Global health in foreign policy in South Africa – Evidence from state actors

Introduction: There are currently debates about why South Africa integrates global health into its foreign policy agendas. This study aimed at exploring motivation and interests’ South African policy actors pursue to advance global health and the processes that lead to such integration. Methods: The study utilized a mixed-method design from a sample of state policy actors at the National Department of Health of South Africa. Participants were selected purposively and had experience of more than three years participating in various international health activities. All participants completed semi-structured questionnaires. Data was analysed to determine frequencies and transcribed text was analyzed using qualitative content analysis. Results: A total of 40 people were invited to participate, of whom 35 agreed. Of the respondent, 89.7% (n= 32) strongly argued that health should facilitate ‘free movement of people, goods and services’. Majority 79.0% (n= 29) agreed that ‘development and equality’ are the main element of foreign policy. Of the respondents, majority 77.1% (n= 27) agreed that ‘moral and human rights’ are main element of foreign policy. Furthermore, 82.8% (n= 29) agreed that the country should advance ‘Africa regionalism and south-south cooperation’ and 85.7% (n= 30) strongly argued for a ‘whole-government approach’ in addressing global health challenges. ‘HIV and AIDS’ and ‘access to medicines agenda’ were the main policy issue advanced. The main domestic factors that will shape South Africa’s involvement in global health were its ‘political leadership’ and “capacity of negotiators’. Conclusions: It is evident that within South Africa, state policy actors are largely concerned with promoting global health interest in the world of low politics, namely, human dignity and development cooperation. Furthermore, South Africa drives its global health through building coalition with other state and non-state actors such as civil society. HIV and AIDS as a policy issue, present a potential entry point for engagement on global health diplomacy.