The influence of global environments on strategy and HIV/Aids interventions

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Introduction

The socio-economic impact of HIV/Aids is influenced by a multitude of external and internal factors which are intertwined in complex systems of mutual reinforcing determinants necessary to achieve sustainable and competitive success. The interplay between these determinants is guided by factors such as skilled labour and infrastructure, demands on the nature of products and services,the international competitiveness of products and services and the ability to create conditions that increase the nature of domestic rivalry. These forces work together and impact on the performance of markets, political structures and the creation of well-being. Well-being enhances productivity and sustainable outcomes. As soon as well-being is negatively affected, it reduces productivity and the sustainable success of economies.

Statement of the problem and research question

The successes of policies in health are closely tied to social development initiatives. The clinical features of HIV/Aids and the long-term features of the epidemic have a significant impact on the structures and design of social security safety nets which are directly linked to public finance structures. Enhancing security needs becomes an intrinsic part of well-being and of combating the negative effects of HIV/Aids.

Aim and objectives of the study

The study aims to put forward recommendations that will allow policy-makers to utilise mechanisms that define and frame the HIV/Aids problem in a fiscal responsible manner. This means that policies must be responsive to the perceived needs and communicate the legislative intention. Policies must be easily administered and take account of the short-, medium- and long-term interests by enabling and providing opportunities to sustain themselves as well as deal with the political, social, health and developmental issues associated with HIV/Aids.

Research approach and methodology

The qualitative study is planned according to a longitudinal design in order to isolate and define issues and categories, study contents, patterns, meanings and experiences and be more focused as the research unfolds. The unobtrusive and applied research provides an inductive exploration of key issues influencing the outcomes relating to the field of public finance and public administration. The descriptive research question in this phenomenological paradigm investigates the problems and phenomena by using comparative case studies. A cross-case analysis over a fifteen-month period involved multiple sources of data and in-depth descriptions to provide a rich narrative of each case study.

