Scaling up antiretroviral therapy in Uganda
Using supply chain management to appraise health systems strengthening
Bibliographic Data
| ID | 19534015 |
|---|---|
| Authors | Ricarda Windisch (0000-0002-8185-1717, Swiss Tropical and Public Health Institute, corresponding author), 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) |
| Year | 2011 |
| Volume | 7 |
| Issue | 1 |
| Pages | 25 |
| Publication date | 2011-01-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Globalization and Health (JOURNAL) |
| Journal identifiers | ISSN: 1744-8603 • E-ISSN: 1744-8603 |
| Publisher | Springer Science and Business Media LLC (PUBLISHER) |
| DOI | 10.1186/1744-8603-7-25 |
| PMID | 21806826 |
| PMCID | PMC3161852 |
| OpenAlex | W2070456588 |
| Language | EN |
| Citations received | 14 |
| References cited | 9 |
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
Pharmaceutical Supply Chain Management Challenges in Developing Countries
Failure is not an option
The long last mile of access to essential medicines
Prevalence and factors associated with delayed antiretroviral therapy initiation among adults with HIV in Alebtong district, Northern Uganda
“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
Global health initiative investments and health systems strengthening
Health sector fragmentation
Analyzing efforts to synergize the global health agenda of universal health coverage, health security and health promotion
Systems approaches for localising the SDGs
Assessing the level of institutionalization of donor-funded anti-retroviral therapy (ART) programs in health facilities in Uganda
Transaction Costs for Delivering HIV&Aids Prevention Services in Uganda
Defining pharmaceutical systems strengthening
Factors that influence the scale up of new interventions in low-income settings
Applying systems theory to global mental health
| Unique citing works | 14 |
|---|---|
| Citations per year | 1,08 |
| Citation span | 2013 - 2025 (13) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 14 |