Article 1: Supervision, Performance Assessment, and Recognition Strategy (SPARS) - a multipronged intervention strategy for strengthening medicines management in Uganda: method presentation and facility performance at baseline.

Martin Olowo Oteba,Birna Trap,Mohammed Khalid,Denis Okidi Ladwar,Martha Embrey,Anita Katharina Wagner

doi:10.1186/s40545-016-0070-x

Abstract

BackgroundUganda introduced a multipronged intervention, the supervision, performance assessment, and recognition strategy (SPARS), to improve medicines management (MM) in public and not-for-profit health facilities. This paper, the first in a series, describes the SPARS intervention and reports on the MM situation in Uganda before SPARS (baseline).MethodsTo build MM capacity at health facilities, health workers were trained as MM supervisors to visit health facilities, assess MM performance, and use the findings to provide support and standardize MM practices. Performance is assessed based on 25 MM indicators covering five domains: dispensing quality (7 indicators), prescribing quality (5), stock management (4), storage management (5) and ordering and reporting (4). From the end of 2010 to 2013, MM supervisors assessed baseline MM performance of 1384 government (85 %) and private not-for-profit facilities at all levels of care in about half of Uganda’s districts.ResultsThe overall MM baseline median score was 10.3 out of a maximum of 25 with inter-quartile range (IQR) of 8.7–11.7. Facility domain scores (out of a maximum of 5) were as follows: storage management, median score of 2.9 (IQR 2.3–3.4); stock management 2.3 (IQR 2.0–2.8), ordering and reporting 2.2 (IQR 1.3–2.5), and dispensing quality 2.1 (IQR 1.7–2.7). Performance in prescribing quality was 0.9 (IQR 0.4–1.4). Significant regional differences were found: overall scores were highest in the Northern region (10.7; IQR 9.2–12.4) and lowest in the Eastern region (9.6; (IQR 7.8–11.2) (p < 0.001). Overall scores did not differ by facility ownership; however, government facilities scored lower in dispensing and storage and higher in ordering and reporting. Hospitals scored higher overall and in domains other than prescribing and stock management. Districts classified a priori as having high capacity for implementing SPARS had higher scores at baseline compared to lower-capacity districts.ConclusionAssessing and building national capacity in MM is needed in both private not-for-profit and government facilities at all levels of care. The indicator-based, multipronged SPARS assessment has been described here, while the strategy’s impact has yet to be documented.Electronic supplementary materialThe online version of this article (doi:10.1186/s40545-016-0070-x) contains supplementary material, which is available to authorized users.

Highlights

Uganda introduced a multipronged intervention, the supervision, performance assessment, and recognition strategy (SPARS), to improve medicines management (MM) in public and not-for-profit health facilities
To get an indication of how well staff is adhering to standard treatment guidelines in the time available for the assessment visit, and as a majority of facilities have only a few prescribers, we reduced the number of records required for review to 10 instead of the 30 to 100 recommended by World Health Organization [28]
Ethical considerations This study describes a national capacity-building strategy and reports medicines management data collected by MM supervisors (MMS) under the Ministry of Health

Summary

Introduction

Uganda introduced a multipronged intervention, the supervision, performance assessment, and recognition strategy (SPARS), to improve medicines management (MM) in public and not-for-profit health facilities. For a health care system to improve individual and population health, needed medicines must be available, accessible, affordable, and appropriately used [1]. To ensure these requirements, numerous pharmaceutical sector processes, including ordering products, managing stock and storage, and prescribing and dispensing medicines must be effective and efficient. Numerous pharmaceutical sector processes, including ordering products, managing stock and storage, and prescribing and dispensing medicines must be effective and efficient These processes are complex and depend on many factors, such as the availability and wise use of money, human resources, and information, and management capacity [2, 3]. Less than 8 % of 376 pharmacy posts in the public sector were filled, and 79 % of all facilities lacked shelves, making it impossible to manage medicines appropriately [5, 8, 9]

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Results

Conclusion