Participatory
Policy Making (PPM) is an emerging policy formulation trend aiming to include
the affected stakeholders and the generate solutions for policy problems that
based on equity and neutrality. Rietbergen-McCracken (2012) stated that the
participatory policy making (PPM) is more of a general approach aiming to
achieve the specific goal to the inclusion of individual, group or civil
societies in the making of the policy rather than a specific tool. The
participatory policy-making requires meaningful and authentic participation
from the stakeholders of various levels, not only the rural poor communities,
which can be vary from cases to cases (Rietbergen-McCracken, 2012).

The
World Bank (p. 1996) suggested the continuum of participation from the minimum
to high level as the “ladder of participation” for the poverty reduction
strategy (PRS) as following; 1) information sharing for the public, 2)
Consultation between the coordinators of the consultants and the public, 3)
Joint decision making between the authority and the public, and 4) Empowerment
of the public by transferring the control over decision making to the
stakeholders.

The
FAO guideline website of participatory method (FAO, 2002) suggests that The
ultimate form of empowerment is that the control over decision making and
resources were in the hands of stakeholders since the beginning to set their
own agenda and carry out the procedures without the presence of external
initiators. PPM carries the participatory method beyond the scope of project
and programme to the policy making.

The
research would be based on the illustration of Participatory policy making
process and analyses empirical case study to explore the efficiency of the
implementation participatory policy making in a developing country, which is
South Africa. In South African case study. The research analyse and illustrate
that the use of Participatory policy making method is inefficient due mainly to
the control of the state and the dependency on the institutionalized engagement
of the civil societies in policy making fora, which these constraints are
typical for a developing country.

 

Brief description of
method

This
research paper is conducted by the gathering and analyzing of both theoretical
and empirical literatures that focus on the participatory policy making in a
developing country from the year 1960s, when the theory emerged, to the early
2000s, when the out of the implementing process of the theory was fully
illustrated, and summarized in Post-apartheid South Africa, the case
study. 

The
research that fits in the criteria of selection need to provide the
comprehensive process of participatory policy making method and analysis of its
advantages and disadvantages through first-handedly researched empirical
evidences. The work that was selected as a main literature had explored the
concept of participatory policy making.

The
criteria of selection for The empirical studies selected were that the
countries need to be developing countries that has already done the
participatory policy making process within the last 20 years and the result of
the procedures were clearly publicized for the reliability and timely
information. 

The
information gathered would then be compared and analyzed concerning the
effectiveness of the social policy established in a developing country via
participatory policy making process.

 

Literature Review

Proponents

The
World Bank’s Participation Source Book (World Bank, 1996, p. xi). has defined
the participatory process as “a process through which stakeholders
influence and share control over development initiatives and the decisions and
resources which affect them” (World Bank, 1996, p. xi).

According
to Baccoro and Papadakis’s research (2009, p. 1) the theory sits on the 2
claims proposed by its proponents which are; 1) a broad participatory to policy
making approach that involves a wide range of social actors alongside with the
public actors would heighten sense and texture of democracy and generate more
effective policies; 2) the actors in the policy fora would coordinate and exchanging
arguments based on the principles and generalizeable interests leading to the
more efficient potential solutions generated than the top-down bureaucratic
approach. The claims have an assumption that the participated parties have
detailed knowledge of the problems and capable of creating the potential
solutions and that no interest or values of the affected groups would be
disregarded in the policy making process (Baccoro and Papadakis, 2009). 

Critiques

In
McGee and Norten’s research (2000, p.63), many critiques report that the
participatory method in practice often end at the information sharing or
consultation level and hardly reaches the joint decision making or empowerment which
stakeholders have autonomy over the impacts of the policy.

The
lack of high level participation in practice are found to be in contrast with
the recent thinking about citizen participation illustrated by Cornwall (2002,
p.56) that increasing development efforts should promote opportunities
for citizen to fully participate and have the space for autonomous decision
making, whereby “citizens gain meaningful opportunities to exercise voice
and hold to account those who invite them to participate”. Some
critiques (Schattschneider, 1960; McConnell, 1966; Lowi, 1969) claim that the
participatory policy making process would be interfered and captured by the
powerful and resourceful private organisations.

Habermas
(1987) argues that the encouragement of the civil society organization to
transform their roles from stimulating social movements to become secondary
associations engaging with the state could have high tendency to develop the
risks of colonialization inherent. Moreover, such associational risks are not
guaranteed to bring about greater policy effectiveness as a counterbalance.

In
addition, Baccoro and Papadakis (2009, p.2) have found in their research on the
participatory policy making process in South Africa, a developing country, the
robust evidence of the inequity and lack of efficiency in PPM by the civil
society supported by the state. They found that the room for manoeuvre of the
state is contrained by international macroeconomic constraints. It is also
unexpectedly founded by their research that the nature of the policy problems
and the feasible solutions suggested by the participating groups are closer to
that of the government’s perspectives than the views of outside non-governmental
groups (Baccoro and papadakis, 2009, P.2).

