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Service availability and readiness assessment (SARA): an annual monitoring system for service delivery : reference manual

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HEALTH FACILITY ASSESSMENT OF SERVICE AVAILABILITY AND READINESS

Service Availability and Readiness Assessment (SARA) An annual monitoring system for service delivery

Reference Manual

WHO/HIS/HSI/2014.5

© World Health Organization 2014 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Cover photo credit: WHO/Evelyn Hockstein

Service Availability and Readiness Assessment (SARA) An annual monitoring system for service delivery

Reference Manual

Version 2.2 December 2014

Acknowledgements The service availability and readiness assessment (SARA) methodology was developed through a joint World Health Organization (WHO) – United States Agency for International Development (USAID) collaboration. The methodology builds upon previous and current approaches designed to assess service delivery including the service availability mapping (SAM) tool developed by WHO, and the service provision assessment (SPA) tool developed by ICF International under the USAID-funded MEASURE DHS project (monitoring and evaluation to assess and use results, demographic and health surveys) project, among others. It draws on best practices and lessons learned from the many countries that have implemented health facility assessments as well as guidelines and standards developed by WHO technical programmes and the work of the International Health Facility Assessment Network (IHFAN). Particular thanks are extended to all those who contributed to the development of the service readiness indicators, indices, and questionnaires during the workshop on "Strengthening Monitoring of Health Services Readiness" held in Geneva, 22–23 September 2010. Many thanks to The Norwegian Agency for Development Cooperation (Norad) whom has supported Statistics Norway to take part in the development of the SARA tools. The support has contributed to the development and implementation of a new electronic questionnaire in CSPro and data verification guidelines. A special thanks to the Medicines Information and Evidence for Policy unit at WHO for their contribution to the SARA training materials and to the Unidad de Calidad y Seguridad de la Atención Médica-Hospital General de México for their contribution of photographs to the SARA data collectors' guide.

Project Management Group

The SARA methodology and tool were developed under the direction and management of Kathy O’Neill and Ashley Sheffel with valuable inputs from Ties Boerma and Marina Takane.

Carla AbouZahr, Maru Aregawi Weldedawit, Sisay Betizazu, Paulus Bloem, Krishna Bose, Maurice Bucagu, Alexandra Cameron, Daniel Chemtob, Meena Cherian, Richard Cibulskis, Mario Dal Poz, Sergey Eremin, Jesus Maria Garcia Calleja, Sandra Gove, Neeru Gupta, Teena Kunjumen, Thierry Lambrechts, Richard Laing, Blerta Maliqi, Shanthi Mendis, Claire Preaud, Andrew Ramsay, Leanne Riley, Cathy Roth, Willy Urassa, Adriana Velasquez Berumen, Junping Yu, Nevio Zagaria, and Evgeny Zheleznyakov.

Project Advisory Group

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Table of contents Acknowledgements ...........................................................................................................3 Abbreviations ....................................................................................................................6 CHAPTER 1 | OVERVIEW ....................................................................................................7 1.1 Background ....................................................................................................................................9 1.2. Survey overview ...........................................................................................................................11 1.3 Pre-survey preparation ................................................................................................................17 1.4. Planning the survey ......................................................................................................................23 1.5. Training field supervisors data collectors and data entry personnel...........................................26 1.6. Preparing for data collection in the field .....................................................................................31 1.7. Data collection in the field ...........................................................................................................37 1.8 Data entry and processing ...........................................................................................................41 1.9. Data analysis ................................................................................................................................47 1.10. Data archiving ..............................................................................................................................56 References ..............................................................................................................................................64

CHAPTER 2 | CORE INSTRUMENT ..................................................................................... 65 CHAPTER 3 | FACILITY REPORTING DATA VERIFICATION TOOL ........................................ 123 CHAPTER 4 | INDICATORS INDEX.................................................................................... 161 4.1 4.2 4.3 4.4 Indicators ID numbers ................................................................................................................163 SARA general service availability indicators...............................................................................163 SARA general service readiness indicators ................................................................................167 SARA service specific availability and readiness indicators .......................................................172

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Abbreviations AIDS ALT CBR CSV DBS DCMI DDI DQRC DV EDC FBO GIS GPS HIV HMIS HRIS ID IHFAN IHP+ IHSN M&E MDG MFL MNCH MoH NADA NGO OECD PMTCT RDT SAM SARA SPA UNAIDS UNDP UNICEF USAID WHO XML acquired immunodeficiency syndrome alanine aminotransferase crude birth rate comma-separated values dried blood spot Dublin Core Metadata Initiative Data Documentation Initiative Data quality report card Data verification electronic data collection device faith-based organization geographical information system global positioning system human immunodeficiency virus health management information system human resources information system identification International Health Facility Assessment Network International Health Partnership and related initiatives International Household Survey Network monitoring and evaluation Millennium Development Goal master facility list maternal, newborn and child health ministry of health national data archive nongovernmental organization Organisation for Economic Co-operation and Development prevention of mother-to-child transmission (of HIV) rapid diagnostic test service availability mapping service availability and readiness assessment service provision assessment Joint United Nations Programme on HIV/AIDS United Nations Development Programme United Nations Children’s Fund United States Agency for International Development World Health Organization extensible markup language

1. Overview

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

1.1

Background

1.1.1 Why measure service availability and readiness? Sound information on the supply and quality of health services is necessary for health systems management, monitoring and evaluation. Efforts to achieve the Millennium Development Goals (MDGs) and to scale up interventions for HIV/AIDS, malaria, safe motherhood and child health through global health partnerships, have drawn attention to the need for strong country monitoring of health services, covering the public, private-forprofit and private not-for-profit sectors, and their readiness to deliver key interventions. With the increased demand for accountability and the need to demonstrate results at country and global levels, information is needed to track how health systems respond to increased inputs and improved processes over time, and the impact such inputs and processes have on improved health outcomes and better health status. However, despite heightened investments in health systems, few countries have up-to-date information on the availability of health systems that covers both the public and private sectors. Fewer still have accurate, up-todate information required to assess and monitor the "readiness" of health facilities to provide quality services. Ensuring access to quality health services is one of the main functions of a health system. Service access includes different components: availability, which refers to the physical presence or reach of the facilities; affordability, which refers to the ability of the client to pay for the services; and acceptability, which refers to the sociocultural dimension. The quality of services is yet another dimension. A prerequisite to service quality is service readiness, i.e. the health facilities should have the capacity to deliver the services offered. This capacity includes the presence of trained staff, guidelines, infrastructure, equipment, medicines and diagnostic tests. Service availability and readiness are prerequisites to quality services, but do not guarantee the delivery of quality services.

1. Overview 1.1.2 The global and country context

Building upon principles derived from the Paris Declaration on Aid Effectiveness and the International Health Partnership and related initiatives (IHP+), global partners and countries have developed a general framework for the monitoring and evaluation (M&E) of health system strengthening (1). This framework centres on country health strategies and related M&E processes such as annual health sector reviews, and at its core is the strengthening of a common monitoring and review platform to improve the availability, quality and use of data to inform health sector review processes and global monitoring (2). Within this context, WHO has been working with USAID, MEASURE Evaluation, MEASURE DHS, ICF International, and other country and global partners to develop tools to fill critical data gaps in measuring and tracking progress in health systems strengthening. Service availability and readiness assessment (SARA) is one tool available to fill data gaps on service delivery. SARA relies on a rapid data collection and analysis methodology, and can be combined with a record review to assess data quality of the facility reporting system. Ideally, SARA is conducted approximately three to five months prior to a health sector review to allow for the results to feed into the health sector review process.

1.1.3 Related surveys and initiatives The service availability and readiness assessment (SARA) effort builds on previous and current approaches designed to assess health facility service delivery including the service availability mapping (SAM) tool developed by WHO (3), and the service provision assessment (SPA) tool developed by ICF International under the USAID-funded MEASURE DHS project (4). The SARA methodology takes into account best practices and lessons learned from the many countries that have implemented health facility assessments of service availability and readiness. It also draws heavily on the work of the International Health Facility Assessment Network (IHFAN) and on experiences from programmeand service-specific facility assessment work. The training materials for SARA draw on best practices and materials developed for survey methods such as the SPA and the WHO/Health Action International (HAI) methodology for measuring medicine prices, availability, affordability and price components (5).

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

1.2. Survey overview 1.2.1 Survey objectives SARA is designed as a systematic survey to assess health facility service delivery. The objective of the survey is to generate reliable and regular information on service delivery including service availability, such as the availability of key human and infrastructure resources, and on the readiness of health facilities to provide basic health-care interventions relating to family planning, child health services, basic and comprehensive obstetric care, HIV/AIDS, tuberculosis, malaria and noncommunicable diseases. The SARA survey generates a set of tracer indicators of service availability and readiness that can be used to: • detect change and measure progress in health system strengthening over time; • plan and monitor the scale-up of interventions that are key to achieving the MDGs, such as implementing interventions to reduce child and maternal mortality, HIV/AIDS, tuberculosis and malaria, and to respond to the increasing burden of noncommunicable diseases; • generate the evidence base to feed into country annual health reviews, to better inform the development of annual operational plans and to guide more effective country and partner investments; • support national planners in planning and managing health systems (e.g. assessing equitable and appropriate distribution of services, human resources and availability of medicines and supplies). Key outputs from SARA form the basis for national and subnational monitoring systems of general service availability and readiness, and service-specific readiness (maternal and child health, HIV/AIDS, tuberculosis, malaria, noncommunicable diseases, surgical care, etc.). SARA products include a regularly updated national database of public and private facilities, and an analytical report of core indicators to assess and monitor availability of health services and readiness to provide services.

QUESTIONS ANSWERED BY SERVICE AVAILABILITY AND READINESS ASSESSMENT (SARA) • • • •

What is the availability of basic packages of essential health services offered by public and private health facilities? Is there an adequate level of qualified staff? Are resources and support systems available to assure a certain quality of services? How well prepared are facilities to provide high-priority services such as reproductive health services, maternal and child health services, and infectious disease diagnosis and treatment (e.g. HIV, sexually transmitted infections, tuberculosis and malaria)? Are facilities ready to respond to the increasing burden of noncommunicable diseases? What are the strengths and weaknesses in the delivery of key services at health-care facilities?

