“If donors woke up tomorrow and said we can't fund you, what would we do?” A health system dynamics analysis of implementation of PMTCT option B+ in Uganda

dc.contributor.authorDoherty, Tanya
dc.contributor.authorBesada, Donela
dc.contributor.authorGoga, Ameena Ebrahim
dc.contributor.authorDaviaud, Emmanuelle
dc.contributor.authorRohde, Sarah
dc.contributor.authorRaphaely, Nika
dc.date.accessioned2017-09-18T10:15:34Z
dc.date.available2017-09-18T10:15:34Z
dc.date.issued2017-07-26
dc.description.abstractBACKGROUND : In October 2012 Uganda extended its prevention of mother to child HIV transmission (PMTCT) policy to Option B+, providing lifelong antiretroviral treatment for HIV positive pregnant and breastfeeding women. The rapid changes and adoptions of new PMTCT policies have not been accompanied by health systems research to explore health system preparedness to implement such programmes. The implementation of Option B+ provides many lessons which can inform the shift to ‘Universal Test and Treat’, a policy which many sub-Saharan African countries are preparing to adopt, despite fragile health systems. METHODS : This qualitative study of PMTCT Option B+ implementation in Uganda three years following the policy adoption, uses the health system dynamics framework to explore the impacts of this programme on ten elements of the health system. Qualitative data were gathered through rapid appraisal during in-country field work. Key informant interviews and focus group discussions (FGDs) were undertaken with the Ministry of Health, implementing partners, multilateral agencies, district management teams, facility-based health workers and community cadres. A total of 82 individual interviews and 16 focus group discussions were completed. We conducted a simple manifest analysis, using the ten elements of a health system for grouping data into categories and themes. RESULTS : Of the ten elements in the health system dynamics framework, context and resources (finances, infrastructure & supplies, and human resources) were the most influential in the implementation of Option B+ in Uganda. Support from international actors and implementing partners attempted to strengthen resources at district level, but had unintended consequences of creating dependence and uncertainty regarding sustainability. CONCLUSIONS : The health system dynamics framework offers a novel approach to analysis of the effects of implementation of a new policy on critical elements of the health system. Its emphasis on relationships between system elements, population and context is helpful in unpacking impacts of and reactions to pressures on the system, which adds value beyond some previous frameworks.en_ZA
dc.description.departmentPaediatrics and Child Healthen_ZA
dc.description.librarianam2017en_ZA
dc.description.sponsorshipUNICEF New York through a grant from the government of Sweden, Norwegian Agency for Development Cooperation (Norad), South African Medical Research Council and National Research Foundation, South Africaen_ZA
dc.description.urihttp://www.globalizationandhealth.comen_ZA
dc.identifier.citationDoherty, T., Besada, D., Goga, A., Daviaud, E., Rohde, S. & Raphaely, N. 2017, '“If donors woke up tomorrow and said we can't fund you, what would we do?” A health system dynamics analysis of implementation of PMTCT option B+ in Uganda', Globalization and Health, vol. 13, art. no. 51, pp. 1-11.en_ZA
dc.identifier.issn1744-8603 (online)
dc.identifier.other10.1186/s12992-017-0272-2
dc.identifier.urihttp://hdl.handle.net/2263/62280
dc.language.isoenen_ZA
dc.publisherBioMed Centralen_ZA
dc.rights© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).en_ZA
dc.subjectHealth systemsen_ZA
dc.subjectOption B +en_ZA
dc.subjectPrevention of mother-to-child transmission (PMTCT)en_ZA
dc.subjectRapid appraisalen_ZA
dc.subjectHuman immunodeficiency virus (HIV)en_ZA
dc.subjectUgandaen_ZA
dc.title“If donors woke up tomorrow and said we can't fund you, what would we do?” A health system dynamics analysis of implementation of PMTCT option B+ in Ugandaen_ZA
dc.typeArticleen_ZA

Files

Original bundle

Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
Doherty_Donors_2017.pdf
Size:
839.51 KB
Format:
Adobe Portable Document Format
Description:
Article

License bundle

Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
license.txt
Size:
1.75 KB
Format:
Item-specific license agreed upon to submission
Description: