Supervision, performance assessment, and recognition strategy - a quasi-experimental pre-post study of the multipronged interventions to and strengthen medicines management in Nepal.

Background: To improve medicines management (MM) in health facilities, Nepal piloted a multipronged intervention - the supervision, performance assessment, and recognition strategy (SPARS). This paper describes a pre-post intervention to assess the SPARS intervention effect on improving MM in selected government health facilities at all levels of care.

Methods: Selected health workers were trained as MM supervisors (MMS) to visit health facilities, assess MM performance, and use the findings to provide support in MM practices. MMS assessed performance using an indicator-based tool containing 25 MM indicators covering five domains: dispensing quality, prescribing quality, stock management, storage management, and ordering and reporting, for a maximum score of 25. From mid-2022 to October 2023, 48 MMS visited 347 government health facilities in 12 randomly selected pilot districts in three provinces. We assessed SPARS indicator performance over 3 supervisory visits.

Results: Between the first and third SPARS visit, we found a significant (p ≤ 0.000) improvement of 123% or a 41.4 percentage-point change in the overall SPARS indicator score from an average of 8.5-18.8. improvements were observed in all five domains. Further, MMS with less than 10 years of experience had a higher impact than more experienced MMS - 39.4 and 33.8 points, respectively. At baseline, no facility had adequate SPARS scores of ≥75%, while 184 facilities (53%) were adequate by the third visit. There was no significant difference in impact measured between provinces; remote and residential facilities; high, medium, and low-level care facilities; and resource-based and behavioural indicators.

Conclusion: Following three supervisory visits, the multipronged intervention significantly improved the overall SPARS score and all 25 indicators assessing performance in stock and storage, ordering and reporting, and dispensing and prescribing quality. We recommend SPARS as an effective approach to strengthen MM in health facilities in Nepal and other low-income countries.