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Tool Name The Service Provision Assessment Origin / Source: MEASURE DHS+ Technical area: Maternal and Newborn health Tools: The following documents are in PDF format. To open them, you need the free Adobe Acrobat Reader. The size of the file is in parentheses.
Basic Description: The Service Provision Assessment is a national health facility survey designed to collect information on the functioning of maternal, child and reproductive health (family planning and STD/HIV) services. The survey provides information on the availability and quality of health services and identifies gaps in services provision. Survey instruments are designed in modular format so that services may be assessed individually if required. Country Applications: The first SPA survey was implemented in Kenya in 1999. Since that time Service Provision Assessments have been carried out in Mexico, Bangladesh, Rwanda and Ghana and further surveys are planned. Language(s) Available: English, French, Spanish pending Purpose: The SPA is designed for needs assessment purposes as well as for monitoring and evaluation. Since the tool has been designed relatively recently, as of January 2002, no country has undertaken more than one survey and hence has not yet been used for monitoring or evaluation purposes. Technical Scope/Purpose: The Service Provision Assessment consists of four principal data collection instruments; a facility inventory, a provider interview, a client observation and client exit interview. In detailed information is collected to address the following issues; To what extent are the surveyed facilities prepared to provide the priority services? (Availability of Resources) To what extent does the service delivery process follow generally accepted standards? (Care Process) To what extent do support systems for maintaining or improving the services exist, and how well are they functioning? (Support Services) What are the issues that the clients and service providers consider relevant to their satisfaction with the service delivery environment? All the instruments are designed to assess whether facilities meet internationally accepted standards and indicators (as promoted by WHO and UNICEF and other agencies). The facility inventory and provider interview collect information on the facility infrastructure; the availability of equipment, supplies, medicines, staff, protocols, client teaching materials and health information records; staff training & supervision. They also collect information about the availability and functioning of facility support system services including management committees, quality assurance programs, pharmacy logistics, equipment maintenance, infection control practices, and various monitoring systems. The observation and client exit interview assess whether the services are delivered to internationally recognised and local standards. The facility inventory and health worker interview for maternal and newborn health services collect information related to antenatal care, delivery and postpartum services. The observation and exit interviews look only at antenatal care services. Design: Cross sectional survey of health facilities, clients and health system personnel. Method: Quantitative Frequency of Administration: The frequency of administration should be decided locally, depending on local needs and budget. Given the cost and slow rate of change of health care systems it is unlikely that national surveys are warranted more than every three- five years. Key Users of the Information: The SPA data is targeted at health system planners, managers and policy makers at the national and provincial levels and programme donors (for example multilateral and bilateral donor agencies). The results of the analysis are also likely to be of interest to district health managers, NGOs and researchers. Objectives and Scope of the Tool: See "technical scope and purpose" above The technical scope of each national survey must be adapted carefully to each country's needs and health system. Before the survey tools are used, they must be carefully reviewed, critically assessed, and adapted to address the specific situation in which they are to be applied. They cannot be used "off the shelf". A key task of the team carrying out the survey is therefore the local adaptation to meet the needs and match the setting in which the survey is implemented. Key Indicators: The SPA maternal and newborn health indicators are design to measure the following domains (See accompanying indicator list for full details)
Tool Design: The SPA survey has been designed for implementation by a local agency under the direction of the Ministry of Health (MOH) and with technical assistance provided by Macro International. Before any fieldwork is carried out several practical issues need to be addressed. These include
Decisions regarding which services and which facilities will be assessed, which modules will be implemented, the level of disaggregation of the information required and the precision of the estimates obtained need to be made in advance of any field work. These factors critically influence the sample size and therefore the cost of any survey. Although the most complete picture of quality and service availability is provided when all four service areas are assessed together, financial, human and other resource constraints may limit the scope of the survey. Although, regional comparisons of SPA data is feasible and provides valuable information for targeting resources, sub-regional disaggregation will, in most cases, not be cost-effective. Over sampling of facilities from specific sub-areas may be useful, however, if the goal is to evaluate the impact of a health service activity or intervention of interest that has been targeted to a limited number of catchment areas. Implementation and Training: A survey committee should be established at the outset to plan and manage the survey. At a minimum this survey team should include persons knowledgeable about program priorities and technical standards being promoted in a country, for maternal, child, and reproductive health, as well as persons knowledgeable about survey methodology and implementation. This committee should assume responsibility for the overall planning and management of the survey, although the actual implementation will be carried out by an in country organisation. Survey activities include
The data collection is carried out by teams of four ( three data collectors and one driver) Data collectors should be health workers with a service delivery background in at least one of the four health services and should be mainly women since almost all clients observed and interviewed will be female. Data collectors are trained over 15 days using a standard survey protocol. Manuals and Guidelines Survey manuals and guidelines include:
Data Processing and Analysis: Data entry is carried out in country by programmers hired for the duration of the survey . Data are analysed using standard tabulation plans. If desired, local programmers may be trained using either CSPRO or SPSS. A national health facility survey report is typically written by appointed members of the survey committee. Technical assistance for both activities is provided by Macro International. Reporting and Dissemination of Results: The main findings from the survey are presented to key health system representatives in national and provincial seminars following the publication of the final report. This information is of major importance in identifying critical areas for health system investment. Costing: The resources required to carry out a SPA will vary in different settings. Under normal circumstances, budget estimates are calculated for approximately 400 facilities in 10 regions, with fieldwork taking an estimated 8-10 weeks (depending on whether 10 or 15 teams of data collectors are used. Each team requires a vehicle as a team remains at a facility a full day. In addition to locally incurred costs, the cost for technical assistance the first time the SPA is conducted in a country must be anticipated. The level of TA required will depend on the in-country experience with health facility surveys and data processing. Initially at least one major international donor will most likely be required to fund the survey. Lessons from Experience: Because the SPA is a new instrument, there are few specific lessons to cite. The results have been used to show system weaknesses that affect all services (e.g. a consistent finding of inadequate infection control measures and minimal counselling across all related services regarding condom use to prevent STIs, in a nation with high prevalence of HIV/AIDS). In addition, the program developers for each service will be able to determine if program policies are being implemented across facilities. There are many ways to achieve the same objective in providing health care and maintaining health systems. These will vary according to the level of development and health system funding in each country. For data to be useful within the country as well as for international comparisons, the adapted tools must capture whether objectives are being achieved, even under conditions where the equipment and supplies vary considerably. The need to adapt the tools for each country and the need to have health personnel familiar with basic health system and health service delivery methods and objectives to collect the data, has become more evident each survey. Contact Person: |