Department of Sociology, Boston University, 100 Cummington Mall, Room 260, Boston, MA, 02215, USA.
Division of Global Health, Ministry of Public Health, Nonthaburi, 11000, Thailand.
BMC Health Serv Res. 2022 Dec 6;22(1):1487. doi: 10.1186/s12913-022-08786-6.
Thailand has achieved global acclaim for its response to HIV/AIDS. However, the success of some of the country's most well-known initiatives was by no means a foregone conclusion. Policy entrepreneurs on the periphery of power had to achieve buy-in from stakeholders in state and society to scale and mainstream their ideas. This paper offers a comparative and historical understanding the process by which three of the country's most well-known initiatives came into being: a civil society campaign to promote condom usage; a Ministry of Public Health program that aimed to prevent the spread of Human Immunodeficiency Virus (HIV) by targeting high-risk populations (the 100% condom program); and a universal Prevention of Mother-To-Child Transmission (PMTCT) program.
The research relied on existing literature and interviews with high-ranking ministerial officials, representatives from international and non-governmental organizations, professors, and philanthropic organizations, in addition to a review of the existing literature. Taking a comparative and historical approach that is common within political science and sociology, we analysed the in-depth qualitative interviews in relation to the literatures and used an inductive cross-case analysis aimed to draw out critical features that the initiatives shared in common.
Common factors in HIV/AIDS prevention that cut across the three key cases include policy entrepreneurs who championed the programs, successful demonstration projects that produced a credible evidence base for policy adoption, and a diverse set of institutional partners that played critical roles in helping to mainstream their initiatives into national HIV/AIDS policy and scale programs nationally. The findings from this comparative research project have implications not only for the building of understanding related to one single project, but for broader theoretical understanding related to the mainstreaming of health policy from peripheral spaces of power.
This analysis draws out the role that demonstration projects played in building a credible evidence base for policy adoption and the role that a diverse set of institutional partners played in elevating the profile of policy entrepreneurs' ideas and helping to scale them nationally as state policy. Success was contingent on entrepreneurs first identifying and then taking advantage of different political opportunities that arose during each of the historical periods. Over time, these initiatives have evolved from vertical programs into an integrated program, in parallel with the evolution of the HIV/AIDS landscape at the global level.
泰国在应对艾滋病方面取得了全球赞誉。然而，该国一些最著名举措的成功并非是理所当然的。处于权力边缘的政策企业家必须获得国家和社会利益相关者的认可，才能扩大和推广他们的想法。本文提供了对泰国三个最著名举措形成过程的比较和历史理解：一场民间社会运动，旨在推广使用避孕套；公共卫生部旨在通过针对高危人群（100% condom 项目）来预防人类免疫缺陷病毒（HIV）传播的计划；以及一个普遍的预防母婴传播（PMTCT）计划。
该研究依赖于现有文献以及对高级部级官员、国际和非政府组织代表、教授和慈善组织的访谈，以及对现有文献的回顾。采用政治学和社会学中常见的比较和历史方法，我们将深入的定性访谈与文献联系起来，并使用归纳性跨案例分析来提取举措共同的关键特征。
跨越三个关键案例的艾滋病预防共同因素包括支持这些项目的政策企业家、成功的示范项目为政策采用提供了可信的证据基础，以及一系列多样化的机构合作伙伴，它们在帮助将其举措纳入国家艾滋病政策主流和在全国范围内扩大项目规模方面发挥了关键作用。这项比较研究项目的结果不仅对理解单个项目有意义，而且对理解从权力边缘空间将卫生政策纳入主流的更广泛理论有意义。
这项分析得出了示范项目在为政策采用建立可信证据基础方面所起的作用，以及多样化的机构合作伙伴在提高政策企业家思想的知名度并帮助将其在全国范围内作为国家政策推广方面所起的作用。成功取决于企业家首先识别并利用每个历史时期出现的不同政治机会。随着时间的推移，这些举措从垂直项目演变为一个综合项目，与全球艾滋病毒/艾滋病领域的演变并行。
