MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Uganda: Expanding Targeted Services Into
Primary Health Care*
Abstract
Dr. Bernard Michael Etukoit1, Mr. Richard Wanyama1
1 The AIDS Support Organization
Several GHIs have funded programmes in Uganda since 2000, most recently the Global Fund and
PEPFAR. Overall, the GHIs have demonstrated system-wide benefits, but in some instances have
negatively impacted health systems. The study explored interactions between GHIs and health
systems. The research aim was to generate information to inform health policy and programming
from the knowledge, experience and perceptions of personnel at GHI-supported facilities. The
study was cross-sectional, employing both quantitative and qualitative methods.
GHIs were associated with improved service delivery in most facilities. They improved human
resources (HR) numbers and capacity with the exception of a few HR cadres. They led to overall
improvements in supply chain management and access to essential commodities (though
increased programme activity did in some instances overload supply, leading to stock-outs).
Leaders and governance structures were supported, but coordination remained a challenge. While
the increase in funding was significant, overall financing remained erratic. GHIs also raised a need
for improved data systems and capacity development/support; without such improvements,
reporting requirements led to staff overload. There also was conflict between infrastructure
development and programme expansion associated with many GHI-supported interventions.
Overall, there were positive synergies between GHI implementation and health systems in
Uganda. However, there were some negative outcomes as well.
Background
Uganda is a landlocked country in East Africa bordered by Sudan in the north, Kenya in the east,
the United Republic of Tanzania and Rwanda in the south, and the Democratic Republic of Congo
in the west. In 2007 Uganda had an estimated population of 30.9 million people with an average
annual population growth of 3.2% per year [1]. Uganda ranked 156 th out of 179 countries on the
Human Development Index in 2006 [2].
The HIV/AIDS prevalence rate in Uganda peaked in the 1990s at 25-30% in major urban areas, but
stabilized at 5.4% by 2007 [3]. About 940 000 people were living with HIV/AIDS by the end of 2007
[4].
An estimated 51% of households do not have access to medical services in Uganda, with health
care delivery especially poor in the northern areas affected by civil war [5]. While 60.89% of the
country’s physicians worked in cities in 2004, only 12.82% of the population lived in an urban area
[6]. General government expenditure on health as a percentage of total government expenditure
increased from 7.3% in 2000 to 10% in 2006 [7]. In 2006, 28.5% of the total health expenditure on
health came from external sources [7].
181