1-year impact of supervision, performance assessment, and recognition strategy (SPARS) on prescribing and dispensing quality in Ugandan health facilities

Abstract

Background: To strengthen appropriate medicine use (AMU) including the prescribing and dispensing quality at public sector health facilities in Uganda, the Ministry of Health introduced a multipronged approach known as the Supervision, Performance Assessment, and Recognition Strategy (SPARS). This paper assesses the impact of the first year of SPARS implementation on key AMU indicators. Methods: District-based health workers trained as supervisors provide in-service training in medicines management complemented by indicator-based performance assessment and targeted supervision during each SPARS facility visit. From 2010 to 2013, health facilities that started the SPARS intervention were assessed during the first and last visit during a period of 12 months of implementing SPARS. This study examines 12 AMU indicators with 57 individual outcomes covering prescribing and dispensing quality. We also explored factors influencing 1-year improvement. Results: We found an overall increase in AMU indicators of 17 percentage points (p < 0.000) between the first and last visit during a period of 12 months of supervisions, which was significant in all levels of health care facilities and in both government and private not-for-profit faith-based sectors. Appropriate dispensing (25 percentage points, p < 0.005) improved more than appropriate prescribing (12 percentage points, p = 0.13). Specific facilities that reached an average score of over 75% across all AMU measures within the first year of supervision improved from 3 to 41% from the first visit (baseline). The greatest overall impact on AMU occurred in lower-level facilities; the level of improvement varied widely across indicators, with the greatest improvements seen for the lowest baseline measures. Supervision frequency had a significant impact on level of improvement in the first year, and private notfor-profit faith-based health facilities had notably higher increases in several dispensing and prescribing indicator scores than public sector facilities.

Article 4: Impact assessment of supervision performance assessment and recognition strategy (SPARS) to improve supply chain management in health facilities in Uganda: a national pre and post study

“…SPARS’s impact on SCM and appropriate medicines use was almost the same—16 versus 17 percent points respectively, but slightly lower compared to a 24 percentage point impact on dispensing practices [ 19 ]. The larger effect on dispensing practices compared to SCM might be linked to the difference in the initial scores, with the SCM starting point at 65% versus 44% for dispensing, which left more room for improvement [ 19 ].…”

“…SPARS is implemented by district health workers trained as medicines management supervisors (MMS) who assess performance and supervise at all levels of public health facilities, including those managed by both government and private not-for-profit (PNFP) organizations. The SPARS intervention and its longitudinal impact on overall medicines management and the five underlying domains is described in previous articles of this theme series on improving the pharmaceutical sector in Uganda [ 7 , 18 , 19 ]…”

“…SPARS is implemented by district health workers trained as medicines management supervisors (MMS) who assess performance and supervise at all levels of public health facilities, including those managed by both government and private not-for-profit (PNFP) organizations. The SPARS intervention and its longitudinal impact on overall medicines management and the five underlying domains is described in previous articles of this theme series on improving the pharmaceutical sector in Uganda [7,18,19] A previous study evaluated the overall impact of the SPARS during the first year of supervision in health facilities that entered the program from 2010 to 2013 [18]. Overall SPARS scores (maximum of 25) improved by 2.3 points (22%) per visit from a mean baseline score of 10.3.; the average improvement per visit was highest at the lowest level health facility (2.4 points) and lowest at the highest health care levels (2.2 points).…”