Understanding the dynamic interactions driving the sustainability of ART scale-up implementation in Uganda

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 sustainability. Utilizing the health system dynamics framework, this study aime...

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Published inGlobal health research and policy Vol. 3; no. 1; p. 23
Main Authors Zakumumpa, Henry, Dube, Nkosiyazi, Damian, Respicius Shumbusho, Rutebemberwa, Elizeus
Format Journal Article
LanguageEnglish
Published England BioMed Central 06.08.2018
BMC
Subjects
Antiretroviral drugs
Dynamic interactions
Health facilities
Health systems
HIV
HIV treatment
Human immunodeficiency virus
Institutionalization
Questionnaires
Research design
Sustainability
Systems thinking
Uganda
Sub-Saharan Africa
HIV treatment
Health systems
Dynamic interactions
Systems thinking
Sustainability
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Summary: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 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. 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 ii) and semi-structured interviews ( ). Qualitative data was analyzed by coding and thematic analysis. Descriptive statistics were managed in STATA (v 13). 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. 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
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ISSN:2397-0642
2397-0642
DOI:10.1186/s41256-018-0079-6