Author/Authors :
Lohman، Nathaniel نويسنده Department of Global Health,University of Washington,Seattle,USA , , Hagopian، Amy نويسنده Department of Global Health, Department of Health Services,University of Washington,Seattle,USA , , Luboga، Samuel Abimerech نويسنده Faculty of Health Sciences,Makerere University,Kampala,Uganda , , Stover، Bert نويسنده Department of Health Services,University of Washington,Seattle,USA , , Lim، Travis نويسنده Division of Global HIV and Tuberculosis,Atlanta,USA , , Makumbi، Frederick نويسنده Faculty of Health Sciences,Makerere University,Kampala,Uganda , , Kiwanuka، Noah نويسنده Faculty of Health Sciences,Makerere University,Kampala,Uganda , , Lubega، Flavia نويسنده Faculty of Health Sciences,Makerere University,Kampala,Uganda , , Ndizihiwe، Assay نويسنده Division of Global HIV and Tuberculosis,Atlanta,USA , , Mukooyo، Eddie نويسنده Resource Center for the
Uganda Ministry of Health,Uganda Ministry of Health,Nakasero,Uganda , , Barnhart، Scott نويسنده Department of Global Health,University of Washington,Seattle,USA , , Pfeiffer، James نويسنده Department of Global Health, Department of Health Services,University of Washington,Seattle,USA ,
Abstract :
Background Vertically oriented global health initiatives (GHIs) addressing the HIV/AIDS epidemic, including the President’s Emergency Plan for AIDS Relief (PEPFAR), have successfully contributed to reducing HIV/AIDS related morbidity and mortality. However, there is still debate about whether these diseasespecific programs have improved or harmed health systems overall, especially with respect to nonHIV health needs. Methods As part of a larger evaluation of PEPFAR’s effects on the health system between 2005-2011, we collected qualitative and quantitative data through semistructured interviews with District Health Officers (DHOs) from all 112 districts in Uganda. We asked DHOs to share their perceptions about the ways in which HIV programs (largely PEPFAR in the Ugandan context) had helped and harmed the health system. We then identified key themes among their responses using qualitative content analysis. Results Ugandan DHOs said PEPFAR had generally helped the health system by improving training, integrating HIV and nonHIV care, and directly providing resources. To a lesser extent, DHOs said PEPFAR caused the health system to focus too narrowly on HIV/AIDS, increased workload for already overburdened staff, and encouraged doctors to leave public sector jobs for higherpaid positions with HIV/AIDS programs. Conclusion Health system leaders in Uganda at the district level were appreciative of resources aimed at HIV they could often apply for broader purposes. As HIV infection becomes a chronic disease requiring strong health systems to manage sustained patient care over time, Uganda’s weak health systems will require broad infrastructure improvements inconsistent with narrow vertical health programming.
