title: Introduction of male circumcision for HIV prevention in Uganda: analysis of the policy process.
abstract: BACKGROUND
  Health policy analysis is important for all health policies especially in fields with ever changing evidence-based interventions such as HIV prevention. However, there are few published reports of health policy analysis in sub-Saharan Africa in this field. This study explored the policy process of the introduction of male circumcision (MC) for HIV prevention in Uganda in order to inform the development processes of similar health policies.
  
  
  METHODS
  Desk review of relevant documents was conducted between March and May 2012. Thematic analysis was used to analyse the data. Conceptual frameworks that demonstrate the interrelationship within the policy development processes and influence of actors in the policy development processes guided the analysis.
  
  
  RESULTS
  Following the introduction of MC on the national policy agenda in 2007, negotiation and policy formulation preceded its communication and implementation. Policy proponents included academic researchers in the early 2000s and development partners around 2007. Favourable contextual factors that supported the development of the policy included the rising HIV prevalence, adoption of MC for HIV prevention in other sub-Saharan African countries, and expertise on MC. Additionally, the networking capability of proponents facilitated the change in position of non-supportive or neutral actors. Non-supportive and neutral actors in the initial stages of the policy development process included the Ministry of Health, traditional and Muslim leaders, and the Republican President. Using political authority, legitimacy, and charisma, actors who opposed the policy tried to block the policy development process. Researchers' initial disregard of the Ministry of Health in the research process of MC and the missing civil society advocacy arm contributed to delays in the policy development process.
  
  
  CONCLUSIONS
  This study underscores the importance of securing top political leadership as well as key implementing partners' support in policy development processes. Equally important is the appreciation of the various forms of actors' power and how such power shapes the policy agenda, development process, and content.
authors.affiliation: East, Central and Southern Africa-Health Community (ECSA), P.O. Box 1009, Arusha, Tanzania. walodoch@yahoo.com.|African Centre for Health System Strengthening Innovations (Afri-CHEST), P.O. Box 367251, Kampala, Uganda. walodoch@yahoo.com.
authors.forename: Walter Denis
authors.initials: WD
authors.lastname: Odoch
authors.affiliation: African Centre for Health System Strengthening Innovations (Afri-CHEST), P.O. Box 367251, Kampala, Uganda. kenkysy@yahoo.com.|Uganda Protestant Medical Bureau, Plot 877, Balintuma Road, P.O. Box 4127, Kampala, Uganda. kenkysy@yahoo.com.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kabali
authors.affiliation: African Centre for Health System Strengthening Innovations (Afri-CHEST), P.O. Box 367251, Kampala, Uganda. ancheal2002@yahoo.com.|Ernest Cook Ultrasound Research Education Institute, Sir Albert Cook Building, Mengo Hospital, P.O. Box 7161, Kampala, Uganda. ancheal2002@yahoo.com.
authors.forename: Racheal
authors.initials: R
authors.lastname: Ankunda
authors.affiliation: Department of Public Health, School of Medicine, University of Zambia, P.O. Box 50110, Lusaka, Zambia. josephmumbazulu@gmail.com.|Umeå International School of Public Health (UISPH), Umeå University, SE 90185, Umeå, Sweden. josephmumbazulu@gmail.com.
authors.forename: Joseph Mumba
authors.initials: JM
authors.lastname: Zulu
authors.affiliation: African Centre for Health System Strengthening Innovations (Afri-CHEST), P.O. Box 367251, Kampala, Uganda. tetuimoses@gmail.com.|Makerere University School of Public Health, New Mulago Hospital Complex, P.O. Box 7072, Kampala, Uganda. tetuimoses@gmail.com.
authors.forename: Moses
authors.initials: M
authors.lastname: Tetui
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control; D017954:Africa South of the Sahara; D002944:Circumcision, Male; D015658:HIV Infections / Q000517:prevention & control*; D006291:Health Policy; D006801:Humans; D008297:Male; D011050:Policy Making; D014454:Uganda