4 research outputs found
Conducting a Large Public Health Data Collection Project in Uganda: Methods, Tools, and Lessons Learned
We report on the implementation experience of carrying out data collection and other activities for a public health evaluation study on whether U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) investment improved utilization of health services and health system strengthening in Uganda. The retrospective study period focused on the PEPFAR scale-up, from mid-2005 through mid-2011, a period of expansion of PEPFAR programing and health services. We visited 315 health care facilities in Uganda in 2011 and 2012 to collect routine health management information system data forms, as well as to conduct interviews with health system leaders. An earlier phase of this research project collected data from all 112 health district headquarters, reported elsewhere. This article describes the lessons learned from collecting data from health care facilities, project management, useful technologies, and mistakes. We used several new technologies to facilitate data collection, including portable document scanners, smartphones, and web-based data collection, along with older but reliable technologies such as car batteries for power, folding tables to create space, and letters of introduction from appropriate authorities to create entrée. Research in limited-resource settings requires an approach that values the skills and talents of local people, institutions and government agencies, and a tolerance for the unexpected. The development of personal relationships was key to the success of the project. We observed that capacity building activities were repaid many fold, especially in data management and technology
District Health Officer Perceptions of PEPFAR’s Influence on the Health System in Uganda, 2005-2011
Background: Vertically oriented global health initiatives (GHIs) addressing the HIV/AIDS epidemic, including
the President’s Emergency Plan for AIDS Relief (PEPFAR), have successfully contributed to reducing HIV/AIDS
related morbidity and mortality. However, there is still debate about whether these disease-specific programs have
improved or harmed health systems overall, especially with respect to non-HIV health needs.
Methods: As part of a larger evaluation of PEPFAR’s effects on the health system between 2005-2011, we collected
qualitative and quantitative data through semi-structured interviews with District Health Officers (DHOs) from
all 112 districts in Uganda. We asked DHOs to share their perceptions about the ways in which HIV programs
(largely PEPFAR in the Ugandan context) had helped and harmed the health system. We then identified key
themes among their responses using qualitative content analysis.
Results: Ugandan DHOs said PEPFAR had generally helped the health system by improving training, integrating
HIV and non-HIV care, and directly providing resources. To a lesser extent, DHOs said PEPFAR caused the
health system to focus too narrowly on HIV/AIDS, increased workload for already overburdened staff, and
encouraged doctors to leave public sector jobs for higher-paid positions with HIV/AIDS programs.
Conclusion: Health system leaders in Uganda at the district level were appreciative of resources aimed at HIV
they could often apply for broader purposes. As HIV infection becomes a chronic disease requiring strong
health systems to manage sustained patient care over time, Uganda’s weak health systems will require broad
infrastructure improvements inconsistent with narrow vertical health programmin
Uganda PEPFAR Health System Effects Study
The US Government’s PEPFAR program has invested more than $30 billion in the care,
treatment and prevention of HIV AIDS. While many studies show benefit in controlling the
epidemic, HIV / AIDS is but one of many illnesses that make up the total burden of illness in
these countries. There are few studies that have looked at whether this large sum of money
has benefited or harmed other aspects of the health system. For example, has the focus on
HIV AIDS allowed for much of the health worker training to “spill over” and benefit patients
with other diseases? Or, has the massive investment lead to a shifting of health care workers
away from care of patients with non-HIV diseases. There are some key questions that are
important in understanding how rapid scale-up of HIV services affect non-targeted services
and the health system at different levels in Uganda