• •

1. Overview 1.2.2 Key topics, indicators and indices The SARA survey is designed to generate a set of core indicators on key inputs and outputs of the health system, which can be used to measure progress in health system strengthening over time (6). Tracer indicators aim to provide objective information about whether or not a facility meets the required conditions to support provision of basic or specific services with a consistent level of quality and quantity. Summary or composite indicators, also called indices, can be used to summarize and communicate information about multiple indicators and domains of indicators. Indices can be used for general and service-specific availability and readiness. There are three main focus areas of SARA. I. Service availability refers to the physical presence of the delivery of services and encompasses health infrastructure, core health personnel and aspects of service utilization. This does not include more complex dimensions such as geographical barriers, travel time and user behaviour, which require more complex input data. Service availability is described by an index using the three areas of tracer indicators (see Table 1.2.1). This is made possible by expressing the indicators as a percentage score compared with a target or benchmark, then taking the mean of the area scores. General service readiness refers to the overall capacity of health facilities to provide general health services. Readiness is defined as the availability of components required to provide services, such as basic amenities, basic equipment, standard precautions for infection prevention, diagnostic capacity and essential medicines. General service readiness is described by an index using the five general service readiness domains (see Table 1.2.1). A score is generated per domain based on the number of domain elements present, then an overall general readiness score is calculated based on the mean of the five domains. Service-specific readiness refers to the ability of health facilities to offer a specific service, and the capacity to provide that service measured through consideration of tracer items that include trained staff, guidelines, equipment, diagnostic capacity, and medicines and commodities.

II.

III.

TABLE 1.2.1: SUMMARY OF TRACER INDICATORS, ITEMS AND SERVICES FOR SERVICE AVAILABILITY AND SERVICE READINESS

Domain I. Service availability 1. Health infrastructure

Tracer indicators, items or services

• • •

Number of health facilities per 10 000 population Number of inpatient beds per 10 000 population Number of maternity beds per 1000 pregnant women Number of health workers per 10 000 population Outpatient visits per capita per year Hospital discharges per 100 population per year

2. Health workforce 3. Service utilization

• • •

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Domain II. General service readiness 1. Basic amenities

Tracer indicators, items or services

Mean availability of seven basic amenities items (%): power, improved water source, room with privacy, adequate sanitation facilities, communication equipment, access to computer with Internet, emergency transportation Mean availability of six basic equipment items (%): adult scale, child scale, thermometer, stethoscope, blood pressure apparatus, light source Mean availability of 9 standard precautions items (%): safe final disposal of sharps, safe final disposal of infectious wastes, appropriate storage of sharps waste, appropriate storage of infectious waste, disinfectant, single-use disposable/auto-disable syringes, soap and running water or alcohol-based hand rub, latex gloves and guidelines for standard precautions Mean availability of 8 laboratory tests available on-site and with appropriate equipment (%): haemoglobin, blood glucose, malaria diagnostic capacity, urine dipstick for protein, urine dipstick for glucose, HIV diagnostic capacity, syphilis RDT and urine pregnancy test Mean availability of 25 essential medicines (%):Amlodipine tablet or alternative calcium channel blocker, amoxicillin (syrup/suspension or dispersible tablets), amoxicillin tablet, ampicillin powder for injection, aspirin (capsules/tablets), beclometasone inhaler, beta blocker (e.g.bisoprolol, metaprolol, carvedilol, atenolol), carbamazepine tablet, ceftriaxone injection, diazepam injection, enalapril tablet or alternative ACE inhibitor (e.g. lisonopril, Ramipril, perindopril), fluoxetine tablet, gentamicin injection, glibenclamide tablet, haloperidol tablet, insulin regular injection, magnesium sulfate injectable, metformin tablet, omeprazole tablet or alternative (e.g. pantoprazole, rabeprazole), oral rehydration solution, oxytocin injection, salbutamol inhaler, simvastatin tablet or other statin (e.g. atorvastatin, pravastatin, fluvastatin), thiazide (e.g. hydrochlorothiazide) and zinc sulphate (tablet or syrup).

2. Basic equipment

3. Standard precautions for infection prevention

4. Diagnostic capacity

5. Essential medicines

III. Service-specific readiness For each service, the readiness score is computed as the mean availability of service-specific tracer items in four domains: staff and training, equipment, diagnostics, and medicines and commodities • • • • • • • • • • • • • • • • • • •

Family planning Antenatal care Basic obstetric care Comprehensive obstetric care Child health immunization Child health preventative and curative care Adolescent health services Lifesaving commodities for women and children Malaria diagnosis or treatment Tuberculosis services HIV counselling and testing HIV/AIDS care and support services Antiretroviral prescription and client management Prevention of mother-to-child transmission (PMTCT) of HIV Sexually transmitted infections diagnosis or treatment Noncommunicable diseases diagnosis or management: diabetes, cardiovascular disease, chronic respiratory disease and cervical cancer screening Basic and comprehensive surgical care Blood transfusion Laboratory capacity

1. Overview 1.2.3 Core instrument The basic approach to SARA is to collect data that are comparable both across countries and within countries (i.e. across regions and/or districts). To achieve this, a standard core questionnaire has been developed. The core questionnaire was pretested in a variety of settings in two countries. The first pretest occurred in Sierra Leone in April, 2011. A second pretest occurred in Kenya in June, 2011. This second pretest was part of a larger pretest of the revised MEASURE DHS Service Provision Assessment (SPA) questionnaire, which includes all core SARA questions as they are embedded in the SPA Inventory questionnaire. Following the pilot test experience, adjustments were made to the questionnaire to account for the information gained, resulting in the standard core questionnaire. Typically, a country adopts the core questionnaire with adaptations to certain elements such as: • • • • • types of facilities managing authority of facilities national guidelines for services staffing categories national policies for medicines (e.g. for tuberculosis, HIV/AIDS).

The questionnaire does not attempt to measure the quality of services or resources, but it can be used in conjunction with additional modules such as management assessment or quality of care.

1.2.4 Survey design methodology The SARA survey requires visits to health facilities with data collection based on key informant interviews and observation of key items. The survey can either be carried out as a sample or a census; the choice between these methodologies will depend on a number of elements including the country's resources, the objectives of the survey and the availability of a master facility list (MFL). For example, if the objective of the survey is to have nationally representative estimates, a sample survey would be appropriate. However, if the objective is to have district estimates, the sampling methodology must be adjusted to either a larger sample or in some cases a full census. Service availability The recommended data source for information on service availability is a national master facility list (MFL) of all public and private facilities (7). A facility census is usually required to establish and maintain a national MFL. A facility census aims to cover ALL public and private health facilities in a country. The census is designed to form the basis for a national and subnational monitoring system of service delivery, which can be supplemented by quality ascertainment through facility surveys and further in-depth assessments. A census is the recommended methodology for forming the baseline of service availability and readiness data. Service availability data should be updated annually through routine, facility-based reporting and validated approximately every five years through a facility census. Service readiness The recommended design methodology for measuring service readiness is a sample survey. Sampling is done in a systematic way to ensure that the findings are representative of the country and region/district in which the survey is being conducted. Drawing a random sample of health facilities is much more complicated if the country does not have a comprehensive and up-to-date MFL. Therefore, it is highly recommended to invest in establishing a MFL that includes all public and private facilities. In cases where a national list of facilities is not available or up-to-date, the service readiness survey can be carried out at the same time as the facility census for service availability.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 Master facility list (MFL) Regardless of the method selected, a complete MFL is required. Therefore, it is highly recommended to invest in establishing a MFL that includes all public and private health facilities. In many countries there are already lists of public facilities and sometimes also nongovernmental facilities. However, private facilities are often excluded or only partially included in these lists. WHO and partners have developed a guide to support countries in creating a MFL. Please refer to the document Creating a master facility list (7) for more information on best practices in establishing a MFL. Data quality assessment The service availability and readiness assessment can be used for to assess data quality of the routine system by comparing results with aggregated routine health information data at district, provincial and national level. In addition, the service readiness assessment can be combined with a record review for data verification purposes, to ascertain the completeness and quality of facility reporting. The data quality report card (DQRC) (8) can be used to verify the quality of routinely reported data for some key coverage indicators, quantifying problems of data completeness accuracy and external consistency.

1.2.5 Timeline of implementation Service availability and readiness assessments should be planned on a yearly or biennial basis to coincide with and feed into national health planning cycles. Sample surveys should be organized every year about three to five months in advance of the annual review. The national MFL should be used to provide the sampling frame (see Figure 1.2.1).

FIGURE 1.2.1: TIMELINE OF IMPLEMENTATION FOR SERVICE AVAILABILITY AND READINESS ASSESSMENT

Service readiness

Facility assessment (sample survey) (with data verification)

Service availability

Facility census

Updating from districts

Facility census

Master facility list Year

0……….1……….2………..3……….4………..5

The time needed to complete a service availability and readiness assessment depends on the size of the country and whether or not there is a need for a full facility census. From the initial country-adaptation of the assessment tool to the dissemination of data and production of country reports, the entire process generally takes from three to six months.

1. Overview Table 1.2.2 below provides an overview of the survey steps and the activities to be undertaken at each step.

TABLE 1.2.2: SUMMARY OF SURVEY STEPS AND ACTIVITIES Steps 1. Survey planning and preparation

Survey activities • • • • • • • •

• •

Establish a survey coordinating group of country stakeholders to oversee and facilitate the objectives, scope, design, implementation and analysis Obtain a list of all health facility sites (public, private, nongovernmental organizations (NGOs) and faith-based organizations (FBOs)), including country facility registry codes Determine appropriate design methodology (census or sample), develop an implementation plan and budget, and secure funding Adapt questionnaires to meet country-specific needs Recruit survey personnel (survey manager, field supervisors, data collectors, data entry/processing personnel, data analysts) Prepare a survey schedule Identify the survey sites (sampling frame). Select the sample size and sample of health facilities (if sampling methodology is chosen) Procure logistics including equipment and transport, taking into consideration the number of sites to be visited, the number of data collection teams, drivers, vehicles, petrol, etc. Plan and conduct training courses for interviewers and field supervisors Pilot test the survey in a selected number of health facilities, evaluate results and make amendments if necessary Plan the data collection visits (prepare a letter of introduction, contact each site, prepare a schedule of visits) Prepare materials and tools for data collectors Arrange for transport and regular communications during fieldwork Assemble materials necessary for local data collection Confirm appointments with health facilities Visit health facilities and collect SARA data in teams (usually two interviewers and a driver) At the end of the interview, check questionnaire and resolve missing/unreliable information Return completed forms and/or transfer electronic files to field supervisor at the conclusion of each day Return forms (paper and/or electronic) to survey manager when data collection is complete Enter data using the CSPro application Edit, validate and clean data set, checking for consistency and accuracy Export the data set for analysis (SARA indicators) Conduct analyses of SARA data using the standard core indicators (SARA automated tool for results graphs and tables) as well as any country-specific indicators of interest Meet with survey coordinating group to analyze and interpret survey results and to finalize recommendations Prepare the final report Plan and implement dissemination activities. The results should be used to support annual health reviews and feed into the M&E platform for the national health plan Document and archive the survey using metadata standards

2. Data collection in the field

• • • • • • • • •

3. Data entry, analysis and interpretation

• • • •

4. Results dissemination

• • • •

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

1.3 1.3.1

Pre-survey preparation

Establishing a survey coordinating group

Bringing partners together and mobilizing them around the survey is a critical first step towards successful implementation. One of the first activities is to identify and establish a group of core stakeholders at country level to oversee, coordinate and facilitate the planning, implementation and follow-up of the facility assessment process. In general, partners include those groups, individuals, and/or organizations that are carrying out or planning similar efforts as well as those for whom the outputs of the health facility assessment will be of interest. These often include: • ministries of health (as well as national institutes of statistics, geographical information system (GIS) units, health management information systems (HMIS) units, health services and other public research institutions); • universities and other academic institutions involved in research; • NGOs and other organizations involved in data collection; • United Nations health-related organizations present in the country (e.g. WHO, UNICEF, UNDP, UNAIDS); • international funders active in the country (i.e. the Global Fund to Fight AIDS, Tuberculosis and Malaria, government agencies for international development). The role of the survey coordinating group should include: • clarifying the objectives of the survey; • supporting the survey manager in planning, preparing and conducting the study, and identifying important policy issues that should inform the survey protocol; • advising on any matters that arise during survey preparation, fieldwork and data analysis; • assisting in interpreting data and developing policy recommendations; • promoting the findings of the survey and advocating for appropriate policy recommendations. It is important to hold regular meetings with the survey coordinating group throughout the survey process. At least one meeting should be held to support the planning and preparation of the SARA survey, and one meeting should be held post-survey for interpreting survey results and developing recommendations. A second post-survey meeting may be beneficial to discuss the results and their policy implications, consolidate all survey results and finalize recommendations.

