Table 5. Uganda DHO Views on Positive and Negative Effects of PEPFAR on Health System Components .

Improved Non-HIV Health Services	Health System Building Blocks	Weakened Non-HIV Health Services
• Financial support for planning meetings (33) • More HIV programs incorporated into the planning process (33) • Additional trainings and mentorship for planning (32) • Technical consultation for planning provided to DHO (23)	Planning Capacity	• HIV programs do not share work plans with DHO (34) • HIV program work plans too narrowly focus on HIV (32) • Planned projects will not be sustained when HIV programs close (16) • DHO and funder budget cycles differ (6)
• M&E for non-HIV integrated into HIV monitoring (59) • M&E training conducted (35) • HIV organizations carry out or directly fund non-HIV M&E (24) • Additional transport available for non-HIV monitoring visits (9)	Monitoring and Evaluating non-HIV Programs	• Too much funding for, and focus on, HIV M&E (37) • DHO staff overwhelmed by additional M&E responsibilities (14) • DHO does not receive M&E reports from HIV organizations (10) • Scaled-up M&E will not be sustained when HIV programs close (4)
• Technical help provided to identify and pursue non-HIV grants (25) • Resources provided by HIV programs also used for non-HIV programming (11) • Additional funding for HIV work allows DHO to dedicate own funds to non-HIV work (10) • Help identifying program gaps and effectively allocating funds (9)	Resource Mobilization for non-HIV	• Available grants focused too narrowly on HIV (32) • Health sector misperceived as having sufficient funding (21) • DHO sits back and waits for funders to come (12) • Development partners outcompete DHO for available grants (7)
• Training provided in use and maintenance of medical equipment (80) • Direct provision of medical equipment and supplies (74) • Transport for medicines and diagnostic specimens (20) • Renovation of labs, storage areas, and waiting shades (13)	Management of Medical Supplies and Equipment	• Dependence on donors for drugs and supplies (11) • Maintenance of scaled-up diagnostic and treatment services will not be possible when HIV programs close (10) • Push systems deliver drugs and supplies that are not needed (9) • Demand for services has risen with increased medical supply availability (2)
• Training and mentoring improves capacity and builds morale (75) • HIV programs hire and pay additional staff to work at DHO (50) • Opportunity for additional allowances motivates work (46) • Improved work space and equipment boosts morale (15)	HRs for Health	• Increased workload and stress (46) • Staff loss to NGO programs (45) • Absenteeism to attend trainings (29) • Damaged morale of staff not working on HIV (19)
• Funding and facilitation of stakeholder meetings provided (86) • Trained and equipped village health teams and community groups (32) • Funding and production of health-themed radio programs (19) • HIV programs assist the formation of coordinating committees and forums (15)	Coordination of Stakeholders	• Those attending coordinating meetings now expect to be paid (9) • DHO will not be able to sustain coordination effort when HIV programs close (9) • DHO has insufficient funds to coordinate all stakeholders in the district (6) • HIV programs do not participate in coordination meetings (5)
• Training and capacity building in data capture and analysis provided (83) • Provision of computers, internet, and data storage (80) • Transport and allowances provided for data collection (19) • HIV programs provided forms and registers for data collection (17)	Management of Information	• Increased data collection workload (22) • Individual reports needed for each HIV program (21) • DHO does not receive data collected by HIV programs (20) • HIV data collection overly emphasized (13)

Abbreviations: DHO, District Health Officer; HRs, human resources; NGO, non-governmental organization; PEPFAR, President’s Emergency Plan for AIDS Relief; M&E, monitoring and evaluation.

Data source: Interviews with Ugandan DHOs (or their proxies) in 112 districts between October and December, 2011. Number of respondents citing each effect in parentheses.