According to Article 6, non-state actors include:. What are private actors? What are state and non state actors? Is a public school a state actor? What are the four basic elements of a country? A State stands identified with its four absolutely essential elements:. What is the difference between state and non state terrorism?
Who are the primary actors in international law? What are the types of non state institution? Are IGOs state actors? What is non state terrorism? What is state institution? What are non state actors PDF? In this period, mainstream access to HIV treatment in the developing world was beginning to be promoted globally.
In , Brazil was the sole middle-income country providing universal coverage for ARV-based medication. Through these public-private partnerships, small-scale ART was implemented in some African and Latin American settings.
After a decade of incremental changes in the national ART initiative, the Thai Health Minister declared the commitment to expand treatment to cover all PHA in need in late Many factors influenced the decision to drive the issue of treatment expansion up the government agenda Tantivess Parallel reforms in the health sector and global efforts to expand access to HIV medicines were also important.
Here we focus on the changes in ART policy networks at the time of policy innovation: in particular, CSOs, who had previously advocated treatment expansion, and were outsiders to the policy-making sphere, began to participate much more closely in policy-making processes.
This was facilitated by legal changes to the Thai Constitution in , whereby the rights of citizens to participate in much public policy-making were explicitly acknowledged.
This principle promoted the participation of PHA and communities in policy decisions and implementation. This provided a framework to formalize PHA activities and encourage close collaboration between the government and CSOs. This was a highly effective and active network at the national level, which was able to draw on support from international networks too.
In they filed a case at the Intellectual Property Court to revoke Bristol-Myers Squibb's patent on didanosine Ford , and in the company cancelled its patent—before the Court ruled.
Treatment advocacy networks also had close relationships with the health system reformists who led the initiation of the UC scheme under the new regime. Nevertheless, prior to the adoption of the universal ART policy in , only a few of these network members for example some HIV specialists joined government AIDS officials in making decisions on the national treatment initiative.
This was because the government excluded ARVs from the UC benefit package owing to concerns about their unaffordable financial burden and programme sustainability.
In several meetings with insurance officials and the Minister of Health, treatment advocates presented evidence on the effectiveness of HAART and the associated cost-savings from opportunistic infections averted in Western countries and Brazil, as well as the availability and prices of ARVs produced by an Indian generic company, Cipla Tantivess Human rights, justice and equity were raised as the rationale of service extension.
A leader of the treatment alliances argued: Those who can afford it are now able to have a good quality of life for a long period of life. This raises the question whether drugs should be considered in the same terms as a commodity … or should it be considered an essential part of people's needs and therefore a right.
Should it be a right to people in the world to receive the drugs needed in order to support their life? Ungphakorn , p. However, state actors also played crucial roles in this policy stage. The progress in research and development and pilot-scale manufacture was monitored closely by the Minister and senior officials.
Parallel to the meetings with civic networks, intensive internal discussions took place within the MoPH. It seemed that a group of health system reformists and economists who provided technical support to the Health Minister on UC introduction dominated the decision-making. Some of these technocrats encouraged the Minister to scale-up treatment since they anticipated not only the clinical and economic benefits of HAART, but also felt the policy would enhance the country's reputation globally.
However, they maintained that ARV medication should be delivered outside the UC scheme because its financial sustainability remained uncertain. This was partly due to the lack of evidence on treatment adherence profiles, drug resistance development and needs for second-line ARVs in the future. As the Health Minister argued in interview in Tantivess , the universal treatment policy was adopted because the government had strong intentions to provide equitable access to all essential health services.
An argument can, thus, be made that the ART policy innovation was not due to domestic or international political pressure but, to some extent, was motivated by true public interest expressed by government officials as well as CSO groups. Government had a commitment to improve treatment access. This was reflected in ministerial policies and actions, for example the programme to strengthen the GPO's capacity in order to extend generic ARV production was, as already noted, implemented immediately after the Thai Rak Thai cabinet came to power.
Such effort indicates that the government had clear objectives and strategies to address the treatment obstacles. Drug price reduction—a vital factor in the adoption of universal ART coverage—was partly the outcome of the administration's advocacy.
At the same time, government commitment to providing ART was accompanied by sustained lobbying and campaigning by networks of activists promoting the rights of individuals to health care.
Opposition to extending ART coverage came largely from a group of actors in the government sector, i. They were concerned about the inadequate preparedness of the health delivery system and the uncertainty of long-term financing. However, these concerns were difficult to maintain in the face of the powerful arguments of those who supported ART expansion. Given that ART delivery was complex, the scale-up of the national treatment programme to achieve universal coverage required substantial changes in both the existing HIV services and general health delivery.
Scale-up affected the designations of responsible agencies; patient enrolment criteria; treatment protocols; and training of health workers in hospitals throughout the country. These formed the core of the policy community. Although these advisory panels were active only in the year , their contributions were beneficial to ART extension. Substantial changes in treatment delivery were introduced as recommended by experts, AIDS officials and NGOs as members of the four panels.
These included, for instance, the suggestion to build up connections with new partners such as the Bangkok Metropolitan Local Government and public insurance schemes other than the UC, aimed at addressing the existing gaps of ART coverage in the capital city and private hospitals Administration Advisory Panel a.