It
is mainly because the NGOs participated in the policy making fora were
dependent on the fund of the government and some were even chosen to be the
government’s representatives. Thus, their roles in the participation policy
making fora are mainly cooperation and support the decisions that were already
made by the government. The government is also not neutral. It has the
preference for the adoption of policy and would just select the policy that support
with their agenda.

Additionally,
Papadakis (2009, Ch. 2) analysed that the notion of civil society participation
in policy making process has been mainstreamed into policy-making discourse
and, as a consequence, has lost much of the transformative connotation and
potential. It has become an ordinary element that is required for the issued of
a public policy.

 

Empirical case study

Political Context
of South Africa

South Africa is a developing country that has
recently passed through the transition from apartheid to democracy era in
1990-94. The transformation of the country has led to a new model of
associational democracy with a variant of socialism, participatory and
anti-bureaucratic idealism (Klug, 1995; Swilling, 1992) The new government at
the time stated that the periodic elections were not sufficient to uproot the
discrimination and inequality in the country that were inheritances from the
apartheid era. The initiative intention of public inclusion is clearly stated
in the 1994 Reconstruction and Development Programme (RDP), the policy
manifesto of the “new democracy” (ANC, 1994a). The participatory fora are
required at all level in the institution of representative democracy with the
civil societies playing a major role in the fora. As seen in the passage below,
the participatory policy making method is highly emphasis in the country’s RDP,
which makes the case study highly appropriate for the comparison of the
declaration of intention and the implementation of such policy.

“Democracy for ordinary citizens must not
end with formal rights and periodic one-person, one vote elections. Without
undermining the authority and responsibilities of elected representative bodies
(the national assembly, provincial legislatures, local government), the
democratic order we envisage must foster a wide range of institutions of
participatory democracy in partnership with civil society on the basis of
informed and empowered citizens (e.g. the various sectoral fora like the National
Economic Forum) and facilitate direct democracy (people’s fora, referenda where
appropriate, and other consultation processes).” (ANC RDP, 1994b, par. 5.2.6.)

 

The
policy making fora that would be used to explore the functioning and outcome of
participatory different policy making fora in South Africa is the South African
National AIDS Council (SANAC).

 

HIV-AIDS
public policy in South Africa and SANAC

·        
The government’s lack of awareness and
understanding towards the epidemic

The
epidemic of HIV/ AIDS has been receiving constant policy priority along with
unemployment, because South Africa has got the most people who got affected by
HIV/AIDS than anywhere in the world according in the year 2003 (Nattrass, 2003).
 According to the 2003 National HIV and
Syphilis Antenatal Sero-prevalence Survey, 5.6 million people were living with
HIV at the end of 2002 with a sharp rise of more than 300,000 people from the
estimated amount (Department of Health, 2004: 10). The national prevalence of
pregnant infected HIV women was estimated to be at 26.5% at the end of 2002.The
HIV transference rate from Mother-to-child (MTC) was about 30 percent. South
Africa Health Review (2004, p. 199) shows that HIV prevalence among women is
actually more than men at 15% comparing to 11.5% making it one of a few
countries with more infected women than men. The same review shows that almost
100,000 babies were infected by the virus. The number of orphans who were
orphans by the AIDS-related deaths were around 38% of all over 885,000 orphans
in 2002. Thus the consequences of AIDS directly affect the labour market and
educational system including the child labour in the country. The epidemic also
contributes to greater income inequality (Nattrass, 2002)

The
government has issued policies to deal with the epidemic, but the policies that
were issued lack of comprehensiveness. The government was concerned about the
need for education and prevention of HIV/AIDS, but the treatment plan has not
been addressed until recently. While the treatment of Antiretroviral
Medications (ARV) and nevirapine are believed to improve the immunization
system of an HIV positive person and delay the progress of AIDS and prevent the
mother-to-child transmission at almost 50% of a breatfeeding population (Guay
et al., 1999), the government does not agree to distribute the medication in a
large scale arguing that the country lack appropriate infrastructure to follow
patients in the phase of prophylaxis (Interview of Mametja in Baccoro and
Papadakis , 2009). Moreover the government also stated that another major
factor that deter the treatment campaign is the high cost of medication due to
high number of potentially involved patients in 2001 (Minister’s Parliamentary
Media Briefing, 2001).1
The key cabinet members were also some alleged “denialist” who disregard the
casual link between HIV and AIDS (Mbali, 2002)

Therefore,
the strategic plan for HIV/ AIDS/ STD for 2000-2005 has given some space to the
treatment of opportunistic infections or targeted use of anti-retroviral drugs,
but no specific guideline was provided on treatment strategy (DoH, 2000)  However, Butler (2005: 610) observes that in
2004, just a few years later, the expenses for medication treatment could no
longer be used as the main excuse for not providing it as the cost has dropped
to around $150 USD per patient annually. Debate about the comprehensive
treatment should be cancelled.