1. Overview 1.3.2 Compiling a master facility list (MFL) Before beginning a health facility assessment, a situation analysis assessing the availability of health facility information must be carried out. An important prerequisite for conducting a SARA survey is the existence of a MFL. The analysis should therefore aim to ascertain the existence and reliability of an official MFL. Regardless of the survey methodology (census or sample), a complete master list of facilities is required. Therefore, it is highly recommended to invest in establishing a MFL that includes public, private for-profit, and NGO facilities. In many countries there are already lists of public facilities and sometimes also nongovernmental facilities. However, the private facilities are often excluded or only partially included in these lists. Before a health facility assessment can be implemented, ALL health facilities in a country must be identified and a health facility list created. This list must include health facilities in all sectors including the public sector, the private sector, FBOs and NGOs. In some countries, a MFL may be available containing all the required information. In most cases however, this information is not readily available and must be compiled. The ministry of health (MoH) generally maintains information on public health facilities and can serve as the basis for the MFL. Other contacts will need to be identified to retrieve information on private, FBO, NGO and other facilities. All available health facility listings have to be reconciled to identify a single, comprehensive list, with each facility assigned a unique identification (ID) code. Facilities should be classified by level of service provision (from hospital at the highest level through clinic at the lowest level) and by ownership (MoH, mission, NGO or private). Locational information should be included in the MFL when available. The geographical coordinate collection method should also be recorded (i.e. global positioning system (GPS) remote device, digital place names, gazetteers, etc.). A key component of the MFL is the unique ID code assigned to each facility. A set of data must be gathered with the specific purpose of uniquely identifying each survey site. In database terminology this set of identifier data is referred to as a "primary key" or a "unique key": a code uniquely identifying a row or column of a database. Without specific ID attached to each survey site, there is a risk of duplicate data collection. In addition to greatly lessening the risk of data duplication, site ID fields allow for cross-survey comparisons as well as comparisons over time. Please refer to the document Creating a master facility list (7) for more information on best practices in establishing a MFL.

1.3.3 Designing a methodology and implementation plan Design methodology There are two potential design methodologies for the SARA survey: • a facility census (i.e. assessment of all health facilities) • a sample survey (i.e. a representative sample of facilities). Service availability requires a denominator that includes all public and private health facilities in the country (i.e. a census). Service readiness can be measured through a representative sample of facilities.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 Facility census The recommended data source for information on service availability is a national MFL of all public and private facilities. A facility census is usually required to establish and maintain the MFL. Service availability data should be updated annually through routine, facility-based reporting, and data should be validated approximately every five years through a facility census. A facility census aims to cover ALL public and private health facilities in a country. The census is designed to form the basis for a national and subnational monitoring system of service delivery, which can be supplemented by quality ascertainment through facility surveys and further in-depth assessments. A census is the recommended methodology for forming the baseline of service availability and readiness data.

Sample survey The recommended design methodology for measuring service readiness is a sample survey. Sampling is done in a systematic way to ensure that the findings are representative of the country or state/province in which the survey is being conducted. Drawing a random sample of health facilities will be much more complicated if the country does not have a comprehensive and up-to-date MFL. Therefore, it is highly recommended to invest in establishing a MFL that includes public, private for-profit, and nongovernmental facilities. If a fairly complete master list of facilities already exists, a sampling approach can be used. Implementation plan and budget An implementation plan should be drafted based on the objectives of the survey and the results of the situation analysis of health facility information. The implementation plan serves as a comprehensive outline of the operational plan for implementing a SARA survey and is key to ensuring the success of the survey. The plan must lay out the reason for carrying out the survey, how the survey will be executed and how to oversee the survey to ensure that it will be completed on time and within budget. The objectives of the survey will help to determine the design methodology, which will in turn drive much of the operational plan and budget for the survey. When designing the budget, it is essential to ensure that the following items are accounted for.

Financial and human resources • human resources − survey manager − field supervisors • training − training venue − daily allowance and accommodation • data collection and validation − daily field allowance and accommodation for data collectors − transport • report production and dissemination • advocacy and communications • overheads • contingency. − materials (paper, pens, etc.) − photocopying − communication (e.g. telephone charges) − transport − materials − expenses related to pilot testing − data collectors − data entry personnel − data analysts

• meetings of the survey coordinating group

1. Overview Technical resources • mobile electronic data collection devices (EDCs) e.g. personal digital assistants (PDAs), tablet computers or laptop computers: one for each data collection team • GPS devices (if the facility coordinates need to be taken): one for each data collection team • batteries for GPS devices • memory cards for EDCs • computer(s) for data entry • data entry application (CSPro recommended) • data analysis program. Once a comprehensive budget has been developed, funding should be secured to cover all survey costs. 1

1.3.4 Adapting the SARA instrument to country-specific needs A standard core questionnaire for measuring service availability and readiness is available. However, the questionnaire must be adapted for country use to reflect the needs of each country and specificities of each health-care system. When adapting the health facility questionnaire, consideration should be given to how changes will affect data collection, and adjustments should be made to ascertain that definitions are specific enough to assure comparability across the country and within districts. Training, data collection and analysis are carried out, even in larger countries, within one month, and adding more to the tool will make it slower and could create problems at the analysis stage if not carefully considered. SARA is not intended to provide comprehensive data on all aspects of health system functioning. Rather, it focuses on key "tracer" elements that are critical to programmes that are scaling up or that are indicative of the essential health system underpinnings or "readiness" to do so. This should be kept in mind while adapting the questionnaire and adding additional modules or questions. The following areas of the SARA tool must always be adapted to the country context: • types of facilities • managing authority of facilities • national guidelines for services • staffing categories • tuberculosis medicines • HIV/AIDS medicines • other country-specific medicines. The questionnaire can be implemented as either a paper questionnaire or an electronic questionnaire. Paper questionnaire: any changes should be made according to the country adaptation process prepared for the survey training. Electronic questionnaire: once a mobile EDC has been selected, the appropriate software can be chosen. This software generally comprises a desktop forms designer and database, a synchronization conduit and the handheld forms application. Once the software is uploaded, the survey form can be designed on a desktop computer and then synchronized with the handheld device. For the SARA survey, the recommended software for electronic questionnaires is CSPro. 1

For information about the Census and Survey Processing System (CSPro), including free download, visit: http://www.census.gov/population/international/software/cspro/

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 1.3.5 Recruiting survey personnel The SARA survey will require involvement of the following personnel: • survey manager • field supervisors • data collectors • data entry personnel • data analysts. Survey manager The survey manager plans and coordinates the survey at the central (national) level. This includes planning the survey’s technical and logistical aspects, recruiting and training survey personnel, supervising data collection and data entry, conducting data quality assurance and data analysis, interpreting results and preparing a survey report. Wherever possible, the survey manager should have experience in conducting surveys and should be very familiar with the health-care system. The survey manager should be familiar with basic statistics and interpreting data. Successful communication of the survey results also requires an understanding of the policymaking process and different advocacy strategies. Where the survey manager does not possess all of these qualities, he or she should select the survey coordinating group members to ensure that the survey management team includes the necessary health, surveying, statistics, policy and advocacy skills. Field supervisors Field supervisors are responsible for overseeing all aspects of data collection in the survey area(s) for which they are responsible. In a small country or in a survey that is conducted in a single region of a country, it may be possible for all fieldwork to be undertaken by a single team. Experience has shown that in larger-scale studies, however, it is advisable to designate a field supervisor in each of the geographical areas that will be surveyed. Field supervisors have a crucial role to play in ensuring data quality and consistency. They should be experienced in data collection and be familiar with health terminology. They are also instrumental in gaining access to facilities; if any field supervisor is unfamiliar with their designated area, a local contact may be needed to assist. Field supervisors may also be responsible for choosing local data collectors when they are not sent from the central level. Data collectors Data collectors are responsible for visiting health facilities and collecting SARA data with a high degree of accuracy. The survey methodology has been designed to minimize as far as possible the need for a high level of technical expertise. However, data collectors should, wherever possible, have the following qualifications, skills and capabilities: • a health qualification (nurse, midwife or medical student) and familiarity with the organization and functioning of health facilities; • some understanding of the principles of sample surveys, ideally with some previous experience in conducting surveys; • an appreciation of the logistics requirements for carrying out field studies; • post-secondary school education as a minimum; • familiarity with the locality and local language or dialect.

1. Overview Data collection requires an aptitude for concentration and attention to detail. The best data collectors combine the discipline of collecting data in a standardized way with the ability to identify unusual situations that require advice from the field supervisor or survey manager. Data collectors must be available to work full time for the duration of the fieldwork. They should be willing to work extended hours if necessary and be able to stay away from their homes for extended periods of time. The number of data collectors required depends on the sample size of the survey. Data collectors should work in pairs. Each visit to a health facility is likely to require about two hours plus transport time. In practice, this means that a team of two data collectors can survey two to four facilities per day. The number of data collectors will also depend on the budget available, the locations of the survey areas, the travel conditions and the number of health facilities to be surveyed. It is better to have a smaller number of better qualified data collectors than to have a large team where some data collectors lack the necessary skills. Data entry and data processing personnel Accurate data entry is vital to ensure the reliability of the results. Two data processing personnel with experience in using the selected data entry software are required: one to enter the data, and the other to reenter the same data to check that the entries are correct. If data are being entered from paper questionnaires, double entry is essential to ensuring the accuracy of the data entry process. If data are collected both electronically and on paper, then the first instance of data entry has already occurred during the electronic data collection and the data entry personnel would only be responsible for the second entry of data for validation purposes. In some cases, it may be possible to use the same personnel for both data collection and data entry, provided they have the necessary expertise to undertake both functions. Data analysts The primary tasks of the data analyst(s) are to inspect, clean, transform, analyse and visualize data with the goal of highlighting useful information, suggesting conclusions and supporting decision-making. It is vital that the data analyst has an advanced knowledge of the chosen analysis software for the SARA survey. A working knowledge of health service delivery and the specific country's health system is important for interpretation of the results and is required of at least one member of the data analysis team.

