[e-drug] Effect of supervision on drug management and use

[Richard Laing <richardl@bu.edu>]

E-drug: Effect of supervision on drug management and use
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E-Druggers may be interested in this recent article. If you need a
copy of the full article, e-mail me and I will send you an individual
copy.

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The impact of supervision on stock management and adherence to
treatment guidelines: a randomized controlled trial  
 
Health Policy and Planning; 16(3): 273-280
Birna Trap, Charles H Todd, Heather Moore and Richard Laing4

Ensuring the availability of essential drugs and using them appro-
priately are crucial if limited resources for health care are to be used
optimally. While training of health workers throughout Zimbabwe in
drug management (including stock management and rational drug
use) resulted in significant improvements in a variety of drug use
indicators, these achievements could not be sustained, and a new
strategy was introduced based on the supervision of primary health
care providers. This was launched in 1995 with a training course in
supervisory skills for district pharmacy staff. 

In order to evaluate the impact of the supervision and the
effectiveness of the training programme, adherence to standard
treatment guidelines (STG) and stock management protocols was
evaluated in a randomized controlled trial. The study compared
three different groups of health facilities: those that received
supervision for either use of STG (n=23) or stock management
(n=21) - each facility acting as control for the other area of
supervision - and a comparison group of facilities which received no
supervision (n=18). On-the-spot supervision by a specially trained
pharmacy staff, based around identified deficiencies, took place at
the start of the study and 3 months later. The evaluation compared
performance on a variety of drug management indicators at baseline
and 6-8 months after the second supervisory visit. 

The results of the study showed that, following supervision, overall
stock management improved significantly when compared with the
control and comparison groups. Similar improvements were
demonstrated for adherence to STG, although the effect was
confounded by other interventions. The study also showed that
supervision has a positive effect on improving performance in areas
other than those supervised, and demonstrated that pharmacy
technicians with limited clinical skills can be trained to influence
primary health care workers to positively improve prescribing
practices. 

Allocating resources to supervision is likely to result in improved
performance of health workers with regard to the rational use of
essential drugs, resulting in improved efficiency and effectiveness.  

Richard Laing
Associate Professor of International Health
Boston University School of Public Health
715 Albany St, T4W, Boston MA 02118 USA
Tel 617 414-1444 Fax 617 638-4476
E-mail richardl@bu.edu


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