The revisions of ARV regimens, related clinical practice guidelines, and training programmes for workforce development were also attributed to this core policy formulation community. Another clear illustration of the administration panel's role was that its proposals to provide opportunities for NGO and PHA participation in training and care delivery were adopted by the MoPH Administration Advisory Panel b.
All of the policy recommendations made by the policy formulation panels were informed by the experience and expertise of the panel members, feedback from previous policy implementation, and the current context of the health delivery system, especially treatment challenges generated by the on-going reforms.
An example is the major revisions of treatment regimens. Evaluations of the national ART programme prior to the policy innovation indicated weaknesses including inefficient procurement, poor inventory and allocation of ARVs to participating hospitals, because as many as eight complicated combinations had been adopted Punpanich et al. The panels for clinical guideline development therefore sought to simplify the protocols, lessen the problems in treatment administration and drug management, and support mass service delivery.
This body aimed to provide an overarching umbrella to integrate the previously disjointed ART initiatives implemented by different departments of the MoPH, with different target populations. This group too included CSOs in its deliberations. As key stakeholders involved in the policy adoption and formulation stages anticipated, ART scaling-up during to was impeded by many factors.
However, networks of sub-national actors acted to counter the impediments and to facilitate the implementation of good quality treatment.
The collaboration between civic groups and their government counterparts was expanded when Thailand obtained financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria in , which required NGO participation at policy-decision and operational levels of the national HIV programme. In two study provinces Tantivess , sub-national networks formed to address problems such as inadequately experienced ART providers and the effects of HIV-related stigma on care-seeking behaviour, seeking ways to ensure service quality.
Although health workers in hospitals and officials in provincial and regional health offices were key people translating treatment expansion policy into action, the role of NGOs and patient group members was also indispensable.
These civic groups carried out some tasks for which health providers had only limited capacity. These included understanding the problems and needs of HIV patients, providing necessary information in lay language, and making adequate time for talking to and working with AIDS patients and their families.
They also replaced the highly visible professional health workers on home visits, to help avoid any further stigmatization of individuals and families given widespread local sensitivities about the disease. In addition, ART-experienced PHA had a role in convincing high-risk and the infected persons, who had been reluctant to receive institutional care, to seek counselling and HIV testing.
In an interview in , one member of a self-help group in a study province pointed out that: Neighbours frequently asked me how my illnesses were relieved—which kinds of medicines I took. They saw me getting healthier … some of them had children or relatives who had the disease so they asked me for advice. They were afraid of visiting hospitals and seeing doctors. I told them not to worry … drugs were available and also we had organized as a group.
It was better joining the group than staying desperately at home. Patient groups were created and managed by health workers in the public hospitals. These groups had fewer members and were less well organized, compared with those in hospitals of the same size in the former province.
However, the group leaders were helpful in treatment delivery as they visited ART recipients at home, encouraged adherence and provided information. A key feature of patient groups in this province was that they obtained very little support from the regional and national PHA alliances, and were not independent of their host hospitals.
While the civic networks were relatively weak, the role of a small community of health professionals was crucial to policy implementation. The extension of treatment was hampered by a lack of experienced prescribers in this province because of the rapid turnover of general practitioners in district hospitals.
To overcome this problem the small health professional group organized training courses for newly graduated doctors, pharmacists and nurses, most of whom were allocated to work in district settings.
A network for consultations on clinical, laboratory and logistic issues was also established to support ART service at district level. From , access to ART in Thailand was expanded gradually, leading to rising budget needs. Like other antimicrobials, use of ARVs inevitably results in the development of viral resistance to drugs, subsequently increasing needs for second-line regimens. Security and justice provision would be transformed if programmes, recognising the multiple layering of providers, were to build bridges across those layers.
A wide range of non-state security actors — commercial, customary and community-based — are involved in security and justice provision in the South. However, there is a realisation among donors that these links should be supported in certain circumstances.
Links between state and non-state actors occur in four main categories: 1 the sharing of intelligence; 2 the sharing of equipment and training; 3 joint patrols and operations; and 4 enrolment by one actor of another. Enrolment refers to one actor aligning its own objectives to some degree with the direction given by another actor. Further findings are that:.
Actively developing links between state and non-state systems offers the opportunity of state oversight according to defined standards and within an affordable national budget. It can also link state systems to non-state providers who enjoy local ownership, sustainability and effective procedures.
They are not allies to any government or state, which makes it possible for them to work individually and also to allow them to influence and interfere with the actions of the state actors.
IGO or Inter-Governmental Organizations Who are allied together regionally or internationally on a common interest, and are established by states through a treaty, e.
Trans-National Actors — Groups or individuals that function below the state level but across borders, e. Violent political Groups — Groups that are politically motivated and who intend to propagate violence and influence the actions of the state like terrorist groups, warlords, Militia, Insurgent groups etc. Criminal groups — Those who are engaged in criminal activities and illegitimate activities.
Their intentions are not politically motivated, rather motivated by financial gains. In addition to these main subdivisions, influential individual figures like Dalai Lama, The Pope, celebrities, etc.
Summary — State Actors vs Non-State Actors International relations deal in studying the manner how the actors in the international arena, state actors and non-state actors, interact with each other. Globalization and the development of technologies have transformed the international order; today, not only state actors have become major players in the international arena, but non-state actors as well.
As a result, most of the actions of state actors are influenced and challenged by this growing demands of non-state actors.
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