Prasad RR, Kafle KK, Shrestha AD, Shrestha N, Karkee SB, Bhuju GB,Shrestha NP INRUD,Nepal

1. PILOT IMPLEMENTATION OF SELF-MONITORING AND PEER-GROUP DISCUSSION STRATEGY TO IMPROVE USE OF MEDICINES IN PHC OUTLETS IN NEPAL Prasad RR, Kafle KK, Shrestha AD, Shrestha N, Karkee SB, Bhuju GB,Shrestha NP INRUD,Nepal

2. Introduction • Prescribing is an important component in the health care delivery. • Improving prescribing practices is a difficult task. • Standard Treatment Guidelines (STGs) have been considered an important tool to improve prescribing practices. • Studies conducted by INRUD/Nepal have shown that both supervision/monitoring and peer-group discussion strategies are effective in improving prescribing practices at primary health care (PHC) outlets.

3. However, supervision/monitoring involves regular visits by the District Health Officer/Supervisor to the health facilities, which would require funding and time that are not available, making the strategy non feasible in practice. • On the other hand, peer-group discussion is conducted in the district at the time of district meeting, which is scheduled regularly.

4. Objective The overall objective was to evaluate the effectiveness of a peer-group discussion strategy implemented through the district health system in improving the use of medicines at PHC outlets

5. Specific Objectives The Specific objectives are to improve prescribing practices of paramedics at primary health care facilities by • increasing the use of ORS, decreasing the use of antidiarrhoeals and antimicrobials in acute watery diarrhoea in children below 5 years. •  increasing the use of cotrimoxazole or amoxycillin alone or with paracetamol for pneumonia, decreasing the use of cotrimoxazole or amoxycillin or other antibiotics in no pneumonia in children below 5 years. • increasing the use of benzyl benzoate or gamma benzene hexachloride and decreasing the use of antibiotics in scabies.

6. Methodology • The study is a pre-post study in a district with pilot implementation of peer-group discussion strategy.  The selected district is Chitwan, in the central region of Nepal. • All three Primary Health Care Centres (PHCCs) and six Health Posts (HPs) of the district are included in the study. • The data are collected prospectively by using the carbon copy of the prescriptions. • All carbon copy prescriptions for three selected health problems are analysed. The carbon copy prescriptions with single diagnosis only are included in the study.

7. The training of trainers (ToT) was conducted for the health workers/district supervisors from the district health office. • The trained health workers conducted trainings for health workers from the different health facilities after one month of baseline data collection. They also conducted separate orientation for health committee members.

8. The peer-group discussion is conducted every month at the district health office by District Public Health Officer for five months. • The discussion uses Ilaka Consolidation Form compiled by the incharges of Primary Health Centres and Health Posts, incorporating self-assessment findings of all prescribers from their health facilities. • Post-intervention data will be collected one month after the fifth peer-group discussion.

9. Results • Curriculum development and development of training manual and trainers manual • Training of Trainers (ToT) for seven health workers/district supervisors including District Public Health Officer • Participants of ToT conducted three trainings (one for district level, one for PHCC/HP level and one for sub-health post level workers). • Three orientations conducted for committee members • Three peer-group discussions completed by February 2004.

10. Conclusions • There has been active participation of the District Health Office in-charge in training of trainers and peer-group discussions. • The incharges from PHCCs and HPs have also actively participated in different activities. • Post-intervention data will be collected in mid-June 2004.