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WHO recommendations and the politics of expertise: policy transfer over AIDS policies in Africa

Perrine Bonvalet
Institut d'Études Politiques de Bordeaux
Perrine Bonvalet
Institut d'Études Politiques de Bordeaux
Open Panel

Abstract

International actors play a prevailing role in shaping AIDS policies in Africa. In this context, the World Health Organisation''s AIDS recommendations are of particular importance in developing similarities among countries'' policies. Presented as rational, consensual and neutral scientific evidence providing a basis for policy-making, they are extremely difficult to challenge, in spite of their constant and necessary improvement. Going back and forth between national and international levels, this paper aims at shedding light on the mechanisms that allow the predominance of these recommendations in shaping policies regardless of national particularities, thus participating in AIDS policy diffusion. This research is based on Benin''s policy for access to treatment (60 in-depth interviews and observational studies) at the national level and on the analysis of recommendations'' building at the international level. The centrality of the WHO and the UNAIDS and the alignment of international donors partly explain their unchallenged predominance at the national level. Using an “epistemic community” approach, this paper shows that there is also a process of internalization of these recommendations among health professionals and state actors, through training and networking, which helps build a consensus about medical knowledge. The appearance of national AIDS experts nonetheless gave the country a capacity to reject unfit recommendations. Controversies however happen only at the margin and the position of the WHO and UNAIDS enables them to keep an upper hand in these “battles over expertise”. It is mostly in international fora that the WHO recommendations are being challenged, sometimes by the very same experts.