Public health workers’ experiences and perceptions of supervision in medicines management – a qualitative study from Uganda

Start date: 4 March, 2012 End date: 4 June, 2012 Project type: Master's Thesis (prior to 2018) Project code: A15117 Countries: Uganda Institutions: University of Copenhagen (UCPH), Denmark Grant recipient: Mette Hessilt and Stine Westergaard Total grant: 15,000 DKK


Aim The aim of the study was to explore the experiences and perceptions about medicines management among health workers who work at public health facilities level III and IV in Uganda.
Background After the implementation of a new supervision strategy, SPARS, public health facilities perform differently with respect to improvement of medicines management. SPARS assesses medicines management in five areas; dispensing and prescription quality, stock- and storage management and ordering & reporting. The performance of health facilities depends on activities, performance and motivation of health workers which is why it is interesting to look at what experiences and perceptions health workers have with SPARS and which factors may influence on performance and motivation of the health workers, according to themselves.
Literature review It was found that performance of health facilities depends on the motivation and performance of the health workers. Factors such as low salary, drug availability and support by managers were found influencing.
Theoretical perspectives The theoretical perspectives applied were Leavitt’s model with Scott Morton’s modifications of changes occurring in an organization, a conceptual framework of factors influencing on health worker motivation by Franco et al. and social cognitive career theory by Lent, Hackett and Brown. These three models were chosen for covering all the fields of the study.
Methods The study was based on qualitative methods. 20 interviews with health workers from four public health facilities level III and four health facilities level IV in the Eastern and the Central regions of Uganda were conducted. Sampling of health facilities was based on performance assessed in SPARS. The four best and poorest performing facilities were included. Observations from the health facilities were also included. Two focus group discussions were conducted with 10 supervisors of SPARS, South Western region. The framework for the analysis was open coding. Method- and researcher triangulation were utilized in the study.
Results Health workers had many roles and responsibilities regarding medicines management. Supervision was perceived as positive and provided health worker with new knowledge and skills. Health workers and supervisors pointed out following factors as being either motivating or demotivating for their performance: Health facility conditions, leadership support, number of staff besides workload, salary, behaviour of the supervisor, rewards, drug availability and staff accommodations.       
Discussion The applied theoretical perspectives were found useful. The validity and reliability of the study is perceived as being good. The findings can be generalized to other parts of Uganda and to developing countries with similar structures of the health care system.
Conclusion Health workers perceive and experience supervision as positive. Supervision provides the health workers with new knowledge and skills. Several factors such as behaviour of supervisor, health facility conditions and rewards are pointed out by health workers and supervisors as influence motivation and performance of the health workers.