Scaling up antiretroviral therapy in Uganda

Using supply chain management to appraise health systems strengthening

Dados Bibliográficos

ID19534015
AutoresRicarda Windisch (0000-0002-8185-1717, Swiss Tropical and Public Health Institute, autor correspondente), Peter Waiswa (0000-0001-8221-902X, Makerere University), Florian Neuhann (0000-0001-5944-1597, Heidelberg University), Florian Scheibe, Florian J B Scheibe (Heidelberg University), Don De Savigny (0000-0002-6903-4722, Swiss Tropical and Public Health Institute)
Ano2011
Volume7
Fascículo1
Páginas25
Data de publicação2011-01-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoGlobalization and Health (JOURNAL)
Identificadores do periódicoISSN: 1744-8603 • E-ISSN: 1744-8603
EditoraSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1186/1744-8603-7-25
PMID21806826
PMCIDPMC3161852
OpenAlexW2070456588
IdiomaEN
Citações recebidas14
Referências citadas9

BACKGROUND: Strengthened national health systems are necessary for effective and sustained expansion of antiretroviral therapy (ART). ART and its supply chain management in Uganda are largely based on parallel and externally supported efforts. The question arises whether systems are being strengthened to sustain access to ART. This study applies systems thinking to assess supply chain management, the role of external support and whether investments create the needed synergies to strengthen health systems. METHODS: This study uses the WHO health systems framework and examines the issues of governance, financing, information, human resources and service delivery in relation to supply chain management of medicines and the technologies. It looks at links and causal chains between supply chain management for ART and the national supply system for essential drugs. It combines data from the literature and key informant interviews with observations at health service delivery level in a study district. RESULTS: Current drug supply chain management in Uganda is characterized by parallel processes and information systems that result in poor quality and inefficiencies. Less than expected health system performance, stock outs and other shortages affect ART and primary care in general. Poor performance of supply chain management is amplified by weak conditions at all levels of the health system, including the areas of financing, governance, human resources and information. Governance issues include the lack to follow up initial policy intentions and a focus on narrow, short-term approaches. CONCLUSION: The opportunity and need to use ART investments for an essential supply chain management and strengthened health system has not been exploited. By applying a systems perspective this work indicates the seriousness of missing system prerequisites. The findings suggest that root causes and capacities across the system have to be addressed synergistically to enable systems that can match and accommodate investments in disease-specific interventions. The multiplicity and complexity of existing challenges require a long-term and systems perspective essentially in contrast to the current short term and program-specific nature of external assistance

Antiretroviral therapy · Business · Economics · Health administration · Health services research · Public health · Quality of Life Research · Social policy · Viral load · Global Maternal and Child Health · Medicine · Nursing · Pharmaceutical Economics and Policy · Pharmaceutical Quality and Counterfeiting · Health Policy · Virology