title: Implementation status of self-assessment/peer-group discussion program: a bottom-up approach of monitoring/supervision in improving quality of health services.
abstract: BACKGROUND
  Monitoring/supervision is an essential component for improving the quality of health services including rational use of medicines. A new bottom-up approach of monitoring/supervision consisting of self-assessment/ peer-group discussion was found to be effective in improving prescribing practices. The new strategy significantly improved the prescribing practices based on standard treatment guidelines. The government has implemented it as a Program in primary health care services of Nepal. This article aims to share the implementation status of the self-assessment/peer-group discussion Program for improving the prescribing practices of common health problems and availability of drugs in the district health system.
  
  
  METHODS
  Concurrent mixed research design was applied for data collection. The data were collected at different levels of health care system using in-depth interviews, participatory observations and documentary analysis.
  
  
  RESULTS
  The Management Division, Department of Health Services implemented the Program in 2009-10 and the PHC Revitalization Division, DoHs is the implementation division since 2010-11. The Program comprised revision of participant's and trainer's manuals, training of trainers and prescribers, finalisation of health conditions and indicators, distribution of carbon copy prescription pads, and conduction of peer-group discussions.The Program was implemented in number of districts.
  
  
  CONCLUSIONS
  The government made the policy decision to implement the Program for monitoring prescribing practices and the availability of free drugs in districts. However, it has covered only few districts and needs escalation to cover all 75 districts of the country.
authors.affiliation: International Network for Rational Use of Drugs, College of Medicine, Nepalese Army Institute of Health Sciences.
authors.forename: K K
authors.initials: KK
authors.lastname: Kafle
authors.affiliation: International Network for Rational Use of Drugs, Department of Drug Administration.
authors.forename: G B
authors.initials: GB
authors.lastname: Bhuju
authors.affiliation: International Network for Rational Use of Drugs, CIST College.
authors.forename: S B
authors.initials: SB
authors.lastname: Karkee
authors.affiliation: International Network for Rational Use of Drugs.
authors.forename: R R
authors.initials: RR
authors.lastname: Prasad
authors.affiliation: International Network for Rational Use of Drugs, Valley College of Technical Sciences.
authors.forename: N
authors.initials: N
authors.lastname: Shrestha
authors.affiliation: International Network for Rational Use of Drugs.
authors.forename: A D
authors.initials: AD
authors.lastname: Shrestha
authors.affiliation: International Network for Rational Use of Drugs.
authors.forename: P L
authors.initials: PL
authors.lastname: Das
authors.affiliation: International Network for Rational Use of Drugs.
authors.forename: B D
authors.initials: BD
authors.lastname: Chataut
authors.affiliation: Department of Health Services.
authors.forename: A
authors.initials: A
authors.lastname: Shrestha
authors.affiliation: PHC Revitalization Division, Kathmandu, Nepal.
authors.forename: B K
authors.initials: BK
authors.lastname: Suvedi
mesh_terms: D011307:Drug Prescriptions / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006801:Humans; D007318:Inservice Training; D009390:Nepal; D010379:Peer Group; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration*; D012647:Self-Assessment