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

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dc.contributor.authorZakumumpa, Henry
dc.contributor.authorDamian, Respicius Shumbusho
dc.contributor.authorDube, Nkosiyazi
dc.contributor.authorRutebemberwa, Elizeus
dc.date.accessioned2019-01-16T07:48:19Z
dc.date.available2019-01-16T07:48:19Z
dc.date.issued2018-07-11
dc.description.abstractBackground: 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.en_US
dc.description.sponsorshipThis research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Wellcome Trust (UK)(Grant No: 087547/Z/08/Z), the Department for International Development (DfID) under the Development Partnerships in Higher Education (DelPHE), the Carnegie Corporation of New York (Grant No: B 8606), the Ford Foundation (Grant No: 1100–0399),Google.Org (Grant No: 191994), Sida (Grant No: 54100029) and MacArthur Foundation Grant No: 10– 95915-000-INP. The funders did not in any way contribute to the design of the study and collection, analysis, and interpretation of data.en_US
dc.identifier.citationZakumumpa, 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), 23.en_US
dc.identifier.urihttp://hdl.handle.net/20.500.11810/5027
dc.language.isoenen_US
dc.publisherGlobal Health Research and Policyen_US
dc.subjectHealth systems, Sustainability, HIV treatment, Dynamic interactions, Systems thinkingen_US
dc.titleUnderstanding the dynamic interactions driving the sustainability of ART scale-up implementation in Ugandaen_US
dc.typeJournal Article, Peer Revieweden_US
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