National responses to global health targets: exploring policy transfer in the context of the UNAIDS ‘90–90–90’ treatment targets in Ghana and Uganda

Abstract

Global health organizations frequently set disease-specific targets with the goal of eliciting adoption at the national-level; consideration of the influence of target setting on national policies, programme and health budgets is of benefit to those setting targets and those intended to respond. In 2014, the Joint United Nations Programme on HIV/AIDS set ‘ambitious’ treatment targets for country adoption: 90% of HIV-positive persons should know their status; 90% of those on treatment; 90% of those achieving viral suppression. Using case studies from Ghana and Uganda, we explore how the target and its associated policy content have been adopted at the national level. That is whether adoption is in rhetoric only or supported by programme, policy or budgetary changes. We review 23 (14 from Ghana, 9 from Uganda) national policy, operational and strategic documents for the HIV response and assess commitments to ‘90–90–90’. In-person semi-structured interviews were conducted with purposively sampled key informants (17 in Ghana, 20 in Uganda) involved in programme-planning and resource allocation within HIV to gain insight into factors facilitating adoption of 90–90–90. Interviews were transcribed and analysed thematically, inductively and deductively, guided by pre-existing policy theories, including Dolowitz and Marsh’s policy transfer framework to describe features of the transfer and the Global Health Advocacy and Policy Project framework to explain observations. Regardless of notable resource constraints, transfer of the 90–90–90 targets was evident beyond rhetoric with substantial shifts in policy and programme activities. In both countries, there was evidence of attempts to minimize resource constraints by seeking programme efficiencies, prioritization of programme activities and devising domestic financing mechanisms; however, significant resource gaps persist. An effective health network, comprised of global and local actors, mediated the adoption and adaptation, facilitating a shift in the HIV programme from ‘business as usual’ to approaches targeting geographies and populations.

Socio-economic Inequality in Comprehensive Knowledge about HIV in Malawi

“…Attainment of good health and well-being for all is among the objectives of the 2030 Sustainable Development Goals (SDG) agenda1,2. The HIV and AIDS pandemic is a potential challenge to the achievement of these goals3 and remains the greatest cause of mortality in low and middle income countries (LMICs)4,5. Malawi and the rest of Sub Saharan Africa (SSA) remain severely affected, with nearly 1 in every 25 adults (4.2%) in the region living with HIV.…”

The influence of constraints on the efficient allocation of resources for HIV prevention

“…The constraints to allocative efficiency we have modelled are, of necessity, arbitrary but rooted in reality. For instance, a recent assessment of Ghanaian and Ugandan national policy indicated the transfer of the UNAIDS 90–90–90 targets into programmatic activities [20], and PEPFAR funding comes to countries with earmarks for certain initiatives [21]. Furthermore, in South Africa, from 1996 to 2007 provinces with greater capacity to spend funds (i.e.…”

The Tale of Two Epidemics: HIV/AIDS in Ghana and Namibia

“…This approach was critical for Ghana to meet the country's commitment to the UNAIDS 90-90-90 goals. Ghana's adaptation of these goals resulted in a significant change in policy, HIV/AIDS programming, and budgeting [28]. The National Strategy Plan (NSP) for 2016-2020 aimed to achieve the first and second goals and focused on system strengthening to meet the third goal [28].…”

“…Ghana's adaptation of these goals resulted in a significant change in policy, HIV/AIDS programming, and budgeting [28]. The National Strategy Plan (NSP) for 2016-2020 aimed to achieve the first and second goals and focused on system strengthening to meet the third goal [28]. However, several factors limited Ghana's ability to meet those goals.…”