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The differential impacts of PEPFAR transition on private for-profit private not-for-profit and publicly owned health facilities in Uganda

机译：PEPFAR过渡对乌干达的私人营利性私人非营利性和公有医疗机构的不同影响

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While transition of donor programs to national control is increasingly common, there is a lack of evidence about the consequences of transition for private health care providers. In 2015, President’s Emergency Plan for AIDS Relief (PEPFAR) identified 734 facilities in Uganda for transition from PEPFAR support, including 137 private not-for-profits (PNFP) and 140 private for-profits (PFPs). We sought to understand the differential impacts of transition on facilities with differing ownership statuses. We used a survey conducted in mid-2017 among 145 public, 29 PNFP and 32 PFP facilities reporting transition from PEPFAR. The survey collected information on current and prior PEPFAR support, service provision, laboratory services and staff time allocation. We used both bivariate and logistic regression to analyse the association between ownership and survey responses. All analyses adjust for survey design. Public facilities were more likely to report increased disruption of sputum microscopy tests following transition than PFPs [odds ratio (OR) = 5.85, 1.79–19.23,  = 0.005]. Compared with public facilities, PNFPs were more likely to report declining frequency of supervision for human immunodeficiency virus (HIV) since transition (OR = 2.27, 1.136–4.518,  = 0.022). Workers in PFP facilities were more likely to report reduced time spent on HIV care since transition (OR = 6.241, 2.709–14.38,  P = 0.011). PNFP facilities’ loss of supervision may require that public sector supervision be extended to them. Reduced HIV clinical care in PFPs, primarily HIV testing and counselling, increases burdens on public facilities. Prior PFP clients who preferred the confidentiality and service of private facilities may opt to forgo HIV testing altogether. Donors and governments should consider the roles and responses of PNFPs and PFPs when transitioning donor-funded health programs.
机译：尽管捐助者计划向国家控制的过渡越来越普遍，但缺乏有关过渡对私人医疗保健提供者的后果的证据。 2015年，总统的艾滋病紧急救援计划（PEPFAR）在乌干达确定了734个设施，可从PEPFAR的支持中过渡，其中包括137个非营利性非营利组织（PNFP）和140个非营利性非营利组织（PFP）。我们试图了解过渡对拥有不同所有权状态的设施的不同影响。我们使用了2017年中期对145个公共，29个PNFP和32个PFP设施进行的调查，这些设施报告从PEPFAR过渡。该调查收集了有关PEPFAR当前和以前的支持，服务提供，实验室服务和人员时间分配的信息。我们使用了双变量和逻辑回归分析所有权和调查响应之间的关联。所有分析均针对调查设计进行调整。与PFP相比，公共设施在过渡后更可能报告痰镜检查的破坏增加[几率（OR）= 5.85，1.79-19.23，0.005]。与公共设施相比，自过渡以来，PNFPs更有可能报告对人类免疫缺陷病毒（HIV）的监管频率下降（OR = 2.27，1.136-4.518，= 0.022）。自过渡以来，PFP设施中的工人更有可能报告花费在HIV护理上的时间减少（OR = 6.241，2.709-14.38，P = 0.011）。 PNFP设施失去监管可能需要对它们进行公共部门的监管。 PFP中减少的HIV临床护理（主要是HIV检测和咨询）增加了公共设施的负担。先前倾向于私人机构的机密性和服务性的PFP客户可以选择完全放弃HIV检测。捐助者和政府在过渡由捐助者资助的卫生计划时应考虑PNFP和PFP的作用和对策。

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