The Urban Private Health Sector Inventory (UPSI)

Abstract

• Name: Urban Private Sector Inventory (UPSI)
• Purpose: The Urban Private Health Sector Inventory was developed to assist program planners in defining the composition, size and basic service capabilities of the urban private sector. The data collected was used to inform decisions made in planning an urban community-based child survival program which partnered private sector health providers with community-based organizations.
• Type of Design: Descriptive and cross sectional. The qualitative data collected allows program and project planners to identify, classify and quantify the range of private sector entities that can be mobilized for health service delivery and promotion within a target area.
• Sample Size: The UPSI was used to collect data on private sector organizations in 13 urban communities, with an estimated total population of 1.7 million.
• Where Used: Nigeria

To survey tool

Basic Information

Name: Urban Private Sector Inventory (UPSI)

Origin: Diana Silimperi, Rose Macauley, John Olu Ayodele, and Sam Orisasona, BASICS Project.

Source: BASICS Project

Basic Description: The UPSI was utilized in Nigeria as a tool for determining the composition, size and basic service capabilities of the urban private sector. Three methods were used prior to or concurrently with the application of the inventory to identify participants for the inventory: review of existing records and professional organization registries; interviews with key informants in the communities; and visual surveys and rapid street assessments. The inventory itself is composed of three questionnaires: one designed to collect information from community-based organizations, the second to collect information from private health providers and facilities, and the third to collect information from owners of pharmacies and chemist shops. These questionnaires collect descriptive data on the organizational and technical capabilities, as well as the stability and potential impact, of private sector organizations and facilities. This data can be used in project development for selecting private sector partners and target communities, and in the development of operational frameworks for program implementation. In addition, the data can be used as a baseline assessment of organizational and technical capabilities among private sector providers.

Country Applications: Nigeria

Languages Available: English

Technical Scope: Primarily private sector providers and immunization services.

Purpose: To determine the composition, size and basic service capabilities of the urban private sector.

Type of Methods: Quantitative.

Design: Descriptive, cross-sectional.

Frequency of Administration: Can be used for baseline assessments and follow-up.

Key Users of Information

Program and project designers and planners

Objectives and Scope of Tool

The UPSI was designed to gather initial information to assess the potential for private sector development and impact in an urban setting. The information gathered by the UPSI was instrumental in designing a model project focusing on strengthening the involvement of the private sector in the promotion and delivery of child health services

Key Monitoring Needs and Evaluation Questions Tool Seeks to Address

The tool provides information on urban private sector capabilities in the promotion and delivery of child health services.

It has been suggested that the use of follow-up inventories could be used to track program evolution, or progress made by specific organizational partners. However, this potential was not exploited due to the development of Leadership and Membership Inventories designed to measure the progress of organizational development within the project. (These inventories are contained in "Process Evaluation of the Community Partners for Health Program of BASICS/Nigeria", authored by William Brieger and Peter Bolade Ogunlade, available from the BASICS Project.)

Key Indicators

The UPSI is used to collect the following information:

Potential sustainability of the organizations identified:

• Years of duration (how long the organization has been in existence);
• Staffing patterns (size and skills of staff members);
• Membership base (size and demographics of clients and members);
• Physical facilities (characteristics of physical facilities utilized);
• Registration status (registered with government or not?).

Experience with child survival programs:

• Client profiles;
• Description of immunization services provided.

Research Design

Standard protocol:
The size of the inventory depends on the scope of the program. The inventory in Nigeria was performed in five local government areas in Lagos chosen on the basis of their high degree of urbanization and low levels of health status. Within these five areas, thirteen communities were inventoried. The total population of these communities was estimated at 1.7 million. Communities were chosen on the basis of three factors: high population levels, poor public health status and low- to middle-income status. A modified version of the tool was later utilized to conduct an inventory in Kano (Nigeria) in ten communities (estimated population: 4 million).

Prior to conducting the inventory, three methods were used to identify potential participants: review of existing records and professional organization registries; interviews with key informants in the communities; and visual surveys and rapid street assessments. The lack of accurate, detailed maps of the target communities made this advance investigation particularly important. Interviewers continued conducting rapid street assessments and visual surveys as they were conducting the interviews with the private sector organizations.

Supervisors monitored completion of assignments, overall progress and quality assurance over the course of the inventory, providing feedback to the interviewers as needed. Checklists and other forms were developed to facilitate the monitoring and organization of the data collected.

Lessons from experience:

• Visual surveys were an important means of identifying private sector providers in the urban environment. The use of local maps greatly enhanced the ability to gather and track information about the locations of private sector providers.
• An inventory of this type is best scheduled during the dry season.
• To save time, it is useful to identify umbrella organizations and their linkages prior to the start of the inventory to facilitate access to their members.

Standard protocol:
A six-day training program was designed to provide interviewers and supervisors with an understanding of the objectives for the inventory, a working knowledge of the questionnaires, and an overview of the logistics, daily planning, quality assurance, and monitoring and supervision necessary for the implementation of the inventory. Training included two days of initial training, two days of pre-testing the method and instruments, and two days of follow-up training after the instruments were revised on the basis of the pre-test. Participatory learning methods were used. The training stressed the importance of accuracy and the need to maintain daily diaries to record specific problems and challenging field situations. Proper preparation of the interviewers and supervisors was critical to the success of the inventory, given the urban environment in Lagos.

