Person:

Wagner, Anita

Background: 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. This paper, the first in a series, describes the SPARS intervention and reports on the MM situation in Uganda before SPARS (baseline). Methods: To 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. Results: The 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. Conclusion: Assessing 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 material The online version of this article (doi:10.1186/s40545-016-0070-x) contains supplementary material, which is available to authorized users.

Background: Supportive supervision has been found to be more effective than corrective fault-oriented inspections. Uganda’s Ministry of Health in 2012 implemented a comprehensive strategy (SPARS) to build medicines management capacity in public sector health facilities. The approach includes supportive supervision. This structured observational study assesses supportive supervision competency among medicines management supervisors (MMS). Method The study used structured observations of two groups of five purposely selected MMS—one group supervising facilities with greater medicines management improvement during one year of SPARS and one group with less improvement, based on quantitative metrics. We observed and scored behaviors and skills of supervisors in 11 categories deemed critical for effective and supportive supervision. Results: Supportive supervision was not evenly or adequately implemented, with the median supportive supervision competency score for all observed supervisors being 38%. Supervisors’ main strengths were problem identification, data interpretation, education, and providing constructive feedback (45%–47%). Their weakest areas were assuring continuity and setting targets (17%), and most MMS were fair to strong in effective communication, use of tools, and problem solving. MMS of facilities with little improvement in medicines management over time were weak in setting targets and promoting participation. There was a 33 percentage point difference in the median supportive supervision competency scores between MMS of facilities with more versus less improvement (57%–24%) and a 77 percentage point difference in competency between the highest and lowest scoring MMS (77%–0%). We did not find a relationship between MMS experience (number of visits implemented) and their supportive supervision competency or facility improvement in medicines management. However, there is a likely relationship between supportive supervision competency and facility improvement. Conclusion: Competency of MMS in supportive supervision among the sampled MMS was generally weak, but with much individual variation. Our results suggest that MMS’ supportive supervision competency is positively related to the SPARS effectiveness scores of the facilities they supervise. We recommend strategies to strengthen supportive supervision behaviors and skills. Electronic supplementary material The online version of this article (10.1186/s40545-017-0121-y) contains supplementary material, which is available to authorized users.