Effect of mentorship and technical health systems strengthening (MaTHSS) model on HIV/AIDS medicines management at private not for profit health facilities in Uganda : a retrospective before and after study
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Introduction: In Uganda, HIV medicines management at the health facility levels has been a challenge leading to perennial stock-outs and wastage due to heavy expiries and pilferage. This further impacts the number of HIV patients accessing treatment and later translates into non-achievement of the 90-90-90 targets for Uganda. This study, therefore, aimed to ascertain if the MaTHSS model has any effect on improving health facility performance on HIV medicines management at Private-not-for-profit health facilities in Uganda. Methods: A retrospective study design using a before and after approach that was guided by document review was utilized to assess if the MaTHSS model had any impact on HIV/AIDS medicines management at 201 private-not-for-profit health facilities for 1 year (from July 2017 to July 2018). The effect was measured by comparing the baseline performance SPARS scores with the performance scores following one year of implementation of the model. A paired t-test was used to determine if there was a significant change in performance following one year of implementation, logistics regression was used to assess the factors associated with adequate performance. Results: The performance of 201 health facilities was reviewed. Nearly half (123, 61.2%) were health centre IIIs, 17.4% (35) hospitals, 16.4% (33) special clinics, and 5.0% (10) health centre IVs. Results of a paired-samples t-test showed that the mean overall SPARS scores differed at baseline (M=73.8%, SD=11.8%) and after one year of implementation of the MaTHSS support supervision model (M=81.8%, SD=8.5%) at the 0.05 level of significance (t=10.6269, p<0.001) which was an 8.0% (95% CI 6.6-9.5) mean difference. At bivariate analysis, the health facility’s level of care, region, and several supervision visits done within a year were the factors found to be significantly associated with a health facility’s attainment of adequate medicines management performance scores while at multivariate analysis only region and number of supervision visits were found to be significantly associated with an improvement in performance. The general perceptions of both the technical officers and health workers were that medicines management practices were lacking before the implementation of the supervision model citing high stock-out rates, poor records management, and poor store management and concurred that these gaps were reduced following implementation of the MaTHSS model. Conclusion: Therefore, a combination of supportive supervision, mentorship, on-job training embedded in MaTHSS model coupled with regular performance assessments yield commendable HIV medicines management performance at health facilities.