and legal components.
Due to its multiple components, there is need for mobilisation and coordination of these stakeholders in terms of their roles to address effectively the problem of HIV/AIDS. The identification of the stakeholders depended on the role they play in addressing the HIV/AIDS problem as well as the influence of HIV/AIDS policies on them. These stakeholders are: • people with HIV; • local community and traditional leaders; • health-care workers; • governments; • nongovernmental organisations (NGOs);
• community-based organisations (CBOs); • faith-based organisations (FBOs); • medical associations; • drug regulatory authorities; • the private sector, i. e. employers, unions; • donors / cooperating partners; • academic institutions. (WHO, 2009c) The consideration of the role of these stakeholders on HIV/AIDS policies and the impact on these policies on the different stakeholders is in terms of position, power, player involvement, and perception of these different stakeholders (Roberts et al. , 2004) relative to the two key policies.
The position of the stakeholders relative to the policy could be either centre or periphery. A centre position means being the focus of the policy while a periphery position means being at the fringes of the policy although still a part of it. The power of stakeholders relative to the policy could be strong, moderate or weak depending on the influence on the policy and impact of the policy. The involvement of the stakeholders could be as active participant, passive recipient or both.
The perception of the stakeholders could be in supportive, indifferent or antagonistic towards the policy, depending on the interest at play on the part of different stakeholders relative to the key policies. In relation to the intervention policy of South Africa implemented in 2000, the policy has strengths and weaknesses relative to stakeholders. The strengths and weaknesses reflected the influence of the socio-political environment in South Africa during this time, which is prior to the United Nations Millennium Declaration that established the MDGs.