Innovative Approach for Improving Medicines Management in Nepal
Ensuring the availability of essential medicines and their appropriate use is an important factor for optimal health care delivery, especially in resource-limited countries. Inefficient medicine stock control and poor dispensing practices at service delivery points can lead to medicine wastage and poor use of limited resources, not to mention the risk related to treatment efficacy of patients and contribute to antimicrobial resistance. The Nepal Ministry of Health and Population (MOHP) recognizes the critical public health need to build its health care cadres’ capacity in medicines management to improve its stock control, reduce waste, and promote appropriate medicine use at all levels of health care, especially at government healthcare pharmacies.
To address these challenges, the USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, in collaboration with the MOHP, is piloting the Supervision, Performance Assessment, and Recognition Strategy or SPARS in Bagmati and Lumbini provinces of Nepal—an innovative, demonstrated approach to building essential medicines and medicines supplies management capacity and improving medicines management at public health facilities, especially at government district hospitals, primary healthcare centers, and health posts. A multipronged strategy developed based on the experience of a prior USAID program in Uganda and the Global Alliance for Vaccines and Immunization (GAVI), SPARS will be piloted in Nepal in three districts in the Lumbini province and three in the Bagmati Province.
Over the years, improvements in Nepal have included increased capacity of health facility managers and pharmacy staff in medicines supply chain management, and the introduction of an electronic logistic management information system; however, their sustenance has been a challenge mainly due to inadequate human resources with pharmaceutical expertise and the absence of ongoing logistical support for trained personnel. As a result, problems such as weak stock control and store management, poor dispensing and prescribing practices, inefficient quantification of needs, and ill-maintained stock records have persisted. Inspectors from Nepal’s national regulatory authority, the Department of Drug Administration (DDA), conducted a special study in 2021 with USAID support and estimated that 43% of inspected government health facility pharmacies would fail a WHO Good Pharmacy Practices (GPP) inspection, a tool used by the DDA to inspect private sector pharmacies. The DDA, responsible for regulating medicines and medical supplies in Nepal, inspects private-sector pharmacies for GPP compliance but is constrained by its limited resources to inspect government healthcare pharmacies.
SPARS implements a new approach to building capacity that can sustainably improve pharmacy practices and equip government healthcare pharmacies to get GPP certified. It couples supervision and on-the-ground training, which has been effective in bolstering medicines management, with a performance assessment and personnel recognition strategy that sustains gains and allows for application of best practices.
Adapting and Implementing SPARS in Nepal
USAID will design the SPARS pilot in Nepal adapted from the implementation experience in Uganda, where the indicator-based approach demonstrated results to build health workers’ capacity in five domains: stock management, storage management, ordering and reporting, prescribing, and dispensing of medicines.
To kickstart the SPARS pilot, in December 2021, high-level provincial officials from both Lumbini and Bagmati provinces, along with the chief officers from District Health Offices and health coordinators from all municipalities, were convened and oriented to SPARS, SPARS tools, and its approach of inducting ‘medicine management supervisors’ or MMS’s in the districts. MMS’s work with health facilities’ staff in their respective provinces to strengthen medicines management, including improving medicines use at the facility level.
“To increase the standard of pharmacies in Nepal is very good but it’s also challenging to implement the program because of many aspects. However, we are supportive to the program and will help to implement the SPARS program as much as we can.” – Hon. Nima Lama, Provincial Health Minister, Bagmati Province
A two-week residential program to build capacities of 30 MMSs, nominated by respective provincial health directorates, was successfully completed in March 2022, in collaboration with Kathmandu University, USAID MTaPS’ training partner for SPARS in Nepal. The provincial health directorates supported the participation of their MMSs in the supervision program, covering their job responsibilities during their absence and facilitating their visits to government healthcare pharmacies to implement SPARS. The data gathered by MMSs during the program will be shared at the central level with the MOHP and its Curative Services Division—the national focal point for SPARS—to inform their assessment of the participating pharmacies’ services and the decision to roll out SPARS to other districts based on impact as captured by data. The findings may also inform other ideas such as considering the participation of pharmacies in the national health insurance scheme.