Ladwar Denis Okidi, Sembatya Moses Nixon, Amony Nancy Miriam, Seru Morries, Ross-Degnan Dennis, Garabedian Laura, Trap Birna
USAID/Uganda Health Supply Chain Program, Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, P.O. Box 71419, Kampala, Uganda.
Pharmacy Division, Ministry of Health Uganda, Plot 6/P.O. Box 7272 Lourdel Rd, Kampala, Uganda.
J Pharm Policy Pract. 2021 Feb 4;14(1):14. doi: 10.1186/s40545-020-00290-8.
To strengthen medicines management capacity, including supply chain management, at public sector health facilities in Uganda, the Ministry of Health introduced a multipronged supervision, performance assessment, and recognition strategy (SPARS). The aim of this study was to assess the impact of SPARS on improving supply chain management. A series of four papers on SPARS described the SPARS concept, its impact on overall and domain practices and appropriate medicines use, and now in the fourth paper describing the effect on supply chain management.
District-based health workers trained as supervisors build facility-level capacity in medicines management using an indicator-based performance assessment followed by targeted supervisory visits. From 2010 to 2013, 1222 SPARS visits were implemented, and the SPARS performance indicator scores determined. This article assesses impact on 13 indicators in three of the five SPARS domains-stock management, storage management, and ordering and reporting quality-using a pre-post design. We also explored factors that may have influenced these outcomes.
Between the first and last visit within one year of SPARS implementation, we found an average improvement of 16 percentage points (p < 0.001) in supply chain management measures across all levels of care. The improvement in scores for stock management, storage management, and ordering and reporting was 22 (ns), 16 (p < 0.001), and 11 (p = 0.032) percentage points, respectively. The study identified the key predictors of positive change as a low initial indicator score, frequent supervisory visits, and engagement of the district health officer.
The multipronged SPARS approach was effective in building supply chain management capacity in lower-level health care facilities with statistically significant improvements in supply chain management overall and in almost all stock and storage- management and ordering and reporting measures after one year of implementation. We recommend broad dissemination of the SPARS approach as an effective strategy to strengthen supply chain management in low-income countries.
The study did not involve or use human participants or identifiable personal data, human tissue, or animals and thus did not require ethical approval or a waiver. It is a study implemented in collaboration with the Ministry of Health and does not require trial registration.
为加强乌干达公共部门卫生设施的药品管理能力，包括供应链管理，卫生部引入了多管齐下的监督、绩效评估和认可战略（SPARS）。本研究的目的是评估SPARS对改善供应链管理的影响。关于SPARS的一系列四篇论文描述了SPARS的概念、其对整体及各领域实践和合理用药的影响，现在第四篇论文描述其对供应链管理的影响。
接受过培训的地区级卫生工作者作为监督员，通过基于指标的绩效评估，随后进行有针对性的监督访问，来建设设施层面的药品管理能力。2010年至2013年期间，实施了1222次SPARS访问，并确定了SPARS绩效指标得分。本文采用前后对照设计，评估对SPARS五个领域中的三个领域（库存管理、储存管理以及订购和报告质量）的13项指标的影响。我们还探讨了可能影响这些结果的因素。
在实施SPARS的一年内，从首次访问到最后一次访问期间，我们发现各级医疗机构的供应链管理措施平均提高了16个百分点（p < 0.001）。库存管理、储存管理以及订购和报告的得分分别提高了22（无统计学意义）、16（p < 0.001）和11（p = 0.032）个百分点。该研究确定积极变化的关键预测因素为初始指标得分较低、频繁进行监督访问以及地区卫生官员的参与。
多管齐下的SPARS方法有效地增强了基层卫生保健设施的供应链管理能力，实施一年后，供应链管理整体以及几乎所有库存和储存管理及订购和报告措施都有统计学上的显著改善。我们建议广泛推广SPARS方法，作为加强低收入国家供应链管理的有效策略。
该研究未涉及或使用人类参与者或可识别的个人数据、人体组织或动物，因此无需伦理批准或豁免。这是一项与卫生部合作开展的研究，无需试验注册。
