Alternative financing mechanisms for ART programs in health facilities in Uganda: a mixed-methods approach

Henry Zakumumpa; Sara Bennett; Freddie Ssengooba

doi:10.1186/s12913-017-2009-6

Alternative financing mechanisms for ART programs in health facilities in Uganda: a mixed-methods approach

Henry Zakumumpa, Sara Bennett, Freddie Ssengooba

Bloomberg School of Public Health

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Background: Sub-Saharan Africa is heavily dependent on global health initiatives (GHIs) for funding antiretroviral therapy (ART) scale-up. There are indications that global investments for ART scale-up are flattening. It is unclear what new funding channels can bridge the funding gap for ART service delivery. Many previous studies have focused on domestic government spending and international funding especially from GHIs. The objective of this study was to identify the funding strategies adopted by health facilities in Uganda to sustain ART programs between 2004 and 2014 and to explore variations in financing mechanisms by ownership of health facility. Methods: A mixed-methods approach was employed. A survey of health facilities (N = 195) across Uganda which commenced ART delivery between 2004 and 2009 was conducted. Six health facilities were purposively selected for in-depth examination. Semi-structured interviews (N = 18) were conducted with ART Clinic managers (three from each of the six health facilities). Statistical analyses were performed in STATA (Version 12.0) and qualitative data were analyzed by coding and thematic analysis. Results: Multiple funding sources for ART programs were common with 140 (72%) of the health facilities indicating at least two concurrent grants supporting ART service delivery between 2009 and 2014. Private philanthropic aid emerged as an important source of supplemental funding for ART service delivery. ART financing strategies were differentiated by ownership of health facility. Private not-for-profit providers were more externally-focused (multiple grants, philanthropic aid). For-profit providers were more client-oriented (fee-for-service, insurance schemes). Public facilities sought additional funding streams not dissimilar to other health facility ownership-types. Conclusion: Over the 10-year study period, health facilities in Uganda diversified funding sources for ART service delivery. The identified alternative funding mechanisms could reduce dependence on GHI funding and increase local ownership of HIV programs. Further research evaluating the potential contribution of the identified alternative financing mechanisms in bridging the global HIV funding gap is recommended.

Original language	English (US)
Article number	65
Pages (from-to)	1-11
Number of pages	11
Journal	BMC health services research
Volume	17
Issue number	1
DOIs	https://doi.org/10.1186/s12913-017-2009-6
State	Published - Jan 23 2017

Keywords

ART scale-up
ART scale-up
Global health initiatives
HIV funding
Health systems
Implementation research
Mixed-methods
PEPFAR
Sustainability

ASJC Scopus subject areas

Health Policy

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10.1186/s12913-017-2009-6

Cite this

@article{c5d4e06977da4173b5e5950159ef2507,

title = "Alternative financing mechanisms for ART programs in health facilities in Uganda: a mixed-methods approach",

abstract = "Background: Sub-Saharan Africa is heavily dependent on global health initiatives (GHIs) for funding antiretroviral therapy (ART) scale-up. There are indications that global investments for ART scale-up are flattening. It is unclear what new funding channels can bridge the funding gap for ART service delivery. Many previous studies have focused on domestic government spending and international funding especially from GHIs. The objective of this study was to identify the funding strategies adopted by health facilities in Uganda to sustain ART programs between 2004 and 2014 and to explore variations in financing mechanisms by ownership of health facility. Methods: A mixed-methods approach was employed. A survey of health facilities (N = 195) across Uganda which commenced ART delivery between 2004 and 2009 was conducted. Six health facilities were purposively selected for in-depth examination. Semi-structured interviews (N = 18) were conducted with ART Clinic managers (three from each of the six health facilities). Statistical analyses were performed in STATA (Version 12.0) and qualitative data were analyzed by coding and thematic analysis. Results: Multiple funding sources for ART programs were common with 140 (72%) of the health facilities indicating at least two concurrent grants supporting ART service delivery between 2009 and 2014. Private philanthropic aid emerged as an important source of supplemental funding for ART service delivery. ART financing strategies were differentiated by ownership of health facility. Private not-for-profit providers were more externally-focused (multiple grants, philanthropic aid). For-profit providers were more client-oriented (fee-for-service, insurance schemes). Public facilities sought additional funding streams not dissimilar to other health facility ownership-types. Conclusion: Over the 10-year study period, health facilities in Uganda diversified funding sources for ART service delivery. The identified alternative funding mechanisms could reduce dependence on GHI funding and increase local ownership of HIV programs. Further research evaluating the potential contribution of the identified alternative financing mechanisms in bridging the global HIV funding gap is recommended.",