Acknowledgements
Abstract
CHAPTER 1: STATEMENT OF PROBLEM AND RESEARCH DESIGN
1.1 Introduction
1.2 Statement of the problem and research question
1.3 Aim and objectives of the study
1.4 Assumptions
1.5 Research approach and methodology
1.5.1 Materials and methods of data collection in Phase I and Phase II
1.5.1.1 Literature
1.5.1.2 Interviews
1.5.1.3 Meetings, conference and publication
1.5.2 Tools used to support data collection in Phase I and Phase II
1.5.2.1 PESTLE Analysis (Political, Economical, Social, Technological, Legislative and Environmental)
1.5.2.2 Situational analysis
1.5.2.3 Theory of constraint (TOC)
1.5.2.4 Functional benchmarking: best practice benchmarks
1.5.2.5 Cost-benefit analysis (CBA)
1.6 Clarification of terminology
1.7 Structure of the research
1.8 Conclusion
CHAPTER 2: STRATEGY FORMULATION AND THE EXTERNAL ENVIRONMENT OF GOVERNMENT
2.1 Introduction
2.2 The remote environment
2.2.1 The global environment
2.2.2 Health care reforms, public finance and partnerships
2.3 How competitive forces shape strategy
2.4 Contending forces and HIV/Aids
2.5 The global environment and strategic considerations for multi- and
transnational organisations
2.5.1 The influence of global environments on strategy and HIV/Aids interventions
2.5.2 Factors that influence strategic decisions in health care
2.5.2.1 Political factors
2.5.2.2 Economic factors
2.5.2.3 Social factors
2.5.2.4 Technical factors
2.5.2.5 Legislative factors
2.5.2.6 HIV/Aids environmental factors
2.6 Conclusion
CHAPTER 3: HIV/AIDS AND HEALTH CARE REFORMS
3.1 Introduction
3.2 HIV/Aids, the disease
3.3 The epidemiology: global, regional and national impact of HIV/Aids on health care systems and public finance
3.4 HIV/Aids: health care reforms, social security networks and fiscal balance
3.5 International legislation and special features of the HIV/Aids policy process
3.6 Conclusion
CHAPTER 4: CONCEPTUALISM OF PUBLIC-PRIVATE PARTNERSHIPS (PPPs) OR PRIVATE FINANCE INITIATIVE (PFI)
4.1 Introduction
4.2 Accountability and responsibility in public finance
4.3 Comparing the operationally relevant objectives for public finance against the 4Es and public finance
4.4 The relative scale of public finance
4.5 Building state capacity: allocation mechanisms
4.5.1 Supply and demand function of the market
4.5.2 Raising public finance: strategic budgeting and the effect of public private partnerships on service delivery
4.5.3 New roles for accountability actors
4.5.3.1 New standards of accountability: a new accountability agenda
4.6 Strategic public finance: “4Es” on spending and delivery
4.7 PPPs and public finance: adding value for money
4.7.1 Defining public-private partnerships (PPPs)
4.7.2 The role of PPP in health care reforms
4.8 Conclusion
CHAPTER 5: THE ROLE AND FUNCTION OF THE STATE AND ITS IMPACT ON INTERVENTIONS 1
5.1 Introduction
5.2 Political ideologies: building blocks in development thinking, public policy making and public administration
5.3 Historical overview of political ideologies: shaping the role of the state and the market
5.3.1 The classic thinkers: civic virtue and civil society
5.3.2 The modern thinkers: civil society and development thinking
5.3.2.1 Ideologies of the nineteenth century
5.3.2.2 Ideologies of the twentieth century
5.4 State intervention: the role of the state in health and health care
5.4.1 Building state capacity
5.4.2 The role of government and the New Public Management (NPM) movement
5.5 Conclusion
CHAPTER 6: CRITERIA FOR HEALTH REFORM POLICIES 13
6.1 Introduction
6.2 International best practice framework
6.2.1 Effectiveness: goal attainment in service delivery
6.2.2 Efficiency: outcomes in health care
6.2.3 Economy: reducing health care costs
6.2.4 Equity: social justice
6.2.5 Implications of the 4E framework for the public sector and public finance
6.3 Situational analysis
6.3.1 External environment (Remote environment)
6.3.1.1 Political factors
6.3.1.2 Economic factors
6.3.1.3 Social factors
6.3.1.4 Technological factors
6.3.1.5 Legislative factors
6.3.1.6 HIV/Aids environmental factors
6.3.2 Internal task environment
6.3.2.1 Health care reforms
6.3.2.2 PPP and value-creating strategies
6.3.3 SWOT analysis
6.4 HIV/Aids interventions and strategies
6.4.1 Criteria for best practices
6.4.1.1 Effectiveness: goal attainment in service delivery (Case Study 5)
6.4.1.2 Efficiency: outcomes in health care
6.4.1.3 Economy: cost containment and the strengthening of service
delivery
6.4.1.4 Equity: social justice
6.4.1.5 Implications of the 4Es Framework for the public sector and public
finance (Case study 5)
6.4.2 A search for alternative strategies and policies
6.5 Conclusion
CHAPTER 7: DEVELOPING ALTERNATIVE HEALTH POLICY OPTIONS 19
7.1 Introduction
7.2 Discussion of international results (external remote environments)
7.2.1 Developed countries
7.2.2 Developing countries
7.2.3 Comparison between capacity-building initiatives within health
reforms in the developed and developing countries
7.2.4 International KPI and key issues that impact on HIV/Aids
intervention strategies
7.2.5 The role of PPP within international health care reforms and
HIV/Aids intervention strategies
7.3 Discussion of national results (external and internal environmental analysis)
7.3.1 The influence of NPM approaches towards strengthening government policy capacity and improving service delivery outcomes in health care and HIV/Aids interventions
7.3.2 Capacity-building initiatives within the NHCS
7.3.2.1 Gaps between strategic intent and internal value-creating strategies
7.3.2.2 The role of PPP as a fiscal responsible mechanism within the NHS and HIV/Aids
7.4 Discussion of the utilisation of PPPs in roll-out plans for HIV/Aids strategies
7.4.1 Developing criteria for a “best practice model”
7.5 Conclusion
CHAPTER 8: CONCLUSIONS AND RECOMMENDATIONS 
8.1 Introduction
8.2 A summary of the main results
8.3 Recommendations for the development of a “best practice model” in the
HIV/Aids policy strategies
8.3.1 Policy implications
8.3.2 Alternative options
8.4 Future research
8.5 Conclusion
REFERENCES

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The utilisation of public-private partnerships: Fiscal responsibility and options to develop intervention strategies for HIV/AIDS in South Africa