The differential impacts of Pepfar transition on private for-profit, private not-for-profit and publicly owned health facilities in Uganda

Bibliographic Data

ID11490659
AuthorsJess Alan Wilhelm (0000-0001-9299-7984, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA, corresponding author), Ligia Paina (0000-0002-8403-7825, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA), Mary Qiu (0000-0003-4814-4591, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA), Henry Zakumumpa (0000-0002-8169-1151, Department of Health Policy and Administration, Makerere University School of Public Health, Kampala, Uganda), Sara Bennett (0000-0001-8094-8798, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA)
Year2020
Volume35
Issue2
Pages133-141
Publication date2020-03-01
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czz090
PMID31713608
OpenAlexW2986323620
LanguageEN
Citations received3
References cited23

While transition of donor programs to national control is increasingly common, there is a lack of evidence about the consequences of transition for private health care providers. In 2015, President’s Emergency Plan for AIDS Relief (PEPFAR) identified 734 facilities in Uganda for transition from PEPFAR support, including 137 private not-for-profits (PNFP) and 140 private for-profits (PFPs). We sought to understand the differential impacts of transition on facilities with differing ownership statuses. We used a survey conducted in mid-2017 among 145 public, 29 PNFP and 32 PFP facilities reporting transition from PEPFAR. The survey collected information on current and prior PEPFAR support, service provision, laboratory services and staff time allocation. We used both bivariate and logistic regression to analyse the association between ownership and survey responses. All analyses adjust for survey design. Public facilities were more likely to report increased disruption of sputum microscopy tests following transition than PFPs [odds ratio (OR) = 5.85, 1.79–19.23, P = 0.005]. Compared with public facilities, PNFPs were more likely to report declining frequency of supervision for human immunodeficiency virus (HIV) since transition (OR = 2.27, 1.136–4.518, P = 0.022). Workers in PFP facilities were more likely to report reduced time spent on HIV care since transition (OR = 6.241, 2.709–14.38, P < 0.001), and PFP facilities were also more likely to discontinue HIV outreach following transition (OR = 3.029, 1.325–6.925; P = 0.011). PNFP facilities’ loss of supervision may require that public sector supervision be extended to them. Reduced HIV clinical care in PFPs, primarily HIV testing and counselling, increases burdens on public facilities. Prior PFP clients who preferred the confidentiality and service of private facilities may opt to forgo HIV testing altogether. Donors and governments should consider the roles and responses of PNFPs and PFPs when transitioning donor-funded health programs

Business · Economic growth · Economics · Environmental health · Health facility · Health services · Logistic regression · Odds · Outreach · Population · Public health · Global Maternal and Child Health · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Nursing

Tools

Open DOISci-HubOpen Access