1.3.6

Preparing the survey schedule

The complete survey should generally take between three and six months to complete, including survey preparation, data collection, data entry, data analysis and report writing. Further time should be allotted for dissemination and follow-up activities. Given that the information gathered from SARA should be used to inform decision-making, it is important that data collection be conducted rapidly and the report generated as soon as possible once data collection is complete. This will ensure that the survey results are relevant and informative for decision-makers. A survey schedule should be developed and consulted regularly to ensure that activities are proceeding according to plan. This schedule should detail the amount of time allotted for each step in the survey process, and should serve as a timeline for all survey activities.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

1.4. Planning the survey 1.4.1 Selecting the sample size and sample Determining the sample size and selecting the sample for a facility survey is a complex subject, which will vary considerably from case to case depending on the desired precision and type of estimates, the number of facilities in the country as well as the specific objectives of the assessment. For example, a SARA conducted to produce national estimates will require a much smaller sample size than if district-level estimates are desired. In order to ensure that the sample is representative, it is best to consult with a sampling expert or a statistician to select an appropriate sampling methodology. For the SARA, the most common sampling strategy is Option 1 in the table below—a nationally representative sample obtained by taking a simple random sample of facilities within each stratum (facility type and managing authority) at the national level. The table below presents different sampling options that could be used to conduct a SARA based on the desired level of estimates: Domains of estimation Option 1: National estimates only National estimates with disaggregation by facility type (3 levels) and managing authority (public/private) Sampling method Small country Stratification by facility type and managing authority, simple/systematic random sampling within each stratum with census or oversampling of hospitals (design effect = 1) Medium country Blend of list and area sampling: list sampling for large health facilities, and area sampling for small facilities (census 3 of facilities in sampled area PSUs ) (deff = 1.2) Option 2: Subnational estimates Regional and national estimates with disaggregation by facility type (3 levels) and managing authority (public/private) Small country Stratification by region, facility type and managing authority, simple/systematic random sampling within each stratum, with census or oversampling of hospitals (deff = 1) Medium/large country Blend of list and area sampling: list sampling for large health facilities, and area sampling for small facilities (census 2 of facilities in sampled area PSUs ) (deff = 1.2) Large country Purposive sample of regions, simple/systematic random sample with oversampling of hospitals for each region Sample size 2 (estimate) 150 – 250 facilities Approximate cost

$60K-100K

250 – 500 facilities

$100K-200K

5 regions: 250 – 500 facilities 10 regions: 500 – 800 facilities Medium country 4 regions: 300 – 500 facilities Large country 4 regions: 400 – 800 facilities 4 regions (150 facilities per region): 600 facilities

$100K-130K $130K-180K

$120K-200K $180K-360K

Option 3: Subnational estimates Regional estimates for a subset of regions, with disaggregation by facility type (3 levels) and managing authority (public/private) for selected regions; no national estimates

$60-100K per region

2 3

Sample size estimates assume a margin of error of 0.1 and 95% level of confidence Administrative units that form the PSUs (Primary Sampling Units) for the area sample should contain approximately 1-5 health facilities each (communes, sub-counties, villages)

1. Overview Domains of estimation Option 4: District sample District estimates for sampled districts; national estimates if sufficiently many facilities are sampled Sampling method Small, medium and large countries List sampling for regional and national hospitals plus sampling of districts (twolevel cluster sample: selection of districts as first level, selection of facilities within these districts as the second level) (deff = 2) Sample size 2 (estimate) Small country 300-500 facilities (104 30 districts ) Medium country 400-800 facilities (20+ districts) Large country 600-1000 facilities (30+ districts) Approximate cost

$100K-200K $160K-320K $270K-470K

Option 5: Facility census All possible domains of estimation

Small, medium and large countries Census of all facilities

Very expensive

Small country: 50 – 100 hospitals, 1000 – 2000 health facilities total, 10 – 80 districts (e.g. Sierra Leone, Togo, Burkina Faso) Medium country: 100-500 hospitals, 2000 – 5000 health facilities total, 80 – 500 districts (e.g. Uganda, Tanzania) Large country: 500 – 1000 hospitals, 5000 – 10000 health facilities total, 500 – 1000 districts (e.g. DRC, Nigeria)

1.4.2

Procuring logistics

Planning for data collection requires consideration of the logistics needs for data collection teams as well as an assessment of the hardware and software needs for data collection. Equipment should be considered for a base camp as well as for fieldwork, and for operations as well as for training. The guiding principle that should be kept in mind when compiling equipment for the field is redundancy, i.e. to have backup components and a contingency plan in case equipment fails, breaks or is lost. All equipment should have one or more backups, depending on the equipment type and survey requirements. If feasible, paper forms and printing capabilities provide a viable contingency plan for the worst-case scenario of mobile device failure. Equipment requirements are also determined according to country-specific needs, as well as the availability of resources and budget. Assigning facilities to teams It is recommended to map all facilities in the survey sample to assist with logistics planning for the data collection. This map can be made either on paper or electronically. The map should include information such as roads, topography, basic geographical features, elevation and location of health facilities, which are useful in determining survey areas. Teams should be assigned to facilities based on the geographical distribution of the selected health facilities. Figure 1.4.1 gives an example of a map that would be useful for SARA logistics planning.

FIGURE 1.4.1 SERVICE AVAILABILITY AND READINESS ASSESSMENT (SARA) EXAMPLE MAP

Number of districts in sample depends on the number of facilities per district

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 Survey team requirements The duration of the field survey depends on the availability of resources, the number of teams, the number of health facilities to be visited, and the size of the country and population. As a general guide, data collection teams consist of two interviewers/data collectors plus a driver. On average, one team can cover at least two health facilities per day. The estimated duration of the survey is calculated during the planning phase and is unique to the needs and resources available in the country. The following examples illustrate the planning that is required. Example 1. A country consisting of 50 districts with on average 40 health facilities per district. One team covers one district (40 health facilities) over 20 days (two facilities per day), and so 10 teams cover 10 districts over 20 days. Therefore 10 teams will cover one country (50 districts) over 100 days (or three months). Example 2. An urban area with an average of 200 health facilities. One team covers 200 health facilities over 100 days (two facilities per day), or 10 teams cover 200 health facilities over 10 days. For all surveys, logistics planning needs to take into account the following: • car hire and fuel for the duration of the survey • per diem for the driver(s) • per diem for the data collectors.

Equipment requirements Equipment requirements are also determined according to country-specific needs, as well as the availability of resources and budget.

1. Overview

1.5. Training field supervisors data collectors and data entry personnel This chapter provides practical guidance on conducting a training workshop for field supervisors, data collectors and data entry personnel. Training is an important element of survey preparation because it helps to ensure the accuracy and reliability of the data gathering and data entry procedures. Consequently, this chapter also covers the issue of ensuring data quality. This chapter has been developed to assist survey managers in conducting training workshops for their survey personnel, regardless of whether they have attended any previous training.

1.5.1

The importance of data quality

It is important to ensure data quality for several reasons: • solid data support conclusions and recommendations; • future policy decisions may rely on the evidence generated in the survey; • critics and opponents will look for weaknesses in the survey methods and results; • results will be publicly accessible and may be used by others, e.g. in conducting international comparisons. There are several reasons for data problems commonly encountered in a survey: • field supervisors, data collectors and data entry personnel receive insufficient or poor-quality training; • the pilot survey is not conducted properly; • work in the field is of poor quality (insufficient supervision, no quality control for submission of completed forms, misunderstanding of instructions, etc.); • data are not checked at every stage of the survey process; • data are entered incorrectly; • there are problems with uniquely identifying facilities; • there are problems of human error; • there is non-response to questions. Data problems can therefore be avoided by: • carefully studying the survey manual and accompanying materials at every step, and following instructions; • selecting capable and reliable personnel and ensuring they are well trained in the survey methodology; • encouraging personnel to communicate openly about uncertainties in survey procedures and questionable data; • double-checking data collection forms for accuracy and completeness after each data collection visit, at the end of each day of fieldwork, and prior to data entry; • conducting double entry of the survey data – data are entered twice by different people and then crosschecked.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 Thorough training of survey personnel is one of the most important ways of ensuring accurate data collection and good-quality data. Experience from previous surveys has shown that poor survey preparation, including inadequate training of survey personnel, results in onerous and time-consuming data checking that can significantly delay the survey’s completion. It is therefore more effective and efficient to apply rigorous data collection methods than to try to clean or correct data once they are already collected.

1.5.2 Overview of training All personnel involved in data collection, supervision and data entry require training to ensure reliable and accurate data collection, completion of questionnaires and data entry. A training workshop for survey personnel should be held as part of the survey preparation. The overall objective of the training workshop is to provide field supervisors, data collectors and data entry personnel with the knowledge and skills required to carry out a SARA survey in an accurate and reliable manner. Upon completion of the training, participants should: • be familiar with the key aspects of the survey and how it is conducted; • understand their roles and responsibilities in the survey, including specific tasks, timelines and reporting requirements; • understand the critical content required to do their job effectively and possess the skills required to undertake each of their activities; • be aware of common issues that may arise during survey activities, and understand troubleshooting/problem-solving strategies to address these issues; • recognize the intrinsic value of good-quality data and be motivated to ensure data quality as part of their activities. Training should therefore focus on teaching the following to the participants: • the overall purpose of the survey; • the consequences of poor-quality data; • how to administer and record responses using the SARA questionnaire, the purpose and meaning of each question, and how to develop good rapport with the respondent; • ethical issues involved in conducting a health facility survey, the importance of administering the informed consent statement, and how to maintain the privacy and confidentiality of the respondent; • problem-solving in the field; • how to enter data for both paper and electronic questionnaires; • how to collect geographical coordinates of visited sites using GPS; • common data collection and data entry mistakes. It is recommended that the duration of a training workshop, which covers both data collection and data entry, is at least five days. Training should include a data collection pilot test in which survey personnel visit public and private sector health facilities and collect data in the same way they would during actual fieldwork. This will not only provide survey personnel with practical experience in collecting data, but will also serve as a check of the appropriateness of the SARA questionnaire.

1. Overview The trainer is usually the survey manager but could be a resource person with technical assistance from partner implementing agencies. The participants should include all field supervisors, data collectors and data entry personnel. For paper-based data collection, training on data entry is required. This can be held as a separate workshop or session for data entry personnel, however, there may be some advantage in holding a combined training session on data collection and data entry, since it will sensitize field supervisors and data collectors to the difficulties in entering poor-quality data. It is also recommended that the members of the survey coordinating group be invited to the introductory session of the training workshop to meet survey personnel and discuss the survey methodology. The training workshop should be held as close as possible to the initiation of data collection – immediate departure for data collection can be scheduled if the survey manager has prepared well. Time lags between training and data collection should be avoided so that survey personnel have better recall of the data collection protocol.

