Aid alignment: a longer term lens on trends in development assistance for health in Uganda

Stierman, Elizabeth; Ssengooba, Freddie; Bennett, Sara

doi:10.1186/1744-8603-9-7

Cited by 37 publications

(49 citation statements)

References 15 publications

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“…Long distances to the nearest health facility are typical [35]. Dependence on donor aid in the health sector has been a persistent challenge [36, 37]. These characteristics of Uganda’s health system are shared with the majority of countries in sub-Saharan Africa [38, 39]; hence, innovations in ART service delivery models in Uganda have immense potential for adoption and implementation in the rest of SSA.…”

Section: Introductionmentioning

confidence: 99%

Modifications to ART service delivery models by health facilities in Uganda in promotion of intervention sustainability: a mixed methods study

2017

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BackgroundIn November 2015, WHO released new treatment guidelines recommending that all diagnosed as HIV positive be enrolled on antiretroviral therapy (ART). Sustaining and expanding ART scale-up programs in resource-limited settings will require adaptations and modifications to traditional ART delivery models to meet the rapid increase in demand. We identify modifications to ART service delivery models by health facilities in Uganda to sustain ART interventions over a 10-year period (2004–2014).MethodsA mixed methods approach involving two study phases was adopted. In the first phase, a survey of a nationally representative sample of health facilities (n = 195) in Uganda which were accredited to provide ART between 2004 and 2009 was conducted. The second phase involved semi-structured interviews (n = 18) with ART clinic managers of 6 of the 195 health facilities purposively selected from the first study phase. We adopted a thematic framework consisting of four categories of modifications (format, setting, personnel, and population).ResultsThe majority of health facilities 185 (95%) reported making modifications to ART interventions between 2004 and 2014. Of the 195 health facilities, 157 (81%) rated the modifications made to ART as “major.” Modifications to ART were reported under all the four themes. The quantitative and qualitative findings are integrated and presented under four themes. Format: Reducing the frequency of clinic appointments and pharmacy-only refill programs was identified as important strategies for decongesting ART clinics. Setting: Home-based care programs were introduced to reduce provider ART delivery costs. Personnel: Task shifting to non-physician cadre was reported in 181 (93%) of the health facilities. Population: Visits to the ART clinic were rationalized in favor of the sub-population deemed to have more clinical need. Two health facilities focused on patients living nearer the health facilities to align with targets set by external donors.ConclusionsOver the study period, health facilities made several modifications ART interventions to improve fit with their resource-constrained settings thereby promoting long-term sustainability. Further research evaluating the effect of these modifications on patient outcomes and ART delivery costs is recommended. Our findings have implications for the sustainability of ART scale-up programs in Uganda and other resource-limited settings.

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Section: Introductionmentioning

confidence: 99%

Modifications to ART service delivery models by health facilities in Uganda in promotion of intervention sustainability: a mixed methods study

2017

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“…[25][26][27] Yet accepting aid implies accepting input, so African governments have been subject to imposed conditions for assistance and inadequate governance and ownership over their own health programs and policies for decades, [28][29][30][31] and despite advances in the realm of development cooperation the age-old problems of donor conditionality, competing interests, and vertical-only programs persist. 28,29,[32][33][34][35] In this context, little is known about power imbalance (real or perceived) so a candid analysis of stakeholder perspectives regarding aid effectiveness issues and their potential solutions is warranted. Furthermore, the formal, externally-facing process is somewhat superficial, as policy is often influenced through informal negotiation behind closed doors.…”

Section: Introductionmentioning

confidence: 99%

Power and Agenda-Setting in Tanzanian Health Policy: An Analysis of Stakeholder Perspectives

Fischer

Strandberg-Larsen

2016

Int J Health Policy Manag

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Background: Global health policy is created largely through a collaborative process between development agencies and aid-recipient governments, yet it remains unclear whether governments retain ownership over the creation of policy in their own countries. An assessment of the power structure in this relationship and its influence over agenda-setting is thus the first step towards understanding where progress is still needed in policymaking for development. Methods: This study employed qualitative policy analysis methodology to examine how health-related policy agendas are adopted in low-income countries, using Tanzania as a case study. Semi-structured, in-depth, key informant interviews with 11 policy-makers were conducted on perspectives of the agenda-setting process and its actors. Kingdon's stream theory was chosen as the lens through which to interpret the data analysis. Results: This study demonstrates that while stakeholders each have ways of influencing the process, the power to do so can be assessed based on three major factors: financial incentives, technical expertise, and influential position. Since donors often have two or all of these elements simultaneously a natural power imbalance ensues, whereby donor interests tend to prevail over recipient government limitations in prioritization of agendas. One way to mediate these imbalances seems to be the initiation of meaningful policy dialogue. Conclusion: In Tanzania, the agenda-setting process operates within a complex network of factors that interact until a "policy window" opens and a decision is made. Power in this process often lies not with the Tanzanian government but with the donors, and the contrast between latent presence and deliberate use of this power seems to be based on the donor ideology behind giving aid (defined here by funding modality). Donors who used pooled funding (PF) modalities were less likely to exploit their inherent power, whereas those who preferred to maintain maximum control over the aid they provided (ie, non-pooled funders) more readily wielded their intrinsic power to push their own priorities. Keywords: Health Policy, Policy Analysis, Agenda-Setting, Power, Tanzania Copyright: © 2016 by Kerman University of Medical Sciences Citation: Fischer SE, Strandberg-Larsen M. Power and agenda-setting in Tanzanian health policy: an analysis of stakeholder perspectives.

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“…Poverty reduction strategy papers, as mentioned within Labonte and Torgerson’s framework [2], were evident, with a focus on the conceptualisation of aid [12] and on alignment of spending and domestic priorities [13]. The development of research was a topic within this; authors focused upon under-representation of low-income countries in the literature, research partnerships and ethical standards of research [14–16].…”

Section: Resultsmentioning

confidence: 99%

Globalization and Health: developing the journal to advance the field

et al. 2016

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Founded in 2005, Globalization and Health was the first open access global health journal. The journal has since expanded the field, and its influence, with the number of downloaded papers rising 17-fold, to over 4 million. Its ground-breaking papers, leading authors -including a Nobel Prize winner-and an impact factor of 2.25 place it among the top global health journals in the world. To mark the ten years since the journal's founding, we, members of the current editorial board, undertook a review of the journal's progress over the last decade. Through the application of an inductive thematic analysis, we systematically identified themes of research published in the journal from 2005 to 2014. We identify key areas the journal has promoted and consider these in the context of an existing framework, identify current gaps in global health research and highlight areas we, as a journal, would like to see strengthened.

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Aid alignment: a longer term lens on trends in development assistance for health in Uganda

Cited by 37 publications

References 15 publications

Modifications to ART service delivery models by health facilities in Uganda in promotion of intervention sustainability: a mixed methods study

Modifications to ART service delivery models by health facilities in Uganda in promotion of intervention sustainability: a mixed methods study

Power and Agenda-Setting in Tanzanian Health Policy: An Analysis of Stakeholder Perspectives

Globalization and Health: developing the journal to advance the field

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