title: Human resources for health strategies adopted by providers in resource-limited settings to sustain long-term delivery of ART: a mixed-methods study from Uganda.
abstract: Human resources for health (HRH) constraints are a major barrier to the sustainability of antiretroviral therapy (ART) scale-up programs in Sub-Saharan Africa. Many prior approaches to HRH constraints have taken a top-down trend of generalized global strategies and policy guidelines. The objective of the study was to examine the human resources for health strategies adopted by front-line providers in Uganda to sustain ART delivery beyond the initial ART scale-up phase between 2004 and 2009.
  
  
  
  A two-phase mixed-methods approach was adopted. In the first phase, a survey of a nationally representative sample of health facilities (n = 195) across Uganda was conducted. The second phase involved in-depth interviews (n = 36) with ART clinic managers and staff of 6 of the 195 health facilities purposively selected from the first study phase. Quantitative data was analysed based on descriptive statistics, and qualitative data was analysed by coding and thematic analysis.
  
  
  
  The identified strategies were categorized into five themes: (1) providing monetary and non-monetary incentives to health workers on busy ART clinic days; (2) workload reduction through spacing ART clinic appointments; (3) adopting training workshops in ART management as a motivation strategy for health workers; (4) adopting non-physician-centred staffing models; and (5) devising ART program leadership styles that enhanced health worker commitment.
  
  
  
  Facility-level strategies for responding to HRH constraints are feasible and can contribute to efforts to increase country ownership of HIV programs in resource-limited settings. Consideration of the human resources for health strategies identified in the study by ART program planners and managers could enhance the long-term sustainment of ART programs by providers in resource-limited settings.
authors.affiliation: School of Public Health, Makerere University, Kampala, Uganda. zakumumpa@yahoo.com.
authors.forename: Henry
authors.initials: H
authors.lastname: Zakumumpa
authors.affiliation: Department of Psychology, Obafemi Awolowo University, Osun State, Nigeria.
authors.forename: Modupe Oladunni
authors.initials: MO
authors.lastname: Taiwo
authors.affiliation: The Infectious Diseases Institute, Makerere University, Kampala, Uganda.
authors.forename: Alex
authors.initials: A
authors.lastname: Muganzi
authors.affiliation: School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Freddie
authors.initials: F
authors.lastname: Ssengooba
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006282:Health Personnel; D006295:Health Resources; D006296:Health Services; D006801:Humans; D007318:Inservice Training; D007857:Leadership; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010558:Personnel Loyalty; D010559:Personnel Management / Q000379:methods*; D014454:Uganda; D014937:Work; D000078329:Workforce; D016526:Workload
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; Health systems; Human resources for health; Implementation science; Sustainability