1.5.3

Preparing for the training workshop

Planning the training workshop can require substantial time and preparation. Workshop preparations should begin early in the survey development process and should run in parallel to other survey planning and preparation activities. In preparing the training, it is essential to ensure that there is an adequate budget to cover costs for the training venue, transport, materials, and a daily allowance and accommodation for participants. Select a training venue A training venue should be selected based on the following criteria: • availability of a room of appropriate size to hold the workshop; • availability of essential technical resources (printer, photocopier, projector for presentations, electricity to charge mobile EDCs, etc.); • proximity to health facilities that can be surveyed during the data collection pilot test; • accessibility by routine modes of transport; • on-site or nearby refreshments and accommodation for out-of-town participants; • reasonable cost. It is useful to check with survey coordinating group members to see if a meeting room can be made available for the training workshop at low or no cost. Schedule dates of the training workshop The training workshop should be scheduled close to the anticipated start of data collection. Do not plan the workshop during a time when weather or other conditions may delay the initiation of data collection. All survey personnel must attend the workshop and should be advised of the dates as early as possible. Invitations to attend the introductory session of the workshop should also be sent to survey coordinating group members. Plan data collection pilot test During the data collection pilot test, each data collection team will visit at least one health facility and collect data by following the survey procedures. It is recommended that each team visit one public health facility and one private health facility during the pilot test. The participation of pilot sites should be secured well in advance of the training workshops. The appointments should be made in advance and reconfirmed before the training session, avoiding peak periods when health facilities may be busy with patients.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 Prior to the training workshop a written schedule should be prepared for each data collection team, indicating the time and location of each health facility visit, and including the name and contact details of the person in charge at the facility. The schedule should also contain the survey manager’s telephone number so that survey personnel can call if there is a query or problem. Secure equipment All necessary equipment should be procured prior to the training session. This includes: • projector, computer, etc. for the training session; • pens, notepads, clipboards; • mobile EDCs loaded with software and electronic forms; • GPS devices for data collection teams; • mobile phones for data collection teams to carry during the pilot test; • access to a printer and photocopier for reproducing the SARA questionnaire. Prepare training materials Each training participant should receive: • one copy of the SARA questionnaire; • one copy of the SARA data collectors’ guide; • training handouts. In addition, sufficient copies of the SARA questionnaire should be available for use in the pilot test.

1.5.4 Conducting the training workshop, including the data collection pilot test The SARA data collectors’ guide is provided as Annex 5. The guide provides: • an overview of data collection processes; • general guidance on interviewing practices and techniques; • detailed explanations and definitions for each question in the questionnaire to provide a uniform understanding of the meaning of each question and response choices, and to improve the consistency of the data collected by different data collectors in different facilities. This manual should be used during the training of all data collectors. In addition, slide presentations and accompanying handouts to complement the SARA data collectors’ guide are available as tools for trainers to use during the training workshop. The quality of data collection is controlled at several points in the data collection process. The first point of quality control is the thorough training of data collectors and the exclusion from fieldwork of any trainees who do not exhibit competency in applying the data collection questionnaires at the end of training. Conducting the data collection pilot test During the pilot test, data collection teams and their field supervisors will visit health facilities and collect data in the same way they would during the actual survey. Each field supervisor and data collector should complete their own SARA questionnaire to gain hands-on experience. Field supervisors should also supervise and watch out for common mistakes. It may be necessary to hold a preliminary pilot test with field supervisors to ensure

1. Overview that they are sufficiently knowledgeable about the survey protocol to supervise data collectors and identify mistakes. During the pilot test, any questions or uncertainties should be noted for clarification during the training workshop. The data collection pilot test also serves as a pre-test of the questions in the SARA questionnaire and should help to highlight any country-specific adaptations that should be made to the survey including issues such as question format, wording and order. The pilot test allows for an opportunity to uncover any defects in the questions, glitches in wording of questions, lack of clarity of instructions, etc. The survey questionnaire should be piloted in all languages in which it will be administered. In addition to testing the paper questionnaire, the pilot test also tests field logistics, supervisory capacity and the application functionality for electronic data entry.

1.5.5

Finalizing the questionnaire

After piloting the SARA questionnaire, changes should be made to its format and/or content based upon any issues discovered during the piloting phase. All changes must be made to both paper and electronic versions of the questionnaire.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

1.6. Preparing for data Collection in the field The success of the SARA survey depends largely on the data collectors in the field, who are gathering and recording accurate, reliable data. Data collection requires careful planning and preparation, involving the following activities: • planning the data collection visits • preparing materials and tools for data collectors • arranging transport and regular communications.

1.6.1

Planning the data collection visits

Who? Survey manager The survey manager is responsible for planning the data collection visits. Before data collection starts, a schedule of visits to health facilities should be prepared for each survey area. The number of days required to collect the data can be estimated on the basis of the number of facilities to be visited in each geographical area, the distance between them and the mode of transport available. In general, two data collectors will require two hours plus travelling time for data collection in each facility. Prepare a letter of introduction

Who? Survey manager A letter of introduction from the survey manager is invaluable in introducing field supervisors – and later data collectors – to staff in the health facilities being surveyed. The survey manager should prepare a letter of introduction containing the following information: • the name of the organization conducting the survey and the name of the survey manager • contact details • the purpose of the study • the names of the data collectors who will visit the facility • the time required for data collection in each facility. The letter should also provide reassurance that the anonymity of the respondent will be maintained. The survey manager should provide field supervisors with sufficient signed copies for use during both the scheduling of field visits and the data collection visits. Make initial contact with health facilities

Who? Field supervisors It is essential that good relations be established with the person in charge of each facility to be surveyed, since they will have to set aside considerable time to provide information for the survey. Ideally, field supervisors should visit the heads of facilities personally, in advance, to seek their permission for data collection in their facility. Field supervisors should show them the letter of and introduction, and make an appointment for data collection on a date and at a time that is convenient for the head of the health facility, avoiding peak periods

1. Overview when he or she may be busy with patients. Field supervisors should note the contact person’s name and telephone number at each health facility. If visits are not possible, then those in charge of the facility should be contacted by phone. The day before the scheduled data collection visit, field supervisors should telephone the health facility to confirm the appointment. The following checklist should be used by field supervisors when contacting health facilities.  Contact each health facility (sample and backup) to introduce the survey.  Introduce the survey using the letter of introduction  Make an appointment for data collection at a date and time that is convenient for the facility, avoiding peak hours. Allow two hours for data collection at a primary level facility, plus travel time. For larger facilities and hospitals, allow for additional time.  Note the name and telephone number of the contact person at each health facility.  Explain about the possibility of a second visit for 'validation', which should ideally take place in 10% of the sampled health facilities.  Before data collection starts, telephone each health facility to confirm the appointment. Prepare a schedule of data collection visits

Who? Field supervisors Field supervisors are responsible for preparing a written schedule for each data collection team. For each facility, the schedule should include the following: • date and time of appointment • name of facility • contact person • location • administrative unit • unique ID number for the facility (provided by survey manager) • name and contact details of a backup facility.

EXAMPLE OF A SCHEDULE FOR DATA COLLECTION VISITS Survey area: Region 1 Data collection Team 1 Date/time of Name of appointment facility 20 April 2012 ABC 10:00 health centre Contact person Mrs Nguyen Location 45 Main Street Eastern City Tel: +22 414 000 Managing authority Private ID number 01234 Backup site contact details XYZ health centre 59 Main Street Eastern City Mr Shah

Data collection Team 2 Date/time of Name of appointment facility

Contact person

Location

Managing authority

ID number

Backup site contact details

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 1.6.2 Preparing materials and tools for data collectors

Finalize and print questionnaire

Who? Survey manager Following the data collection pilot test conducted as part of the training workshop, the survey manager should review and, if necessary, revise the SARA questionnaire. Both the paper and electronic versions of the questionnaire will need to be updated. Once the questionnaire has been finalized, the survey manager will need to print sufficient copies and also deploy the electronic forms to the mobile data collection devices. Prepare data collection forms for each facility to be visited

Who? Field supervisor The survey manager should provide the field supervisor with a separate questionnaire (data collection form) for: • each sample health facility in the assigned survey area • each backup facility • each validation visit. The survey manager should also provide the field supervisor with a list of the sampe facilities in the survey area. Ideally, about 10% of the sampled facilities should be visited a second time for validation. The field supervisor will identify the validation sites by randomly selecting at least one public facility and one private facility from the list of sample facilities. The field supervisor should prepare the data collection forms for each facility by completing the front page of the form (see Figure 1.6.1) with the identifying information of each sample facility, backup facility and validation facility, i.e. completing the following fields: • name of health facility • health facility unique ID • name of town/village • region and district • type of facility • managing authority The following fields should not be completed by the field supervisor, as these will be completed by data collectors during the facility visits: • date; • name(s) of person(s) who provided information; • name(s) of data collectors.

The verification at the top of the page should only be completed once the data collection form has been completed.

1. Overview FIGURE 1.6.1: FRONT PAGE OF THE SARA DATA COLLECTION FORM

The field supervisor should complete this section before distributing to data collectors

Arrange for storage of completed questionnaires

Who? Field supervisor and Survey manager Field supervisors should arrange to store completed questionnaires until all fieldwork is completed, at which time they are transferred to the survey manager. A copy of all paper forms should be made by the field supervisor, and all paper forms should be stored in sealed plastic bags to prevent damage. Electronic forms should be synchronized daily to a central computer and a copy of all records should be stored on a memory card as backup. Field supervisors should always keep a copy of all data collection forms, in case those sent to the survey manager are lost or damaged. The survey manager should arrange for the safe storage of all completed forms in secure conditions for an indefinite period, in the event that data need to be checked at a later date.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 Prepare materials and tools for data collectors

Who? Field supervisor Data collectors need to bring tools and information with them on each day of data collection. Field supervisors should prepare resource kits containing all needed items for each data collection team. Before each day of data collection, the field supervisor should ensure that the data collectors have all the necessary tools and information with them including the following.  A list of data collection teams and contact information.  Contact details of the field supervisor, including a mobile phone number to call in case of difficulty in the field.  A schedule of visits to survey sites.  Contact details of the sites to be visited.  Details of backup facilities to be visited if scheduled visits are not possible.  Copies of letter of introduction.  Data collector’s guide and relevant handouts.  A SARA data collection form for each health facility to be visited that day.  A SARA data collection form for each backup site that may need to be visited that day.  An EDC (fully charged and loaded with the SARA questionnaire), batteries and power cable  A memory card for data backup (if applicable, depending on EDC selected) or USB key.  A fully charged and accurately configured GPS unit.  Pens (pencils should not be used to record data), a clipboard and other supplies.  A notebook to record any significant events or findings.  A field allowance for local expenses.  An identity document with a photograph for each data collector.  A mobile phone for each team and credit. Where feasible, each data collection team should also be equipped with a mobile phone and credit to contact the field supervisor. Additional supplies may include a local map and extra batteries.

