scaling up antiretroviral therapy in uganda using supply chain management to appraise health systems strengthening扩大抗逆转录病毒疗法在乌干达使用供应链管理评价加强卫生系统.pdfVIP

Windisch et al. Globalization and Health 2011, 7:25 /content/7/1/25 RESEARCH Open Access Scaling up antiretroviral therapy in Uganda: using supply chain management to appraise health systems strengthening 1,2* 3,4 5 5 1,2 Ricarda Windisch , Peter Waiswa , Florian Neuhann , Florian Scheibe and Don de Savigny Abstract Background: Strengthened national health systems are necessary for effective and sustained expansion of antiretroviral therapy (ART). ART and its supply chain management in Uganda are largely based on parallel and externally supported efforts. The question arises whether systems are being strengthened to sustain access to ART. This study applies systems thinking to assess supply chain management, the role of external support and whether investments create the needed synergies to strengthen health systems. Methods: This study uses the WHO health systems framework and examines the issues of governance, financing, information, human resources and service delivery in relation to supply chain management of medicines and the technologies. It looks at links and causal chains between supply chain management for ART and the national supply system for essential drugs. It combines data from the literature and key informant interviews with observations at health service delivery level in a study district. Results: Current drug supply chain management in Uganda is characterized by parallel processes and information systems that result in poor quality and inefficiencies. Less than expected health system performance, stock outs and other shortages affect ART and primary care in general. Poor performance of supply chain management is amplified by weak conditions at all levels of the health