New Performance Based Reward Strategy to Improve Pharmacy. Appropriate Medicines Use in the Public Sector in Uganda

Transcription

1 New Performance Based Reward Strategy to Improve Pharmacy Practices, Financial Management, and Appropriate Medicines Use in the Public Sector in Uganda Birna Trap (1), Martin Oteba (2), Kt Kate Kikule (3), and Belinda Blick (1) (1) Management Sciences for Health, SURE, Uganda; (2) Ministry of Health, Pharmacy Division, Uganda; (3) National Drug Authority, Uganda

2 BACKGROUND To strengthen Medicines Management SPARS was introduced SRARS combines all four intervention strategies: Theoretical Educational Regulatory Managerial Financial On the job training Practical SPARS Performance Assessment Recognition strategy Supervision or On the job training District and HSD staff are trained as Medicines Management Supervisors (MMS) in a 2 weeks examinable course followed by practical field training enabling them to do on the job (OTJ) training. Performance assessment Performance assessment based on 25 qualitative and quantitative indicators assessing: Recognition Recognition strategy is targeting both the MMS and the facilities that performs well ( mugs to netbook and motor bikes) 3

3 STUDY AIMS To assess impact of a) SPARS implemented by trained MMSs b) Financial Management c) Computerization of medical stores (Rx Solution) on: stock and storage management prescribing and dispensing quality, and ordering and reporting quality 4

4 Setting METHODS The study includes 45 intervention ti districts, i t 9 control districts, with all level of care facilities Design Pre post with control and randomized longitudinal intervention study with randomization by facilities; Preliminary assessment 72 facilities by level of care (hospital, HC 4, 3, 2) from 9 intervention districts Pre/post assessment. Statistical analysis Pre post analysis: Preliminary assessment and intervention A and B vs. Control paired observations, Wilcoxon sign ranksum and paired student t test Longitudinal analysis: Multivariate analysis of variance (MANOVA) for repeated measurements or generalized estimating equations analyses. 5

5 Intervention Intervention A: SPARS. Performance assessment /OJT intervention to all facilities in 45 intervention districts. Sustainability measured after 6 months. Comparison to 63 control facilities randomly selected from 9 control districts Intervention B: Financial management and computerization. After four OJT, 42 hospitals and 68 HC 4 are randomly allocated to one of three groups (1) OJT in FM targeted at certification in goodfm FM, (2) OJT in stores computerization and (3) control group. Time (month) Intervention SPARS Sustainability Intervention A H;4;3;2 (1482HF/45 D) V1 OJT V2 OJT V3 OJT V4 OJT V5 PA PA PA PA PA Pre/post data PRE POST POST longitudial data B A A A A Intervention ti B Financial management H(42) HC 4 (68)/45 D a V5OJT V6OJT V7OJT V8OJT V9 PA PA PA PA PA FM FM FM FM FM ICIUM Intervention: Rx b V5OJT V6OJT V7OJT V8OJT V9 PA PA PA PA PA Rx Rx Rx Rx Rx c V5 V6 PA PA Control V1 V2 V3 H;4;3;2 (63HF/9 D) PA PA PA Performance Assessment: PA in pharmacy practice PA + financial management PA + Rx indicators 5

6 Performance indicators A. Dispensingquality C. Storage management 1. Dispensing time 13. Stock card availability 2. Packaging material 14. Correct filling of stock card 3. Dispensing equipment 15. Does physical count agree with 4. Services available 5. Patient care 6. Labeling 7. Discrepancy prescribed/dispensed B. Prescribing quality 8. Correct recording of prescriptions 9. Rational prescribing 10. Adherence to STGs for Diarrhea 11. Adherence to STGs Cough/cold (ARI) stock card balance 16. Is stock book correctly used D. Storage management 17. Cleanliness of the pharmacy 18. Hygiene of the pharmacy 19. System for storage of medicines 20. Storage conditions 12. Adherence to STGs Malaria 21. Storage practices of medicines E. Ordering and reporting quality 22. Reorder level calculation 23. Timeliness of order and distribution tion 24. Accuracy of HMIS reports 25. Filing 6

7 RESULTS 1 Ordering & reporting quality Dispensing quality Prescribing quality visit 1 visit 3 Storage management Stock management Improvement following only 2 OJT 7

8 Results 2 Average improvement was 58% Improvements: stock management, dispensing and prescribing quality : 67 75% ordering and reporting improving : 44% storage g management : 29% Highest improvements included: Correct use of stock card and having correct balance Use appropriate packaging material dispensing envelope instead of paper cone, and lbli labeling Ensuring that a full course of antibiotics was given. Adherence to STG for diarrhoea and common cough and cold (no use of antibiotics). 8

9 Key lessons learned 1. SPARS result in significant improvement in all but 2 of the 25 indicators. 2. SPARS was found to make a significant impact : stock and storage management prescribing and dispensing quality, ordering and reporting quality. Staff are proud about their achievement 10

10 Implications SPARS to be used for capacity building in other areas and to strengthen MOH technical programs Public sector HF for first time to meets NDA inspection criteria's MMS new focus on pharmaceuticals at district level SPARS ensures critical mass Future research agenda Assess impact of strengthened financial management capacity and computerized logistic management (RxSolution) combined with SPARS on PP and AMU Explore sustainability Assess costs and benefits in longer term 10