Assessing the level of institutionalization of donor-funded anti-retroviral therapy (ART) programs in health facilities in Uganda
Implications for program sustainability
Bibliographic Data
| ID | 19529515 |
|---|---|
| Authors | Henry Zakumumpa (0000-0002-8169-1151, Makerere University, corresponding author), Japheth Kwiringira (0000-0002-3323-6613, Kyambogo University), Joseph Rujumba (0000-0002-9485-8790, Makerere University), Freddie Ssengooba (0000-0003-3489-0745, Makerere University) |
| Year | 2018 |
| Volume | 11 |
| Issue | 1 |
| Pages | 1523302 |
| Publication date | 2018-01-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Global Health Action (JOURNAL) |
| Journal identifiers | ISSN: 1654-9716 • E-ISSN: 1654-9880 |
| Publisher | Informa UK Limited (PUBLISHER • GB) |
| DOI | 10.1080/16549716.2018.1523302 |
| PMID | 30295159 |
| OpenAlex | W2897239124 |
| Language | EN |
| References cited | 52 |
BACKGROUND: In the context of declining international assistance for ART scale-up in Sub-Saharan Africa, the institutionalization of ART programs through integrating them in the organizational routines of health facilities is gaining importance as a program sustainability strategy. OBJECTIVE: The aims of this study were; (i) to compare the level of institutionalization of ART programs in health facilities in Uganda and (ii) to explore reasons for variations in the degree of program institutionalization. METHODS: In Phase One, we utilized Level of Institutionalization Scales developed by Goodman (1993) to measure the degree of institutionalization of ART interventions in 195 health facilities across Uganda. The 45-item questionnaire measured institutionalization based on four sub-systems (production, maintenance, supportive, managerial) theorized to make up an organization assessed against two levels of institutionalization; routines (lowest) niche saturation (highest). In Phase Two, four health facilities were purposively selected (2 with the highest and 2 with the lowest institutionalization scores) for a multiple case-study involving semi-structured interviews with ART clinic managers(n = 32), on-site observations and document review. RESULTS: The two highest scoring health facilities had a longer HIV intervention implementation history of between 8 and 11 years. The highest scoring cases associated intervention institutionalization with sustained workforce trainings in ART management, the retention of ART-trained personnel and generating in-house ART manuals. The turnover of ART-proficient staff was identified as a barrier to intervention institutionalization in the lowest-ranked cases. Significant differences in organizational contexts were identified. The two highest-ranked health facilities were well-established, higher-tier hospitals while the lowest scoring health facilities were lower-level health facilities. CONCLUSIONS: The level of institutionalization of ART interventions appeared to be differentiated by level of care in the Ugandan health system. Interventions aimed at strengthening program institutionalization in lower-level health centers at the level of human resources for health could enhance ART scale-up sustainability
Geography · Institutionalisation · Political science · Psychiatry · Psychological intervention · Sustainability · Workforce · Global Maternal and Child Health · HIV/AIDS drug development and treatment · HIV/AIDS Research and Interventions · Medicine · Nursing
The social psychology of organizations
The sustainability of new programs and innovations
Making public health programs last
Building capacity and sustainable prevention innovations
Public health program capacity for sustainability
Reimagining HIV service delivery
Sustainability science
Building the Field of Health Policy and Systems Research
Planning for the sustainability of community-based health programs
Investment in HIV/Aids programs
“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
Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and Pepfar-funded HIV-activities
“The problem is ours, it is not CRAIDS’ ”. Evaluating sustainability of Community Based Organisations for HIV/Aids in a rural district in Zambia
Scaling up antiretroviral therapy in Uganda
Scaling up antiretroviral treatment and improving patient retention in care
Balancing the cost of leaving with the cost of living
What does sustainability mean in the HIV and Aids response
The future of financing for HIV services in Uganda and the wider sub-Saharan Africa region
Is Sustainability Possible? A Review and Commentary on Empirical Studies of Program Sustainability
The effects of global health initiatives on country health systems
Implementation Matters
Sustainability of Social Programs
Exploring program sustainability
Understanding the dynamic interactions driving Zambian health centre performance
Sustainability of Public Health Programs
An Agenda for Research on the Sustainability of Public Health Programs
Can they get along without us? Sustainability of donor-supported health projects in Central America and Africa
Scaling-up antiretroviral treatment in Southern African countries with human resource shortage
Using Mixed-Methods Sequential Explanatory Design
| Citation velocity | historical |
|---|---|
| Highly cited | No |