Scaling up antiretroviral therapy in Uganda using supply chain management to appraise health systems strengthening 英文参考文献.docVIP

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Scaling up antiretroviral therapy in Uganda using supply chain management to appraise health systems strengthening 英文参考文献.doc

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Scaling up antiretroviral therapy in Uganda using supply chain management to appraise health systems strengthening 英文参考文献

Windischetal.GlobalizationandHealth2011,7:25 /content/7/1/25 RESEARCH OpenAccess ScalingupantiretroviraltherapyinUganda:using supplychainmanagementtoappraisehealth systemsstrengthening RicardaWindisch1,2*,PeterWaiswa3,4,FlorianNeuhann5,FlorianScheibe5andDondeSavigny1,2 Abstract Background:Strengthenednationalhealthsystemsarenecessaryforeffectiveandsustainedexpansionof antiretroviraltherapy(ART).ARTanditssupplychainmanagementinUgandaarelargelybasedonparalleland externallysupportedefforts.ThequestionariseswhethersystemsarebeingstrengthenedtosustainaccesstoART. Thisstudyappliessystemsthinkingtoassesssupplychainmanagement,theroleofexternalsupportandwhether investmentscreatetheneededsynergiestostrengthenhealthsystems. Methods:ThisstudyusestheWHOhealthsystemsframeworkandexaminestheissuesofgovernance,financing, information,humanresourcesandservicedeliveryinrelationtosupplychainmanagementofmedicinesandthe technologies.ItlooksatlinksandcausalchainsbetweensupplychainmanagementforARTandthenational supplysystemforessentialdrugs.Itcombinesdatafromtheliteratureandkeyinformantinterviewswith observationsathealthservicedeliverylevelinastudydistrict. Results:CurrentdrugsupplychainmanagementinUgandaischaracterizedbyparallelprocessesandinformation systemsthatresultinpoorqualityandinefficiencies.Lessthanexpectedhealthsystemperformance,stockouts andothershortagesaffectARTandprimarycareingeneral.Poorperformanceofsupplychainmanagementis amplifiedbyweakconditionsatalllevelsofthehealthsystem,includingtheareasoffinancing,governance, humanresourcesandinformation.Governanceissuesincludethelacktofollowupinitialpolicyintentionsanda focusonnarrow,short-termapproaches. Conclusion:TheopportunityandneedtouseARTinvestmentsforanessentialsupplychainmanagementand strengthenedhealthsystemhasnotbeenexploited.Byapplyingasystemsperspectivethisworkindicatesthe seriousnessofmissingsystemprerequisites.Thefindingssuggestthatrootcausesandcapacitiesacrossthesystem havetobeaddressedsynergisticallytoenablesystemst