District Health Officer perceptions of PEPFAR's influence on the health system in Uganda, 2005-2011

Abstract

Vertically oriented global health initiatives (GHIs) addressing the HIV/AIDS epidemic, including the President's Emergency Plan for AIDS Relief (PEPFAR), have been successful at reducing HIV/AIDS related morbidity and mortality. However there is still debate about whether these disease specific programs have improved or harmed overall health systems. As part of a larger evaluation of PEPFAR's effects on the Ugandan health system between 2005-2011, we asked District Health Officers (DHOs) from all 112 districts to share their perceptions about the ways in which GHIs had helped and harmed the health system. Ugandan DHOs said that GHIs had generally helped the health system by improving training, integrating HIV and non-HIV care, and directly providing resources. To a lesser extent, however, DHOs also said that GHIs caused the health system to focus too narrowly on HIV/AIDS, increased workloads for already overburdened staff, and encouraged doctors to leave public-sector jobs for higher paid positions with HIV/AIDS programs.