Published in PLOS One on 2026-02-02, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original study title: The sustainability of public health programs following donor transition: A comparative case study of HIV services and maternal and newborn care in Uganda
Original authors: Henry Zakumumpa, Eric Ssegujja, Marjorie Kyomuhendo, Beryl Maritim, Timothy Musila, Freddie Ssengooba
Source: PLOS One • DOI 10.1371/journal.pone.0341328
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Although there is emerging evidence on the impact of donor transition on health programs, there is little research comparing sustainability outcomes across health programs. We sought to compare drivers of health program sustainability concerning maternal and newborn care in Western Uganda after the end of the ‘Saving Mothers Giving Life’(SMGL) project and HIV services in eastern Uganda following loss of PEPFAR support.
We report qualitative findings from a larger mixed-methods study. In-depth interviews were held with Ministry of Health officials (n = 11), district health teams (n = 27), facility in-charges (n = 39) and representatives of donor-implementing organizations (n = 22). Data were collected in eight districts in Western and Eastern Uganda. Data were analyzed by thematic approach based on the five themes proposed under the Integrated Sustainability Framework (ISF).
Our case studies identified several enablers and hindrances to the sustainment of public health gains across HIV and Maternal and Newborn Health (MNH). The recipient government appeared to assign a higher political priority to MNH relative to HIV following donor transition. MNH attracted multiple external funders after the end of SMGL support. In terms of donor transition processes, the MNH intervention was perceived as a ‘terminal’ project, while PEPFAR support was perceived as more ‘open-ended’. In contrast to districts in Eastern Uganda, which lost PEPFAR support, internal ‘program champions’ were identified in districts in Western Uganda. Differences in disease control approaches were identified; HIV was described as more ‘capital intensive’ with more ‘recurrent’ needs compared to MNH programming. The expanded MNH workforce (such as nurses and midwives) was transitioned to the public sector payroll, while PEPFAR-salaried officials were not. Participants perceived the SMGL project on MNH to have been more embedded in the local health system while PEPFAR support was perceived as more ‘vertical’.
Our analysis suggests that variations in sustainability outcomes cross the two focus projects stem from differences in donor aid delivery mechanisms, transition processes and domestic political priorities. Our study suggests that donor transition is not a ‘one size fits all’ phenomenon regarding health programs, which has implications for planning for donor transition in Uganda and similar settings.
Introduction
Over the past three decades, low- and middle-income countries (LMICs) have achieved remarkable public health gains with substantial development assistance for health (DAH) [1–3]. DAH takes various forms, ranging from bilateral support, such as the United States President’s Emergency Plan for AIDS Relief (PEPFAR), to multilateral mechanisms, such as Global Alliance for Vaccine Initiative (GAVI) and the Global Fund for AIDS, Malaria, and Tuberculosis (GFTAM) [4].
Several studies have demonstrated the long-term impact of DAH on population health, such as a reduction in HIV-associated mortality [2], maternal and newborn mortality [1], increased uptake of immunization [3], and malaria control [5].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Henry Zakumumpa, Eric Ssegujja, Marjorie Kyomuhendo, Beryl Maritim, Timothy Musila, Freddie Ssengooba. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Acceptability of Suubi+Adherence intervention to improve ART adherence in Southern Uganda: A qualitative analysis
- Evidence brief: Participant perspectives on a person-centred care model for mobile individuals in HIV care from the SEARCH Dynamic Choice Treatment trial in rural Kenya and Uganda
- Evidence brief: Multi-level determinants of tuberculosis treatment completion in rural Uganda: A cross-sectional study
