Costs and Effectiveness of the Supervision, Performance Assessment and Recognition (SPARS) Strategy for Medicines Management in Uganda

Journal Article
  • Brendan Kwesiga
  • Anita Katharina Wagner
  • Morries Seru
  • Dennis Ross-Degnan
  • Birna Trap
Journal of Pharmaceutical Policy and Practice
2019; 12: 36. DOI:



Essential medicines and health supplies (EMHS) are fundamental to providing quality health care that is critical for saving lives. Ensuring that medicines of good quality are available, accessible, affordable, and appropriately used is a key objective of the Uganda National Medicines Policy. Central to achieving this objective are good medicines management practices at all health facilities. Despite Uganda’s long-standing commitment to its medicines policy, the pharmaceutical supply chain has faced many well-documented constraints. In an effort to improve medicines management capacity at health facilities, Uganda developed and implemented a multi-pronged, evidence-based supervision, performance assessment, and recognition strategy (SPARS).


We wanted to estimate the costs and cost effectiveness of SPARS implementation in public (government and private not-for-profit) health facilities in Uganda. This information is critical for further SPARS scale up in Uganda and for SPARS implementation in countries with similar contexts that want to consider rolling out SPARS as a national strategy. SPARS has been implemented by Uganda’s Ministry of Health since 2010 with support from the US Agency for International Development. SPARS is implemented by district-level health care staff who are trained as MMS to provide on-the-job supervision and training of health workers.


Evidence shows that SPARS is an effective intervention to improve performance in key medicines management domains. Based on our estimates from this study, implementing and operating SPARS costs about US$370,000 annually for 1460 facilities, which would extrapolate to approximately US$760,000 for about 3000 government sector facilities or about 0.3% of the total government- and donor-funded EMHS budget.