Lessons from experience:

• More time should have been devoted to intensive interviewer training.

• The inclusion of pretesting in the training was valuable to evaluate the interviewers mastery of the questionnaires, as well as to update the content of the questionnaires, and the methods used in the application of the tools.
• Since many of the urban sites and conditions were unfamiliar to the interviewers, a "street-wise" orientation was included in the training to prepare them for the realities of inner-city interviewing.
• The importance of a standard, clear, simple introductory statement became clear during pretesting. Some respondents believed that the interviewers were government agents , and were reluctant to participate.

Implementation

The survey team consisted of 21 interviewers, two supervisors, and one principal inventory coordinator. While only a few had medical backgrounds, all interviewers had earned at least an undergraduate degree.

Following the identification and initial mapping of private sector organizations, the target communities were divided into "workable" subareas. Based on the initial tally of streets in the areas, interviewers were assigned a number of streets to cover each day. Supervisors monitored daily contacts by the interviewers, as well as rescheduled interviews, refusals, successfully completed interviews, and street completion status. Interviewers worked in teams of ten or eleven members, completing one subarea at a time. The teams worked in the field from 9:00 a.m. to 4:00 p.m., avoiding work during non-daylight hours. The urban environment accentuated the extent of logistical preparation necessary to ensure transport and proper security. One to two hours per day were required for transport of interviewers to and from survey sites. Female interviewers were encouraged to work in pairs for safety reasons.

Questionnaires were printed in English, and translated into other languages by the interviewers as needed.

Five forms were used to facilitate the monitoring and organization of the data collected: interviewer daily itinerary, interviewer daily checklist, interviewer diary report, daily attendance registry, and daily evaluation. These forms were used by the supervisors to ensure consistent, high-quality performance according to the time frame. Supervisors reviewed the completed questionnaires on a daily basis to ensure that corrections were made before the team moved to a new site.

Following completion of the inventory, a simple validation study was carried out. This study consisted primarily of re-creating visual surveys, and was intended to broadly estimate the detection power of the inventory.

Lessons from experience:

• The training, pretesting, rapid street assessments, visual surveys, and questionnaire administration took 20 days. Actual administration of the tools took approximately eleven days in the field (182 total person days).
• Maps used by the interviewers were updated daily.
• In most health facilities, it was necessary to conduct the interview with the proprietor/medical director. Interviews were scheduled to coincide with the times when this person was available.
• It is important to schedule sufficient time for travel to and from sites. Providing transport so that interviewers can travel to the work sites together reduces the logistical burden.
• Time constraints were an issue for the respondents. As a result, an abridged questionnaire was developed for use with health practitioners. Interviews were also completed on multiple visits, if necessary. Where possible, other staff members were able to answer specific questions to reduce the burden placed on the director.
• The supervisor held daily team review sessions to discuss problems and provide feedback for improvement. The daily written diaries maintained by the interviewers provided concrete information for these review sessions.
• A high supervisor to interviewer ratio is necessary to provide sufficient quality control.
• The validation study found that, while allopathic facilities, pharmacies and chemist shops were well identified, traditional healers were consistently under-identified in the full inventory.
• The approximate cost of the inventory, excluding technical assistance provided by BASICS staff, was $15,000.

Analysis

The UPSI has a companion computer software package based on Epi Info, complete with code book and instruction guide for data entry. The cleaned data, reviewed by the team supervisors, was entered into this database on a daily basis by two data processors. The data was analyzed using Epi Info 6.0. Simple frequencies and percentiles were calculated for all variables. Cross tabulations with chi square tests were performed for selected variables, and summary aggregate tables of key findings were developed, along with graphic representations. Schematic mapping of the surveyed sites, including the locations of the private sector organizations, was also performed. Identification and geographic codes were designed to promote easy linkages with future surveys (household and facility based), as well as with program activities.

Reporting

The UPSI produces the following types of information:

• Absolute numbers of community-based organizations and health facilities per community.
• Types of community-based organizations and health facilities per community.
• Number of community-based organizations or health facilities with largest potential impact.
• Networking potential (based on range and type of potential private sector partners).

While official reports were not produced, the data collected by the UPSI was used by BASICS Project program planners to assist in project design. Once the program design was completed, the data was made available to the participating community private sector organizations to assist in the development of partnerships and action plans.

Dissemination of Results

A document (Urban Private Health Sector Inventory: A First Step in Mobilizing Private Initiative for Child Survival) detailing the development, design, findings and utility of the UPSI in Nigeria has been produced by the BASICS Project.

Manuals and Guidelines

The following manuals were developed for use with the UPSI:

• Guidelines for Research Assistants (Interviewers' manual, including guidelines for administering each of the three inventory questionnaires).
• Codebook and instruction guide for data entry for UPSI software package.

The interviewers manual is available in "Urban Private Health Sector Inventory: A First Step in Mobilizing Private Initiative for Child Survival".

Contact Person
Carolyn Kruger
BASICS Project
1600 Wilson Blvd.
Arlington, VA 22209
703-312-6800