Schneider H, Stein J
Centre for Health Policy, University of Witwatersrand, Johannesburg, South Africa.
Soc Sci Med. 2001 Mar;52(5):723-31. doi: 10.1016/s0277-9536(00)00174-x.
In common with the rest of the Southern African sub-continent. South Africa is currently experiencing a serious HIV epidemic. When it came into power in 1994, the new, Mandela-led government immediately mobilised funds and adopted a far-reaching AIDS Plan for the country. However, the implementation of AIDS policy in the first four years after 1994 has been characterised by a lack of progress and a breakdown of trust and co-operation, both within government and between government and NGOs. This paper outlines the political context which shaped the development of the AIDS Policy, then examines the difficulties of implementing a comprehensive response to AIDS in a country undergoing restructuring at every level. It questions the notion of "inadequate political will" as an explanation for lack of progress. Involvement by politicians has, in fact, been experienced as a double-edged sword in South Africa, with inappropriate, "quick-fix" actions creating conflict and hampering a more longer-term, effective response. The paper also highlights the importance of groupings outside of government in promoting effective policy actions, and the types of leadership required to mobilise a broad range of actors around a common vision. It concludes by emphasising the need to develop approaches to policy implementation rooted in the possibilities and constraints of the local situation, rather than relying on universal blue-prints developed out of context.
与南部非洲次大陆的其他地区一样，南非目前正经历着严重的艾滋病疫情。1994年新的、由曼德拉领导的政府上台后，立即筹集资金并为该国制定了一项影响深远的艾滋病计划。然而，1994年后的头四年里，艾滋病政策的实施表现为缺乏进展，政府内部以及政府与非政府组织之间的信任与合作破裂。本文概述了影响艾滋病政策发展的政治背景，然后探讨了在一个各层面都在进行结构调整的国家全面应对艾滋病的困难。它对用“政治意愿不足”来解释缺乏进展的观点提出质疑。在南非，政治家的参与实际上是一把双刃剑，不恰当的“快速解决”行动引发了冲突，阻碍了更长期、有效的应对。本文还强调了政府之外的团体在推动有效政策行动方面的重要性，以及围绕共同愿景动员广泛行为体所需的领导类型。文章最后强调，需要制定基于当地情况的可能性和限制因素的政策实施方法，而不是依赖脱离实际情况制定的通用蓝图。