keywords = "ART scale-up, ART scale-up, Global health initiatives, HIV funding, Health systems, Implementation research, Mixed-methods, PEPFAR, Sustainability",

author = "Henry Zakumumpa and Sara Bennett and Freddie Ssengooba",

note = "Funding Information: This research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Wellcome Trust (UK) (Grant No: 087547/Z/08/Z), the Department for International Development (DfID) under the Development Partnerships in Higher Education (DelPHE), the Carnegie Corporation of New York (Grant No: B 8606), the Ford Foundation (Grant No: 1100-0399), Google. Org (Grant No: 191994), Sida (Grant No: 54100029) and MacArthur Foundation Grant No: 10-95915-000-INP. The funders did not in any way contribute to the design of the study and collection, analysis, and interpretation of data. Funding Information: Health facilities in Uganda diversified funding sources for ART provision beyond the traditional funding partners. Participating health facilities attracted supplemental funding from a variety of sources for components of the ART program not supported by their national and GHI funding partners. ART program funding strategies were differentiated by the type of ownership of a health facility. Private philanthropic organizations and individual donors emerged as important sources of additional funding for ART service delivery in Not-for-profit and Public health facilities. Private for-profit health facilities represent an under-explored avenue for increasing domestic financing of ART service delivery through private insurance schemes and ART-specific service fees. The alternative funding mechanisms identified could reduce dependence on GHI funding and increase local ownership of HIV programs in Uganda and other donor-dependent countries. Further research evaluating the potential contribution of the identified alternative financing mechanisms to bridge the global HIV funding gap is recommended. Publisher Copyright: {\textcopyright} 2017 The Author(s).",

year = "2017",

month = jan,

day = "23",

doi = "10.1186/s12913-017-2009-6",

language = "English (US)",

volume = "17",

pages = "1--11",

journal = "BMC health services research",

issn = "1472-6963",

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TY - JOUR

T1 - Alternative financing mechanisms for ART programs in health facilities in Uganda

T2 - a mixed-methods approach

AU - Zakumumpa, Henry

AU - Bennett, Sara

AU - Ssengooba, Freddie

N1 - Funding Information: This research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Wellcome Trust (UK) (Grant No: 087547/Z/08/Z), the Department for International Development (DfID) under the Development Partnerships in Higher Education (DelPHE), the Carnegie Corporation of New York (Grant No: B 8606), the Ford Foundation (Grant No: 1100-0399), Google. Org (Grant No: 191994), Sida (Grant No: 54100029) and MacArthur Foundation Grant No: 10-95915-000-INP. The funders did not in any way contribute to the design of the study and collection, analysis, and interpretation of data. Funding Information: Health facilities in Uganda diversified funding sources for ART provision beyond the traditional funding partners. Participating health facilities attracted supplemental funding from a variety of sources for components of the ART program not supported by their national and GHI funding partners. ART program funding strategies were differentiated by the type of ownership of a health facility. Private philanthropic organizations and individual donors emerged as important sources of additional funding for ART service delivery in Not-for-profit and Public health facilities. Private for-profit health facilities represent an under-explored avenue for increasing domestic financing of ART service delivery through private insurance schemes and ART-specific service fees. The alternative funding mechanisms identified could reduce dependence on GHI funding and increase local ownership of HIV programs in Uganda and other donor-dependent countries. Further research evaluating the potential contribution of the identified alternative financing mechanisms to bridge the global HIV funding gap is recommended. Publisher Copyright: © 2017 The Author(s).

