Health Policy and Planning Advance Access originally published online on July 25, 2008
Health Policy and Planning 2008 23(5):328-338; doi:10.1093/heapol/czn023
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This article appears in the following Health Policy and Planning issue: Future directions for health policy analysis: a tribute to the work of Professor Gill Walt [View the issue table of contents]
The role of state and non-state actors in the policy process: the contribution of policy networks to the scale-up of antiretroviral therapy in Thailand
1International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand.
2London School of Hygiene and Tropical Medicine, London, UK.
* Corresponding author. International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand. Tel: +66-2–5902366. Fax: +66-2–5902385. E-mail: sripen{at}ihpp.thaigov.net
Antiretroviral therapy (ART) is difficult in poor settings. In 2001, the Thai government adopted the policy to scale-up its treatment initiative to meet the needs of all its people. Employing qualitative approaches, including in-depth interviews, document review and direct observation, this study examines the processes by which the universal ART policy developed between 2001 and 2007, with the focus on the connections between actors who shared common interests—so-called policy networks. Research findings illustrate the crucial contributions of non-state networks in the policy process. The supportive roles of public-civic networks could be observed at every policy stage, and at different levels of the health sector. Although this particular health policy may be unique in case and setting, it does suggest clearly that while the state dominated the policy process initially, non-state actors played extremely important roles. Their contribution was not simply at agenda-setting stages—for example by lobbying government—but in the actual development and implementation of health policy. Further it illustrates that these processes were dynamic, took place over long periods and were not limited to national borders, but extended beyond, to include global actors and processes.
Key Words: Policy networks, policy process, policy analysis, antiretroviral therapy, HIV, Thailand
Accepted for publication 22 June 2008.