Foreign aid dependency and sustainability of art service delivery in Uganda’s PNFP sector: a panel analysis (2020–2024)

Abstract

This study examined the relationship between foreign aid dependence and antiretroviral therapy (ART) service delivery outcomes in Uganda’s Private Not-for-Profit (PNFP) health sector over the period 2020–2024. The study was motivated by growing concerns regarding the sustainability of HIV/AIDS programs in the context of fluctuating donor funding. The specific objectives were to assess the effect of foreign aid dependence on ART service quality, examine its influence on service continuity, and evaluate the implications of sustained donor reliance for long-term sustainability. A quantitative panel data approach was adopted, utilizing a structured dataset comprising 600 observations. Fixed-effects regression models were used to analyze ART service quality outcomes, while a logit model was employed to examine service continuity indicators. Key variables included foreign aid dependence, viral suppression, patient retention, attrition rates, stock-out days, and service disruption. The findings indicate that foreign aid dependence is positively associated with improvements in ART service delivery. Higher levels of donor funding were associated with increased viral suppression and retention, alongside reductions in attrition, stock-outs, and service disruptions. However, the results also reveal persistently high dependence on external financing, exceeding 80% on average, which poses significant risks to long-term sustainability. The study concludes that while foreign aid remains critical in supporting ART service delivery within the PNFP sector, a gradual transition toward stronger domestic financing mechanisms is necessary to ensure resilience. These findings highlight the importance of balancing donor support with increased domestic resource mobilization to sustain HIV/AIDS service delivery in Uganda.