1.6.3 Arranging transport and regular communications Arranging transport

Who? Survey manager or Field supervisor Once all the survey sites are known, the survey manager or field supervisor should arrange transportation according to the number of sites to be visited, the number of teams going into the field, and the number of people per team.

1. Overview Arranging regular communications

Who? Survey manager and Field supervisor Throughout the data collection process, field supervisors should be available to provide advice to data collectors and answer any questions they may have. Providing data collectors with their field supervisor’s mobile phone number, when feasible, is one way of ensuring timely communication. Data collectors should also meet with their field supervisor on a regular basis so that completed forms can be checked and any issues can be resolved. Ideally, this should occur at the end of each day of data collection so that errors do not carry over into future data collection visits. In addition, data collectors will be better able to recall the data collection visit, which may be useful in clarifying erroneous or illegible data. During data collection, data collectors should record how problems were solved or how data collection was simplified. These notes should be reviewed with the field supervisor during the debriefing. The survey manager should also be available throughout the data collection process to respond to questions from field supervisors, and the survey manager should provide field supervisors with his/her mobile phone number for this purpose. Ideally, the survey manager should visit each survey area during data collection to supervise activities. If this is not possible, he or she should arrange for regular communications with each field supervisor to receive updates on the data collection process.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

1.7. Data collection in the field This chapter describes procedures for data collection in the field. Table 1.7.1 shows the activities involved for each day of data collection.

TABLE 1.7.1 DAILY ACTIVITIES FOR DATA COLLECTION When? Before going out to collect data each day What? Check that the data collection teams have all the materials necessary for field visits and confirm transport arrangements Call each facility to be visited and confirm appointment On arrival at the facility Introduce survey team and remind facility staff of the purpose of the visit Verify and complete the SARA questionnaire Check that all data are entered on the SARA questionnaire before leaving the facility. At the end of each day Conduct meeting between field supervisors and their data collectors, and discuss any difficulties Review each SARA questionnaire and clarify missing/unreliable information Sign, copy and store all checked data collection forms Who? Field supervisors/data collectors

Field supervisors Data collectors Data collectors Data collectors Field supervisors/data collectors Field supervisors Field supervisors

Each step of data collection is described below according to the personnel responsible, namely field supervisors and data collectors.

1.7.1

Field supervisors: fieldwork responsibilities

Field supervisors are responsible for ensuring the accuracy and reliability of data collection. This involves the following activities. Field supervision Field supervisors should meet with their data collectors at the end of each day to check completed data collection forms, get feedback on the data collection process and resolve any problems. They should visit the health facilities regularly with the data collection teams to ensure that the agreed procedures are being followed. Daily check of completed SARA questionnaires It is important that field supervisors review completed SARA questionnaires at the end of each day to check that the data are complete, consistent and legible. Once the team has left the field, it becomes difficult to verify information that may be missing or incomplete. The supervisors should highlight any missing or unreliable information on the form and identify the source of the problem. If necessary, data collectors should return to the facility to collect any further data required. Once the field supervisor is satisfied with the completeness and reliability of a SARA questionnaire, he or she should

1. Overview sign the form in the designated place to record that it has been checked. Forms should then be safely stored until completion of data collection, at which time they are transferred to the survey manager. Validation of data collection Field supervisors should validate data collection by repeating the survey at selected health facilities and checking their results against those of their data collectors. Where possible, health facilities visited for validation should be selected at random. Ideally, the validation should be done on the same day as data collection (soon after the data collectors have left the facility) to avoid changes in the availability of the items. Any discrepancies between the results of the field supervisor and those of their data collectors should be discussed with the data collectors, and the data collection protocol should be clarified as necessary. Any problems that cannot be resolved in the field should be discussed with the survey manager. Storing of completed SARA questionnaires Completed paper questionnaires should be copied and stored in sealed waterproof plastic bags, in a location that is protected from moisture, direct sunlight, rodents and insects. Originals should be stored in a separate location from copies. Electronic questionnaires should be synchronized with a central computer and saved both on the computer hard drive and on an external memory card for safe keeping. All original data collection questionnaires, including those for validation visits, should be transferred to the survey manager upon completion of fieldwork. Field supervisors should retain the copies for use in the event that the originals become lost or damaged. In order to accomplish these tasks, each field supervisor should have the following materials:                  A full list of sample sites (and backup sites) for survey area and contact details. An assignment of sites by data collection team. A list of data collection teams and contact information when in the field. A schedule of visits to survey sites and contact details of the sites. Copies of letter of introduction. Copies of the supervisor and data collector’s guides and other relevant documents/material. Extra copies of the SARA data collection form. A data collection form for data validation at each facility that may need to be visited that day. A fully-charged laptop computer with appropriate software (CSPro) Extra EDCs as backup (fully charged and loaded with the SARA questionnaire) in case of loss or damage, with extra batteries and power cables. Extra memory cards for data backup or USB keys (depending on the EDC used). Extra GPS units as backup (fully charged and accurately configured). Pens (pencils should not be used to record data), a clipboard and other supplies. A notebook to record any significant events or findings. A field allowance for local expenses. An identity document with a photograph. A cell phone with credit

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 1.7.2 Data collectors: fieldwork responsibilities Before visiting the facilities each day Before visiting the facilities each day, data collectors should check that they have all the materials they will need for data collection.   A list of data collection teams and contact information.  Contact details of the field supervisor, including a mobile phone number to call in case of difficulty in the field.  A schedule of visits to survey sites.  Contact details of the sites to be visited.  Details of backup facilities to be visited if scheduled visits are not possible.  Copies of letter of introduction.  Data collector’s guide and relevant handouts.  A SARA data collection form for each health facility to be visited that day.  A SARA data collection form for each backup site that may need to be visited that day.  An EDC (fully charged and loaded with the SARA questionnaire), batteries and power cable  A memory card for data backup (if applicable, depending on EDC selected) or USB key.  A fully charged and accurately configured GPS unit.  Pens (pencils should not be used to record data), a clipboard and other supplies.  A notebook to record any significant events or findings.  A field allowance for local expenses.  An identity document with a photograph for each data collector.  A mobile phone for each team and credit.

Where feasible, each data collection team should also be equipped with a mobile phone and credit to contact the field supervisor. Additional supplies may include a local map and extra batteries. On arrival at the facility On arrival at the health facility, data collectors should do the following. • Introduce themselves and remind health facility staff of the survey’s purpose as well as the scheduled data collection visit. Data collectors should also thank the staff for their cooperation and, if necessary, remind them that the respondents' identity will be kept confidential. • Check that the facility information on the first page of the SARA questionnaire is complete and correct, informing the field supervisor at the end of the day if there were any inaccuracies. • Fill in the date and names of the data collectors on the cover page. • Take the GPS coordinates of the health facility. • Obtain informed consent to begin the survey. • Fill out the SARA questionnaire making sure to speak to the most knowledgeable person in the health facility for each section of the questionnaire. One data collector should complete the SARA data collection paper form and another should complete the SARA electronic form, paying close attention to the instructions on the forms. Data collectors should not leave the SARA data collection form at the facility to be filled in later. A separate SARA data collection form should be completed at each facility.

1. Overview Before leaving the facility Before leaving the health facility, data collectors should do the following. • Double-check that the data collection form is legible, accurate and complete. NOTE: Backup facilities to be visited are identified in the schedule. The field supervisor should determine when it is necessary to visit a backup facility. When visiting a backup facility, questionnaires should be completed in exactly the same way as in other facilities, making sure to complete the SARA data collection form that corresponds to that facility. • Thank staff at the facility for their participation. At the daily meeting with the field supervisor At the end of each day, data collectors should meet with the field supervisor and do the following: 1. 2. 3. 4. 5. 6. 7. back-up electronic data on the memory card in the EDC submit the data collection forms and files completed that day transfer data from the EDC to the central computer report on the activities of the day recharge the battery of the EDC to be ready for the next day check the battery life of the GPS unit and get a second set of batteries if necessary recharge mobile phone if necessary.

Data collectors should alert their field supervisor of any problems or uncertainties regarding data collection procedures. They should also report any problems with electronic equipment and arrange to get replacements if necessary.

1.7.3

Ensuring data quality

The quality of the information that the SARA survey generates depends on the accuracy of data collection. The survey manager has overall responsibility for the quality of the data, although all survey personnel have a role to play in ensuring the accuracy of the data collected. The field supervisors and data collectors should receive regular supervision. Rigorous enforcement of data collection procedures will pay off with the ease with which data entry and analysis occur. The following steps will also help to ensure greater accuracy of data collection. 1. 2. Ensure that there is thorough preparation and training as a first step in minimizing errors. Establish procedures to check for data completeness, consistency, plausibility and legibility in the field when it is still possible to correct errors or to fill in missing information. Field supervisors should review data collection forms every day after completion of the fieldwork and resolve any problems before the next day of data collection. Plan random checks to ensure the quality of data collection. The field supervisor should return to randomly-selected health facilities to collect the same data so as to check the accuracy of the first data set. Ideally, the validation should be done on the same day as data collection (soon after the data collectors have left the facility) to avoid changes in the availability of survey items. Double-check all completed SARA questionnaires; verify any suspicious, incomplete or illegible data prior to the initiation of data entry.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

1.8

Data entry and processing

If data are collected on paper forms, they must be entered electronically before proceeding with data processing and analysis. If data are collected in electronic forms, then one can proceed directly to the data processing step. Once in electronic form, the data need to be checked for accuracy, completeness and consistency before the data set can be finalized. Any errors or inconsistencies must be flagged and resolved prior to analysis. The purpose of editing is to eliminate omissions and invalid entries, e.g. by changing inconsistent entries, and should be kept to a minimum: data should never be changed to conform to expectations. It is good practice to always preserve an unedited copy of the data set and to document in detail the data editing process. Finally, once the data have been checked and verified, it is customary to export the final data set in some commonly-used file format, such as a spreadsheet file format or CSV (comma-separated values). This is useful for sharing the data with other parties, and to perform analysis in other statistical software packages.

1.8.1 Data entry Any data collected on paper must be entered electronically before it can be processed and analysed. With input from technical members of the survey coordinating group, the survey manager selects the appropriate data entry software and sets up a data entry operation. Transferring the data from paper to electronic form can be a source of error; therefore, it is important to have the appropriate data validation processes in place to ensure accurate data entry. If electronic data collection has been used, the data already exist in an electronic format and this step is complete. Selecting data entry software When selecting data entry software, there are two main principles to consider: 1. 2. use software that speeds up data entry and minimizes errors have a thorough knowledge of the software selected.

