BACKGROUND : South Africa, as an emerging middle-income country, is becoming increasingly
influential in global health diplomacy (GHD). However, little empirical research has been
conducted to inform arguments for the integration of domestic health into foreign policy by
state and non-state actors. This study seeks to address this knowledge gap. It takes the form
of an empirical case study which analyses how South Africa integrates domestic health into
its foreign policy, using the lens of access to antiretroviral (ARV) medicines.
OBJECTIVE : To explore state and non-state actors’ perceptions regarding how domestic health
policy is integrated into foreign policy. The ultimate goal of this study was to achieve better
insights into the health and foreign policy processes at the national level.
METHODS : Employing qualitative approaches, we examined changes in the South African and
global AIDS policy environment. Purposive sampling was used to select key informants, a
sample of state and non-state actors who participated in in-depth interviews. Secondary data
were collected through a systematic literature review of documents retrieved from five
electronic databases, including review of key policy documents. Qualitative data were analysed
for content. This content was coded, and the codes were collated into tentative
categories and sub-categories using Atlas.ti v.7 software.
RESULTS : The findings of this work illustrate the interplay among social, political, economic
and institutional conditions in determining the success of this integration process. Our study
shows that a series of national and external developments, stakeholders, and advocacy efforts
and collaboration created these integrative processes. South Africa’s domestic HIV/AIDS
constituencies, in partnership with the global advocacy movement, catalysed the mobilization
of support for universal access to ARV treatment nationally and globally, and the
promotion of access to healthcare as a human right.
CONCLUSIONS : Transnational networks may influence government’s decision making by providing
information and moving issues up the agenda.