Kafle K K, Bhuju G B, Karkee S B, Prasad R R, Shrestha N, Shrestha A D, Das P L, Chataut B D, Daud M
International Network for Rational Use of Drugs (INRUD, Nepal), Kathmandu, Nepal.
Nepal Med Coll J. 2009 Dec;11(4):217-21.
To improve the quality of health care in Nepal, supervision/ monitoring involving periodic visits by the district supervisor to health facilities (top-down approach) is in practice. It is not objectively implemented because of time and financial constraints and terrain of the country. To assess the effectiveness of a pre-tested strategy i.e. peer-group discussion with self-assessment piloted through the district health system in improving quality of care. A pre-post pilot study was conducted in 41 PHC facilities of Chitwan district of Central Nepal. The intervention included small-group training to prescribers followed by peer-group discussion with self-assessment data. It involved visit of in-charges from health facilities to district level regular meeting with self-assessment data on the treatment of four targeted health problems and also the availability of drugs of their health facilities as well as from health facilities which were under their supervision (bottom-up approach). In under-five children, there was a significant improvement in use of antimicrobials in diarrhoea, paracetamol alone and antibiotics in no pneumonia, and co-trimoxazole or amoxycillin alone or with paracetamol in pneumonia. The use of benzyl benzoate or gamma benzene hexachloride alone and antibiotics in scabies were also significantly improved. The peer-group discussion, a bottom-up approach of supervision/monitoring implemented through district health system improves the prescribing practices and availability of drugs in the district.
为提高尼泊尔的医疗保健质量，目前实行由地区督导员定期走访医疗机构的监督/监测（自上而下的方法）。但由于时间、资金限制以及该国的地形因素，这种监督/监测并未得到客观实施。为评估一种经过预测试的策略的有效性，即通过地区卫生系统开展的同伴小组讨论及自我评估，来改善医疗服务质量。在尼泊尔中部奇旺地区的41个初级卫生保健机构开展了一项前后对照的试点研究。干预措施包括对开处方者进行小组培训，随后进行同伴小组讨论并提供自我评估数据。这涉及医疗机构负责人前往地区级例会，会上提交关于四种目标健康问题治疗情况的自我评估数据，以及其所在医疗机构和受其监督的医疗机构的药品供应情况（自下而上的方法）。在五岁以下儿童中，腹泻时抗菌药物的使用、非肺炎时单独使用对乙酰氨基酚和抗生素的情况，以及肺炎时单独使用复方新诺明或阿莫西林或与对乙酰氨基酚联用的情况均有显著改善。疥疮时单独使用苯甲酸苄酯或γ-六氯环己烷以及使用抗生素的情况也有显著改善。通过地区卫生系统实施的同伴小组讨论这种自下而上的监督/监测方法，改善了该地区的处方行为和药品供应情况。
