Understanding the dynamic interactions driving the sustainability of ART scale-up implementation in Uganda
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Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
Global health research and policy
Abstract
Despite increasing recognition that health-systems constraints are the fundamental barrier to
attaining anti-retroviral therapy (ART) scale-up targets in Sub-Saharan Africa, current discourses are
dominated by a focus on financial sustainability. Utilizing the health system dynamics framework, this study
aimed to explore the interactions in health system components and their influence on the sustainability of
ART scale-up implementation in Uganda.
Methods: This study entailed qualitative organizational case-studies within a two-phased mixed-methods
sequential explanatory research design. In Phase One, a survey of 195 health facilities across Uganda which
commenced ART services between 2004 and 2009 was conducted. In Phase Two, six health facilities were
purposively selected for in-depth examination involving i) In-depth interviews (n = 44) ii) and semistructured
interviews (n = 35). Qualitative data was analyzed by coding and thematic analysis. Descriptive
statistics were managed in STATA (v 13).
Results: Five dynamic interactions in ART program sustainability drivers were identified; i) Failure to update
basic ART program records contributed to chronic ART medicines stock-outs ii) Health workforce shortages
and escalating patient volumes prompted adaptations in ART service delivery models iii) Broader
governance issues manifested in poor road networks undermined ART medicines supply chains iv)
Sustained financing for ART programs was influenced by external donors v) The values associated with the
ownership-type of a health facility affected ART service delivery and coverage.
Conclusion: The sustainability of ART programs at the facility-level in Uganda is a function of a complex
interaction in elements of the health system and must be understood beyond sustaining international
funding for ART scale-up.
Description
Keywords
Health systems, Sustainability, HIV treatment, Dynamic interactions, Systems thinking
Citation
Zakumumpa, H., Dube, N., Damian, R. S., & Rutebemberwa, E. (2018). Understanding the dynamic interactions driving the sustainability of ART scale-up implementation in Uganda. Global health research and policy, 3, 1-12. https://doi.org/10.1186/s41256-018-0079-6