Trap Birna, Musoke Richard, Kirunda Anthony, Oteba Martin Olowo, Embrey Martha, Ross-Degnan Dennis
USAID/Uganda Health Supply Chain Program, Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, P.O. Box 71419, Kampala Uganda.
Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, P.O. Box 71419, Kampala Uganda.
J Pharm Policy Pract. 2018 Jul 5;11:15. doi: 10.1186/s40545-018-0142-1. eCollection 2018.
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. This paper assesses the impact of SPARS in health facilities during their first year of supervision.
SPARS 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.
Health 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) ( = 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).
SPARS 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.
2010年末，乌干达引入了一项监督、绩效评估和认可战略（SPARS），以提高政府及私立非营利性医疗机构药品管理方面的工作人员能力。本文评估了SPARS在实施监督的第一年对医疗机构的影响。
SPARS利用接受过培训的医务人员作为药品管理监督员（MMS）来监督医疗机构，并解决通过基于指标的绩效评估在五个领域发现的问题：库存管理、储存管理、订购与报告、处方质量和配药质量。我们使用在对1222家医疗机构进行SPARS访问期间生成的常规数据，来评估监督第一年期间的绩效变化以及在此期间达到合格分数所需的时间。我们还探讨了与医疗机构、MMS以及实施强度相关的变量，作为绩效改善和达到合格分数所需时间的预测因素。
在监督的第一年，医疗机构平均接受3.4次MMS访问，访问间隔平均为88天；每位MMS每年实施的访问中位数为28次。总体SPARS分数（满分25分）从平均基线分数10.3分开始，每次访问提高2.3分（22.3%）。初级卫生保健机构的总体SPARS分数调整后改善幅度（2.36）显著高于高级卫生机构和医院（2.15）（P = 0.001）。在第二次访问时增量改善最高，随后的访问中虽有下降但仍持续有正向增长。每次访问的调整后平均增量改善在处方质量领域最高，其次是配药质量、订购与报告、库存管理和储存管理。SPARS分数的调整后改善因地区、实施年份和机构所有权而异。经过一年的SPARS实施，22%的机构达到了18.75分的合格分数（满分的75%）。
SPARS在建设医疗机构药品管理能力方面是有效的，第一年总体改善中位数近70%。最大的改善发生在处方质量和较低级别的医疗服务中，尽管储存管理方面取得了最高的绩效水平。我们建议在所有乌干达医疗机构以及其他寻求实用战略以改善药品管理绩效的国家广泛推广SPARS方法。
