Ensuring the availability of essential drugs and using them appropriately 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.