Article 2: Longitudinal study assessing the one-year effects of supervision performance assessment and recognition strategy (SPARS) to improve medicines management in Uganda health facilities

Martha Embrey,Dennis Ross-Degnan,Birna Trap,Anthony Kirunda,Richard Musoke,Martin Olowo Oteba

doi:10.1186/s40545-018-0142-1

Abstract

BackgroundIn late 2010, Uganda introduced a supervision, performance assessment, and recognition strategy (SPARS) to improve staff capacity in medicines management in government and private not-for-profit health facilities. This paper assesses the impact of SPARS in health facilities during their first year of supervision.MethodsSPARS uses health workers trained as Medicines Management Supervisors (MMS) to supervise health facilities and address issues identified through indicatorbased performance assessment in five domains: stock management, storage management, ordering and reporting, prescribing quality, and dispensing quality. We used routine data generated during SPARS visits to 1222 health facilities to evaluate performance changes during the first year of supervision as well as the time until achieving an adequate score in this period. We also explored variables related to facilities, MMS, and intensity of implementation as predictors of performance improvement and time until achieving an adequate score.ResultsHealth facilities received an average of 3.4 MMS visits during the first year of supervision, with an average of 88 days between visits; each MMS implemented a median of 28 visits per year. Overall SPARS scores (maximum of 25) improved by 2.3 points (22.3%) per visit from a mean baseline score of 10.3. The adjusted improvement in overall SPARS score was significantly higher in primary health care facilities (2.36) versus higher-level health facilities and hospitals (2.15) (p = 0.001). The incremental improvement was highest at visit 2, with decreasing but continuing positive gains in subsequent visits. The adjusted mean incremental improvement per visit was highest in the prescribing quality domain, followed by dispensing quality, ordering and reporting, stock management, and storage management. Adjusted improvement in SPARS scores varied by region, year of implementation, and facility ownership. After one year of SPARS, 22% of facilities achieved an adequate score of 18.75 (75% of maximum score).ConclusionsSPARS was effective in building health facility capacity in medicines management, with a median overall improvement of almost 70% during the first year. The greatest improvements occurred in prescribing quality and at lower levels of care, although the highest level of performance was achieved in storage management. We recommend broad dissemination of the SPARS approach in all Ugandan health facilities as well as in other countries seeking a practical strategy to improve medicines management performance.

Highlights

In late 2010, Uganda introduced a supervision, performance assessment, and recognition strategy (SPARS) to improve staff capacity in medicines management in government and private not-for-profit health facilities
The greatest improvements occurred in prescribing quality and at lower levels of care, the highest level of performance was achieved in storage management
A greater percentage of HC2s were supervised by only one Management Supervisors (MMS) (p < 0.001) and higher-level facilities had a greater percentage of initial visits in which two or more health workers were supervised (p < 0.001)

Summary

Introduction

In late 2010, Uganda introduced a supervision, performance assessment, and recognition strategy (SPARS) to improve staff capacity in medicines management in government and private not-for-profit health facilities. In Uganda, the Ministry of Health’s (MOH) Pharmacy Department implemented a new national strategy that reorganizes health services around patients’ needs and coordinates relationships between essential medicines and health supplies (EMHS) and other health system components to increase responsiveness and produce better outcomes [1] As part of this focus on responsiveness and accountability, facilities need to be able to optimize available resources and meet growing expectations for better performance in medicines management (MM). In late 2010, Uganda’s MOH began to pilot a Supervision, Performance Assessment and Recognition Strategy (SPARS) to improve MM in health facilities, an approach that uses supportive supervisory visits, indicator-based performance assessment, sharing performance findings with managers at all levels, and special recognition for good performance. The SPARS method is described in detail in the first article of this theme issue [2]

Methods

Results

Discussion

Conclusion