Supervision, performance assessment, and recognition strategy (SPARS) - a multipronged strategy to strengthen medicines management in Nepal: pilot study methods and baseline results.

Background: Nepal piloted a multipronged supervision, performance assessment, and recognition strategy (SPARS), to improve medicines management (MM) in public health facilities. This paper describes the SPARS pilot intervention and reports on MM performance at baseline. Methods: To build MM capacity at public sector health facilities, health workers were trained as MM supervisors to visit and supervise government health facilities, assess MM performance, and use the findings to provide support in MM practices. Performance was assessed using a SPARS indicator-based tool containing 25 indicators covering five MM domains: dispensing quality, prescribing quality, stock management, storage management, and ordering and reporting. From the middle of 2022, we trained 60 MM supervisors who began conducting supervisory visits at 284 health facilities in 12 randomly selected pilot districts located in three provinces. The intent, pending funding, is to continue supervision and expand SPARS to achieve national coverage. Results: The overall MM baseline median score was 8.5 (34%) (maximum 25) with an inter-quartile range (IQR) of 6.4-10.7. Median facility domain scores (maximum 5) were: storage management, 2.0 (IQR 1.4-2.6); stock management 0.3 (IQR 0.0-1.0); ordering and reporting 2.5 (IQR 1.7-3.5); dispensing quality 1.3 (IQR 0.9-1.6); and prescribing quality 2.3 (IQR 1.3-3.3). The overall score did not differ significantly by level of care; however, hospitals had the lowest overall baseline score and individual domain scores. Conclusion: The baseline assessment using the SPARS tool provides valuable information on the current state of MM in Nepal, which was poor, assessed by the 25 SPARS indicators covering stock and storage management, ordering and reporting, prescribing, and dispensing. Assessing and building national capacity in MM is needed at health facilities at all levels of care.