·        
The establishment of SANAC

Together
with the issue of the strategic plan ANC, the ruling party, and the Department
of National Health and Population Development had initiated a national
conference called the National AIDS Convention of South Africa (NACOSA), which suggested
the creation of participatory structure for the planning process. The formula
had previously been a successful tool in Uganda for increasing the political
weight to the plan and make it easy to implement as various actors have already
involved in the formulating process (Rwomushana, 2000, in van der Vliet, 2004:
54). Moreover, the establishment of a Country-Coordinating Mechanism (CCM) with
civil society sectors participation is to fulfill the requirement of the Global
Fund for HIV/AIDS, TB and Malaria in order to be able to receive the
disbursement of money.2

o  
Participating body

Therefore,
the participating body named South African National Aids Council (SANAC) was
established in 2000 with 15 government representatives and 16 civil society
representatives: each from the different sector including trade unions, women,
youth, traditional healers, legal and human rights, and local government. The
member of the participating body were major leaders of civil society groups
participated in their individual capacity. They were selected by government
based on their reputation and achievements relating to HIV/AIDS. The most
significant umbrella organization participated was the National Association of
People Living with AIDS (NAPWA).

o  
Role and Agenda

SANAC
was chaired by the Deputy President and carried the duty of holding a
discussion among all stakeholders and role-players regarding to the solution
for the decreasing of HIV/AIDS epidemic. It was also assigned the role to
monitor the implementation of Strategic Plan and mobilise resources. SANAC
shared the same agenda with the government in focusing on the prevention and
forgoing treatment of HIV/AIDS.

o  
Critiques

SANAC
was criticized for the absent of treatment provision policy and the silence on
key aspects of government policy. According to informants that were mentioned
in Baracco and Papadakis’ research (2009) SANAC has failed to address the
important controversial issues in HIV/AIDS field such as mother to child
transmission (MTCT), and the provision of antiretroviral for women victim of
rape not to mention large scale treatment (interview of Heywood; Munro,
Mazibuko, Clark; LeRoux in Baracco and Papadakis, 2009).

These
issues were left unaddressed and complicated by the incorrect belief regarding
origin of virus and how to cure or prevent it (Baracco and Papadakis, 2009).
For example, the disease was believed to be created in a laboratory by the
Apartheid state to be used on the black indigenous and the promotion of condom
usage is also to limit the number of black population. Also it is an incorrect
belief that having sexual intercourse with a virgin will cure AIDS. The female
population in South African are considered to be inferior and, therefore, have
high tendency to be raped.

 

Analysis of empirical
case study

The
goal is to track down whether the fora have developed as originally visionalised
by the state and whether the outcome of the participatory for a is a more
effective public policy and stimulate deeper sense of democratic participation
in public arena. The outcome is that the role of participating fora in South
Africa is totally inefficient because of the factors below;

The control of the
state

The
ideal role of the state in the participatory policy making process needs need
to be different from the past. The theory recommends the engagement of the
civil society group with the state for the joint resolution with the assumption
that the exchange of knowledge and reason would lead to the efficient outcome. The
method focuses heavily on the discussion and joint decision making of the fora.
Therefore, the state should not take the lead role, but the facilitating role
of the fora. It should no longer provide direct solutions to regulatory
problems. Instead it should mainly lay out the broad agenda or objectives of
the regulations to be issued, promote the representational symmetries and equal
representation through structure, select in the universe of groups with
qualitative features that enable them to be the ideal participants with the
notion of “common good” associational, and, most importantly, encourage
associations to come together, discuss the solution and experiment solving the
problem by incentivizing them to learn from the experience of each group (Dorf
and Sabel, 1998; Sabel, 1999).

The
state case should learn from the management techniques of big private organizations
with decentralized collaborative pattern which ventures both collaborate and
compete with each other for the most effective and practical solutions to
technical problems (Helper et al, 2000).

However,
in the case of SANAC, the South African state has interfered and control the
participating fora’s agenda, handpicked the representative of each organization
by itself, and have preferences for the adopting of only certain policy that
fits its perspective. As a result, it is not surprising that the view of SANAC,
some national associations for HIV/AIDS and the government’s perspective on the
issue are systematically the same. They shared the view that the links between
HIV and AIDS are ambiguous and believe that the infrastructure and the economic
status of the country is not appropriate for the treatment action campaign.
Moreover, the perceived that the distribution of antiretrovirals would have
serious undesirable effects on the patients’ health leading to the absent of
treatment policy and AIDS infected people are left on their own (Barracco and
papadakis, 2009). When the perspectives turn out to be the same with the
government, the so called “second association” has no negotiating power and act
like a mouthpiece of the government instead of the public.

