Health policy compliance: When do countries take on new policies advocated by global policy networks?

Scholarship on global social movements has identified multiple factors that influence movement success: the ability of global and domestic networks to mobilize attention and resources, network strategies, the relative openness of the policy process to civil society input, and the number of policy gatekeepers that can prevent or facilitate policy action. However, even when controlling for these factors, there are important differences in how countries respond to pressure for health policy change. This study examines why South Africa has been more compliant with global tuberculosis policy recommendations than AIDS policy proposals.  South Africa was selected because it is a high-burden country for AIDS and tuberculosis, and it has been the target of global campaigns for both diseases. To investigate this issue I conducted approximately 35 interviews with South African policymakers, civil society organizations, and representatives of global policy networks, and analyzed around 300 policy and advocacy documents, government statements in response to civil society pressure, and political speeches on AIDS and tuberculosis. Initial results indicate that global social movements for AIDS and tuberculosis used similar strategies in their attempt to influence policy, both used scientific evidence and negative normative pressure to shame South Africa for its policy shortcomings. Divergence in compliance was not related to strategy but to alignment (or misalignment in the case of AIDS) between social movement and government narratives on disease origin, risk, and responsibility. These findings suggest that the resonance of disease narratives among policy gatekeepers is a key factor in the effectiveness of social movements.