Evolution of prevention of mother to child transmission of HIV policy in Zambia: Application of the policy triangle to understand the roles of actors, process and power

摘要

The Prevention of Mother-to-child Transmission (PMTCT) of HIV programin Zambia has undergone several policy iterations over the past 10 years.This qualitative study aimed to contribute towards addressing thisknowledge gap by analysing the evolution and actors’ influence duringthe policy process using the Walt and Gilson policy triangle as ourevaluation framework. Document review and key informant interviewswith policy makers were undertaken to identify the contextual factorsthat had shaped the PMTCT policy evolution in Zambia. Overall, thestudy revealed that over the past decade, at least five PMTCT policychanges have occurred, averaging three years per policy with extensiveoverlap between policies. This resulted in more than two policies beingimplemented at a given time. Pressure from the internationalcommunity and scientific evidence were the main drivers of policychange in Zambia, with local actors being mainly reactive. Amonginternational agencies, UNICEF and WHO were the key actors who haddriven the policy changes as they had the power and resources. Therapid changes, negatively impacted the health system, disrupted servicedelivery, which was unprepared to effectively and efficiently shift fromone policy to another.