Table 1 System effects of ART expansion in Uganda
System Outcomes | Description of System Causes and Effects | Primary Sub-system affected |
|---|---|---|
More people on ART | The country has rapidly expanded ART with a 50% coverage of those in need by the end of 2009. Effects include creation of demands that require the systems to sustain an appropriate level of care. | Service delivery, with knock-on effects on all other sub-systems |
Supply shortages (essential drugs) and expiry (ARVs) | Little investments in strengthening supply systems for essential drugs, lack of qualified staff leading. Effects include poor health outcomes, inefficiencies, financial and credibility losses. | Technologies, with knock-on effects on all other sub-systems |
New supply chain management systems and governance structures for ART | Interest for short-term targets easier achieved through parallel systems. New structures and interests difficult to readjust later on. Effects include poor outcomes, vicious circles between weak systems and vertical approaches. | Governance, Technologies, Information, as well as the other sub-systems |
ART program related mismanagement | Partly due to lack of absorptive capacity for rapid and large funding. Effects include misappropriation, withdrawal of funding, inefficiencies. | Governance, with knock-on effects on all other sub-systems |
Brain drain, lack of qualified and motivated staff | Focus on short-term trainings, lack of training, higher salaries and other incentives within disease-specific programs compared to the public sector | Human Resources, knock-on effects on all sub-systems |
Lack of appropriate data | Parallel, partly inefficient as well as unfeasible programme specific information systems. Effects include failure to focus on one national information system that meets quality standards, inefficiencies, superfluous tasks at facility level. | Information, knock-on effects on all sub-systems |