It
should be noted that it is difficult in a developing country like South Africa to
seek for the reliable and neutral state as the public fora advocator, since a developing
country are prone priorities its economic status. Since they believe that
poverty is the main cause of various kinds of problem in the country. Economic
growth has received the first priority for the eradication of poverty and other
problems that were perceived to be consequences of poverty (Baracco and
Papadakis, 2009).

 

The
dependency on institutionalized engagement

SANAC
was not empowered by the state, but got captured in the institutionalized engagement
with the government. It is, therefore, was failed to achieve the standard of
empowered participatory governance (Fung and Wright, 2003). In this case, the
government seems to use the participating fora for the facilitation of the
public compliance in controversial policies. The ruling ANC party is also very
powerful in the country and the civil and political society are difficult to separate
(Friedman, 1992). “in the field of HIV/AIDS SANAC is certainly not an example
of good practice.” While the “collective voices of civil society, private
sector and the church need to be heard,” these voices are not heard within
SANAC, but, more easily, outside of it” (see Deane, 2003). The comparison of
SANAC and TAC below will further illustrate the claim.

Treatment
Action Campaign (TAC), the largest and most influential NGO in the HIV/AIDS
field, hold the strongest critiques of SANAC. TAC has been critical about the
structure of the participating body as well as the representatives of
organizations participating in the body. Geffen, N., the national coordinator
of TAC, stated through an email exchange with Papadakis, K (Baracco and
Papadakis, 2009, p. 4), that “SANAC’s participants have not been able to
actively influence the agenda of this body and have remained prisoners to the
agenda of the government.” This is in fact relevant with the fact that the
representative from each organization and sector were hand-picked by the
government. The committee of SANAC is also the government officer, Deputy
President resulting in the issue systematically similar agenda of SANAC and the
government

TAC
was established in 1998 to lobby the government for more affordable treatment
provision. The relationship between the organization and the government
deteriorate after the government decided to not provided the comprehensive
treatment in a large scale.  

Then
the TAC decided to help bring the treatment by its own way. TAC filed the case
against the government for the failure to provide HIV/AIDS treatment. The
Constitutional Court finally upheld the decision of High Court and confirmed that
failure to treatment provision violated the constitutional rights of women and
babies.

Department
of Health still delayed the rolling out of the distribution plan after the
verdict with the excuse that the infrastructure was insufficient. TAC has
responded by creating a public disobedient campaign to request for the equality
in the distribution. The TAC mobilization was also majorly responsible for the
changes in SANAC institutional structure that happened in 2003. The
participants in SANAC was then elected by each sector themselves instead of the
government and also the composition of various sector is wider including the
national representative of TAC. On the other hand, TAC, the NGOs that is not in
the participating body has a more active role and has power to push for new
policy through many methods except participation which it views as mere
co-opting with the government.

 

Conclusion

Despite
such strong intention to participate civil society in the policy making
process, the participatory policy implementation by the South African
government through main policy-making fora that open for civil society
participation and influence have failed to be the important mechanism to direct
democracy due to high level of state interference, lack of neutrality, lack of
real interest or expected self-benefits, and dependency of the civil society
toward the state.  Comparing to the civil
society outside the institutional structure like TAC, SANAC did not reflect the
needs of the public nor actually be their representatives. In this case, the
NGOs have demonstrated higher capacity in pushing the public policy and
representing the public voice. However, it cannot be refused that every social
movement need to engage the state at one point to push its agenda to transform
public policy and the engagement would be the most productive when the civil
society maintain its capacity to mobilise and create public awareness via other
method by itself.

 

 
 

1 Ministry of
Health reported that “In South Africa, we cannot afford these medicines. The
budget for medicines is R2 billion. We face a number of diseases in this
country, and if we bought anti-retrovirals, we

couldn’t afford to treat any of the
others. At the meeting with the pharmaceutical companies in June, we all agreed

that the medications were very
expensive. You also need to keep a supply of twelve different cocktails,
because

resistance builds up so quickly.”
(Minister’s
Parliamentary Media Briefing September 13, 2001, see

http://www.pmg.org.za/briefings/010913health.htm).

2
37
Guideline 1 of the International Guidelines on HIV/AIDS and Human
Rights states: “States should establish an

effective national
framework for their response to HIV/AIDS which ensures a co-ordinated,
participatory, transparent

and accountable
approach, integrating HIV/AIDS policy and programme responsibilities, across
all branches of government.(http://www.unaids.org/en/in+focus/hiv_aids_human_rights/international_guidelines.asp)