Keeping these principles in mind when thinking about data entry software options helps to narrow down the potential options and results in selection of an appropriate solution. While it is possible to use many types of software for data entry (including statistical programs, database management systems and spreadsheets), it is recommended that a specialized data entry software such as CSPro be used to minimize the possibility of entry errors and to facilitate validation.

Statistical software Statistical software package programs are software packages that are specialized for data analysis. Some include data entry and data checking functions in addition to data analysis (e.g. CSPro), while others are useful primarily for data analysis and visualization. Some advantages of using a software package with built-in data entry and verification functionality are (1) data entry clerks are less likely to make mistakes when entering data, and (2) mistakes are much easier to identify and fix. In particular, the software can be programmed to provide 5 a highly-structured data entry environment so that only valid values are accepted and skip patterns are automatically integrated. In addition, such software facilitates independent data verification, in which the data are entered manually twice and differences are later reconciled. Once the data have been entered, it may be 5

Skip patterns are a particular type of survey branching logic that will jump a respondent over a group of questions that isn’t relevant to them.

1. Overview necessary to use a different statistical software package to perform analysis, depending on whether the package offers the desired data analysis and graphing functions. These types of tools require some advanced technical knowledge, but overall result in improved data quality. For SARA, the recommended data entry software is CSPro: a statistical software package with built-in data collection/entry functionality that allows for speedy data entry while also providing sufficient checks and data validation to ensure quality data. CSPro includes all the necessary functionality for SARA and can be downloaded free of cost.

Database management systems A database management system is an application that allows the creation and management of databases, including storage and retrieval of data. There are different types of databases, but the most popular is a relational database that stores data in tables where each row ("record") in the table holds the same sort of information. Each record has a unique identifier ("key"), which allows retrieval of information from related tables. Databases are more difficult to set up than spreadsheets, but they allow more sophisticated data retrieval and search. In addition, it is possible to write scripts using a query language such as SQL to perform simple data checking and other functions. However, these programs are designed mainly for data storage and retrieval, and are usually not designed to facilitate manual data entry. For the SARA survey, it is recommended that a database system be used to store the data once it has been entered, but not for data entry itself.

Spreadsheets Spreadsheet programs offer the most basic option for data entry. Although spreadsheets are easy to use and many people are knowledgeable about how to use the software programs, there are many disadvantages of using spreadsheets for data entry: it is very easy to make a mistake, data entry is slow, and there is no built-in checking for valid values. As a result, for the SARA survey, it is not recommended to use a spreadsheet for data entry unless there are no other viable options. Spreadsheet software is often useful to view data once it has been digitized and stored in a database. Preparing for data entry The data entry application must be designed using the selected data entry software. Valid values should be defined for certain responses and entry of data should be restricted to these values alone. Furthermore, special keys for missing data should be included in the value set and may use a standard identifying digit. Open-ended questions or the selection of the broad category of "other" can also be programmed to allow for entering the written response. This keying of open-ended questions will require the manual coding of these responses at some future date. A centralized system for data entry should be set up, with one or more groups of data entry clerks managed by a supervisor. The number of data entry clerks will depend on a number of factors, including (1) budget, (2) timeline, (3) the availability of qualified personnel, and (4) the availability of computers and other equipment for data entry. Generally, the more data entry clerks there are, the quicker the data can be entered. Part of the management and organization of a data entry operation requires establishing a specified work schedule. Monitoring the productivity of the individual data entry clerks should be part of a data entry system as well. Like other process, the data entry process requires good organizational and project management skills.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 Entering data Data should be entered using the software that has been selected. In the data entry process, it is important to consider the following issues.

Missing data In general, it is not good practice to use blanks as missing data codes. Missing data can arise in a number of ways, and it is important to distinguish among these different instances. There are at least five missing data situations, each of which should have a distinct missing data code. • Refusal/no answer. The subject explicitly refused to answer the question or did not answer the question when he or she should have. • Don’t know. The subject was unable to answer the question, either because he or she had no opinion or because the required information was not available (e.g. a respondent could not provide information on the functionality of equipment due to inaccessibility). • Processing error. For some reason, there is no answer to the question although the subject provided one. This can result from interviewer error, incorrect coding, machine failure or other problems. • Not applicable. For one reason or another, the subject was never asked the question. Sometimes this 6 results from “skip patterns” that occur (e.g. for facilities that do not have a generator, questions regarding generator functionality and availability of fuel would be not applicable). • No match. This situation may arise when data are drawn from different sources (e.g. a survey questionnaire and an administrative database), and information from one source cannot be located.

Selecting missing data codes Missing data codes should always match the content of the field. If the field is numeric, the codes should be numeric, and if the field is alphabetic, the codes may be numeric or alphabetic. Most researchers use codes for missing data that are above the maximum valid value for the variable (e.g. 97, 98 and 99). Missing data codes should be standardized so that only one code is used for each missing data type across all variables in the data file or across the entire collection if the study produced multiple data files.

Not applicable and skip patterns Handling skip patterns is a constant source of error in both data management and analysis. On the management side, deciding what to do about codes for respondents who are not asked certain questions is crucial. "Not applicable" codes, as noted above, should be distinct from other missing data codes. It is not good practice to leave the record blank. Data set documentation should clearly show for every item exactly who was asked and who was not asked the question. At the data cleaning stage, all “filter items” should be checked against items that follow to make sure that no one provides answers to the item who should not, and that those who did not answer the item have the correct kind of missing data code.

Skip patterns are a particular type of survey branching logic that will jump a respondent over a group of questions that isn’t relevant to them.

1. Overview 1.8.2 Data processing After data entry, data should be checked for inconsistencies and possible errors. If the data are collected electronically, field supervisors should, for the duration of the data collection phase, check data for all health facilities that were visited each day. If the data are transferred from paper to electronic versions, the data should be checked for entry errors. It is particularly important to check that the facility ID items such as the facility number, name, location, facility type and managing authority have been entered correctly, and that there are no inconsistent or missing data. Usually errors can be resolved by reviewing all of the information provided by a respondent or by referring to the paper copy of the questionnaire responses. Edit and correct data The purpose of editing is to make the data as representative of the real life situation as possible; this can be done by eliminating omissions and invalid entries, and by changing inconsistent entries. Below are some important principles that should be followed. • The fewest number of changes should be made to the originally recorded data. The goal is to make a record or questionnaire acceptable, not to make it conform to what one thinks should be acceptable. • For certain items it may be acceptable to have a "not reported [NR]" or “not stated [NS]" category. Thus, in case of an omission or an inconsistent, impossible or unreasonable entry, a code for "NR" or "NS" can be assigned. • Obvious inconsistencies among the entries should be eliminated. • Providing corrected values for erroneous or missing items should be supplied by using other values as a guide, and always in accordance with specified procedures. • Specifications for editing the questionnaire data should be developed at the same time as the questionnaire itself.

Remove any duplicate records It is possible that a facility has been entered in the database twice and thus the duplicate record must be removed. For any records that are identical, one should be removed. If two records appear to be duplicates according to facility name, but do not contain the same data, a list of criteria must be used to determine if it is a true duplicate. The following data elements could be used as the criteria for determining duplicates: • district • facility code/name • GPS coordinates • facility type • managing authority • interviewer's name. If these are all the same it is safe to consider the records as duplicates. At this point, the most complete record should stay in the data set. If both records are complete, the record with latest time stamp should be kept.

Check validity of GPS coordinates GPS coordinates should be checked to ensure that they fall within the boundaries for the country and region. Sometimes latitude and longitude coordinates can be entered incorrectly (they can be inversed and +/- signs can be reversed, or an incorrect format can be entered). All GPS coordinates should be double-checked to ensure they are valid for the area being surveyed.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 Check validity of responses Data entry software often has built-in functionality to check data as it is being entered, such as range checks and within-record consistency checks. Data editing programs can be written to check the validity of responses after data entry, including whether the data follow the appropriate skip patterns.

Recode values for “other” Questions where "other" is a possible response option should be checked, and the written responses reviewed to determine if the response actually corresponds with one of the pre-coded options. If this is the case, these responses should be recoded to the appropriate response category.

Review comments sections At the end of the survey, there are several questions allowing for the interviewer to provide comments. Please review these sections for any relevant information. Data validation and verification Verification is a process of double entry of the same questionnaire and comparing the responses. This can either be the paper questionnaire entered twice or validation between paper and electronic versions if electronic data collection is used with paper questionnaires as a backup. Differences in keyed data of the same questionnaire need to be reconciled. A system of verification can virtually assure that the information presented in the questionnaire is faithfully keyed. Verification can be dependent or independent. Dependent data entry uses one data file and reconciles any identified error with the original data file. Independent verification is the process of keying to fully independent data files of the same questionnaire or cluster and comparing the two files. A report of inconsistencies is issued and the differences between the two data files must be fully reconciled. Data clean-up Before finalizing and exporting the data set, the following steps should be taken to clean the data set as applicable.

Rename the variables The variable should be named according to the corresponding question number in the survey. This may already be the case if the database is set up in this way. If electronic software is used, variables are often assigned names based on category headings, which are sometimes long and cumbersome to use and do not provide a good description of the variable and thus require renaming. For example, the variable “_2_001_date” which corresponds to question 001 in the survey will be renamed “q001”.

Label the variables Adding a label to a variable allows a text description to be associated with the variable name. For example, the new variable “q001” can have a label called "date." This enables the user to more easily identify what each variable represents.

Remove variables for which no data exist If data are collected using electronic software, there may be variables in the data set which are actually instructions from the questionnaire and do not include any data. These variables must be removed from the data set.

1. Overview Define the data type associated with variables There are generally two data types associated with variables: numeric and string. Numeric variables are simple: they contain numbers. String variables contain text that can contain any characters on the keyboard: letters, numbers and special characters. It is important to define each variable according to the appropriate type in order for statistical analysis to be carried out on the data.

Adjust variables in which two numeric responses have been chosen All variables with numeric responses should contain only one response. It is possible that a single select numeric variable is erroneously assigned two values. In some programs, this is represented in the data set as #;# and causes the variable to be categorized as a string variable due to the non-numeric character. These values must be imputed so that only one numeric value is recorded and then the data type of the variable must be converted from a string to a numeric value.