PY - 2017/1/23

Y1 - 2017/1/23

N2 - Background: Sub-Saharan Africa is heavily dependent on global health initiatives (GHIs) for funding antiretroviral therapy (ART) scale-up. There are indications that global investments for ART scale-up are flattening. It is unclear what new funding channels can bridge the funding gap for ART service delivery. Many previous studies have focused on domestic government spending and international funding especially from GHIs. The objective of this study was to identify the funding strategies adopted by health facilities in Uganda to sustain ART programs between 2004 and 2014 and to explore variations in financing mechanisms by ownership of health facility. Methods: A mixed-methods approach was employed. A survey of health facilities (N = 195) across Uganda which commenced ART delivery between 2004 and 2009 was conducted. Six health facilities were purposively selected for in-depth examination. Semi-structured interviews (N = 18) were conducted with ART Clinic managers (three from each of the six health facilities). Statistical analyses were performed in STATA (Version 12.0) and qualitative data were analyzed by coding and thematic analysis. Results: Multiple funding sources for ART programs were common with 140 (72%) of the health facilities indicating at least two concurrent grants supporting ART service delivery between 2009 and 2014. Private philanthropic aid emerged as an important source of supplemental funding for ART service delivery. ART financing strategies were differentiated by ownership of health facility. Private not-for-profit providers were more externally-focused (multiple grants, philanthropic aid). For-profit providers were more client-oriented (fee-for-service, insurance schemes). Public facilities sought additional funding streams not dissimilar to other health facility ownership-types. Conclusion: Over the 10-year study period, health facilities in Uganda diversified funding sources for ART service delivery. The identified alternative funding mechanisms could reduce dependence on GHI funding and increase local ownership of HIV programs. Further research evaluating the potential contribution of the identified alternative financing mechanisms in bridging the global HIV funding gap is recommended.

AB - Background: Sub-Saharan Africa is heavily dependent on global health initiatives (GHIs) for funding antiretroviral therapy (ART) scale-up. There are indications that global investments for ART scale-up are flattening. It is unclear what new funding channels can bridge the funding gap for ART service delivery. Many previous studies have focused on domestic government spending and international funding especially from GHIs. The objective of this study was to identify the funding strategies adopted by health facilities in Uganda to sustain ART programs between 2004 and 2014 and to explore variations in financing mechanisms by ownership of health facility. Methods: A mixed-methods approach was employed. A survey of health facilities (N = 195) across Uganda which commenced ART delivery between 2004 and 2009 was conducted. Six health facilities were purposively selected for in-depth examination. Semi-structured interviews (N = 18) were conducted with ART Clinic managers (three from each of the six health facilities). Statistical analyses were performed in STATA (Version 12.0) and qualitative data were analyzed by coding and thematic analysis. Results: Multiple funding sources for ART programs were common with 140 (72%) of the health facilities indicating at least two concurrent grants supporting ART service delivery between 2009 and 2014. Private philanthropic aid emerged as an important source of supplemental funding for ART service delivery. ART financing strategies were differentiated by ownership of health facility. Private not-for-profit providers were more externally-focused (multiple grants, philanthropic aid). For-profit providers were more client-oriented (fee-for-service, insurance schemes). Public facilities sought additional funding streams not dissimilar to other health facility ownership-types. Conclusion: Over the 10-year study period, health facilities in Uganda diversified funding sources for ART service delivery. The identified alternative funding mechanisms could reduce dependence on GHI funding and increase local ownership of HIV programs. Further research evaluating the potential contribution of the identified alternative financing mechanisms in bridging the global HIV funding gap is recommended.

KW - ART scale-up

KW - Global health initiatives

KW - HIV funding

KW - Health systems

KW - Implementation research

KW - Mixed-methods

KW - PEPFAR

KW - Sustainability

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ER -

Alternative financing mechanisms for ART programs in health facilities in Uganda: a mixed-methods approach

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