1.8.3

Exporting the data set

Once the data set has been processed and verified, it is good practice to export the finalized data set into some commonly used file format such as a spreadsheet format or CSV (.csv). This is useful when sharing the data and for analysis of the data using statistical software packages.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

1.9. Data analysis Once data have been verified, data analysis can begin. There are many different types of results that can be obtained from surveys. The types of analysis used depend to a large extent on the design determined in the planning phase of the SARA survey. Some data analyses are standard and are included in most survey reports. However, not all of the analyses of the survey data need to be included in the final report, as the focus should be on the most important and relevant results. Therefore, survey managers should generate the full range of survey results, and together with the survey coordinating group, select the most significant findings for inclusion in the final report. It is only by conducting a complete analysis of the survey data that it can be assured that important findings have not been overlooked. Based on the initial set of results from the standard analyses, there is often further analysis in areas of interest. Following data analysis, a meeting with the survey coordinating group should be held to assist in interpreting the results and developing recommendations. Survey indicators are important in providing crucial information for informed policy choices, especially to decision-makers, programme planners and policy-makers. Serving as baselines, indicators are important for setting goals and targets for the future and allow for a certain level of comparability between surveys of different location and time period. Moreover, indicators help place focus on predetermined areas of a survey that are deemed to be most useful, relevant and important to the current health system. Having a consistent indicator set also contributes to standardized analytical reporting. SARA uses both tracer indicators and composite indicators in data analysis. Tracer indicators aim to provide objective information about whether or not a facility meets the required conditions to support provision of basic or specific services with a consistent level of quality and quantity. Summary or composite indicators, also called indices, are a useful means to summarize and communicate information about multiple indicators and domains of indicators. Composite indices are useful to help get an overall view of the situation and to summarize multiple pieces of information. For SARA, composite indices are useful to compare districts or regions or to look at change over time. However, composite indices also have limitations. It can be difficult to understand the individual factors contributing to an index score, and thus it is important to have information on individual indicator items in addition to composite index scores. The following sections provide an overview of how to calculate SARA indicators and indices.

1.9.1 Calculating the service availability indicators and index Overview An important note regarding service availability: although this information is collected through the SARA questionnaire, these indicators should not be calculated for a sample of facilities. Data must be available for ALL facilities in an administrative unit in order to calculate service availability. All service availability measures require data that link the numerator (e.g. number of facilities) to the denominator (e.g. population size). A sample survey would not allow computation of the service availability indicators as it is not clear what the corresponding population size to be used as the denominator should be. The information needed to calculate service availability can be gathered from multiple sources in addition to the SARA questionnaire, namely the HMIS and other routine information systems, and should be collated for all facilities before calculating the service availability indicators. If SARA is implemented as a census, then it can be used to calculate service availability. Service availability is described by three domains of tracer indicators: health infrastructure, health workforce and service utilization.

1. Overview Health infrastructure indicators • Facility density (number per 10 000 population): the facility density is primarily an indicator of outpatient service access. • Inpatient bed density (number per 10 000 population): inpatient bed density provides an indicator of the inpatient services access. Paediatric beds (cots) are included, but maternity beds are excluded. • Maternity bed density (number per 1000 pregnant women): maternity bed density provides an indicator of access to delivery services. Data on maternity beds can be used calculate the density of maternal beds per 1000 pregnant women per year. The denominator is estimated from the population data. The indicator does not include delivery beds.

Health workforce indicator • Health workforce density (number per 10 000 population): the health workforce density is the number of core medical professionals per 10 000 population: physicians, non-physician clinicians, registered nurses and midwives. This includes part-time physicians who are given the value of 0.5 in the scoring.

Service utilization indicators In populations with poor or suboptimal health infrastructure, the service utilization rate is an indicator of access. • Outpatient service utilization (number of outpatient visits per capita per year): the number of visits for ambulant care, not including immunization, over the total population. • Inpatient service utilization (number of hospital discharges per 100 population per year, excluding deliveries): this indicator provides additional information on the availability and access to inpatient services. These indicators must all be expressed as a percentage score compared with a target or benchmark. Table 1.9.1 shows the target and computation of each indicator. If the tracer indicator score exceeds the target, it is scored as 100%.

TABLE 1.9.1 SERVICE AVAILABILITY INDICATORS Domain Health infrastructure a b c d e f Facility density Inpatient bed density Maternity bed density Number per 10 000 population (n) Number per 10 000 population (n) Number per 1000 pregnant women (n) Number per 10 000 population (n) Outpatient visits per person per year (n) Hospital discharges per 100 per year (n) 2 25 10 n / 2 × 100 n / 25 × 100 n / 10 × 100 n / 23 × 100 n / 5 × 100 n / 10 × 100 Indicator Target* Score (%) (n / target, maximum 100)

Health workforce Core health workforce density 23 Service utilization Outpatient service utilization Inpatient service utilization 5 10

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 Health infrastructure targets and scores The rationale for the targets can be summarized as follows. Facility density (a): usually there is a country target, such as at least one facility per 5000 population, or two facilities per 10 000 population. A major limitation is that this indicator does not take into account the size of the facilities. The indicator is scored as n / 2 × 100% (maximum 100), where n is the number of facilities per 10 000 population. Inpatient bed density (b): the global average is 27 per 10 000 (10). Lower- and upper-middle-income countries have 18 and 39 hospital beds per 10 000, respectively (10). For SARA, an arbitrary benchmark of 25 per 10 000 is selected. The indicator is scored as n / 25 × 100% (maximum 100), where n is the number of inpatient beds per 10 000 population. Maternity bed density (c): under the assumption that there should be sufficient beds for all pregnant women with an occupancy rate of 80% (to account for the uneven spread of demand over time) and a mean duration of stay of 3 days, the target should be (1000 / 0.8) × (3 / 365) = 10 per 1000 pregnant women. The indicator is scored as n / 10 × 100% (maximum 100), where n is the number of maternity beds per 1000 pregnant women. An estimation for the number of pregnant women in the population can be derived from the CBR (crude birth 7 rate) for the country of interest and the following equations: A = estimated number of live births = (CBR per 1000 × total population) B = estimated live births expected per month = (A / 12) C = estimated number of pregnancies ending in stillbirths or miscarriages = (A × 0.15) D = estimated pregnancies expected in the year = (A + C) E = estimated number of women pregnant in a given month = (0.70 × D) F = estimated % of total population who are pregnant at a given period = (E / total population × 100).

Health workforce target and score Health worker density (d): The published figure by WHO is 23 per 10 000 population (9). The indicator is scored as n / 23 × 100% (maximum 100), where n is the number of core health workers per 10 000 population.

Service utilization targets and scores Outpatient service utilization (e): in countries of the Organisation for Economic Co-operation and Development (OECD), the average number of physician consultations per person per year is about six (10). For SARA, the proposed benchmark is five visits per person per year. The indicator is scored as n / 5 × 100% (maximum 100), where n is the number of outpatient visits per person per year. Inpatient service utilization (f): in OECD countries, which have an ageing population, there are about 15 discharges per 100 population per year (11). For SARA, the proposed benchmark is 10 discharges per 100 people per year. The indicator is scored as n / 10 × 100% (maximum 100), where n is the number of hospital discharges per 100 people per year. The service availability index is calculated using the six above mentioned indicators. First, indices are calculated for health services infrastructure, health workforce and service utilization. The calculations for creating those indices are shown in Table 1.9.2 (please refer Table 1.9.1 for the definitions of indicators a–f). The service availability index is the unweighted average of the three areas: infrastructure, health workforce and utilization: [((a + b + c) / 3) + d + ((e + f) / 2)] / 3, and is a percentage score. These equations can be found at: http://www.who.int/reproductivehealth/publications/emergencies/field_manual_rh_humanitarian_settings.pdf, Chapter 5, Annex 3. 7

1. Overview

TABLE 1.9.2: SERVICE AVAILABILITY INDICES Index Health infrastructure index Indicator Average score of the three indicators: facility density, inpatient bed density, maternity bed density Core health worker density Average score of the two indicators: outpatient visits, hospital discharges Unweighted average of the three areas: infrastructure, workforce and utilization Target 100 Score (a + b + c) / 3

Health workforce index

100

Service utilization index

100

( e + f) / 2

Service availability index

100

[((a + b + c) /3) + d + ((e + f) / 2)] / 3

Required data sources Table 1.9.3 shows the required information and potential data sources for calculating service availability.

TABLE 1.9.3: DATA SOURCES Information needed List of all health facilities Service utilization data Health workforce data Inpatient and maternity beds data Population data (national and regional/district depending on how results will be reported) Potential data source MFL HMIS Human resources information system (HRIS) Varies by country National Bureau of Statistics

Example calculation Table 1.9.4 shows the data used for this example.

TABLE 1.9.4: EXAMPLE DATA Data item Number of facilities Number of inpatient beds Number of maternity beds Number of core health workers Number of outpatient visits per year Number of hospital discharges per Population Crude birth rate (CBR) Value 400 5500 800 4600 9 000 000 225 000 3 000 000 40

There are three main steps to calculate the service availability index.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 Step 1. Calculate service availability indicators The first step is to calculate the six service availability indicators. The following example (Table 1.9.5) shows the equations used to calculate each of the six indicators using the example data values.

TABLE 1.9.5: CALCULATING THE INDICATORS Indicator Facility density (number per 10 000 population) Value number of facilities / population = n / 10 000 400 / 3 000 000 = n / 10 000 n = 1.33 Inpatient bed density (number per 10 000 population) number of inpatient beds / population = n / 10 000 5500 / 3 000 000 = n / 10 000 n = 18.33 number of maternity beds / pregnant population* = n / 1000 Maternity bed density (number per 1000 pregnant women) 800 / 96 600 = n / 1000 n = 8.28 *see Table 1.9.6 for how to calculate number of pregnant women Health workforce density (number per 10 000 population) number of core health workers / population = n / 10 000 4600 / 3 000 000 = n / 10 000 n = 15.33 Outpatient service utilization (outpatient visits per capita per year) number of outpatient visits per year / population = n 9 000 000 / 3 000 000 = n n = 3.00 Inpatient service utilization (hospital discharges per 100 population, excluding deliveries) number of hospital discharges per year / population = n / 100 225 000 / 3 000 000 = n / 100 n = 7.50

TABLE 1.9.6: CALCULATING THE NUMBER OF PREGNANT WOMEN A = Estimated number of live births = (CBR per 1000 × total population) B = Estimated live births expected per month = (A / 12) C = Estimated number of pregnancies ending in stillbirths or miscarriages = (A × 0.15) D = Estimated pregnancies expected in the year = (A + C) E = Estimated number of women pregnant in a given month = (0.70 × D) F = Estimated % of total population who are pregnant at a given period = (E / total population × 100) (40 / 1000) x 3 000 000 = 120 000 120 000 / 12 = 10 000 120 000 x 0.15 = 18 000 120 000 + 18 000 = 138 000 0.7 x 138 000 = 96 600 (96 600 / 3 000 000) x 100 = 3.22

1. Overview Service availability indicators can each be displayed in a graph such as the one for health workforce density in Figure 1.9.1.

FIGURE 1.9.1: CORE HEALTH WORKERS PER 10 000 POPULATION Core health workers per 10 000 pop 40 32 30 20 10 0 26 20 15 17 9 8 Target 15 8 7 Overall 4 Urban Peri-urban Rural

Step 2. Calculate service availability indicator scores Next, use the values obtained from Step one to calculate the service availability indicator scores. The scores compare the indicator to a target and are expressed as a percentage. Table 1.9.7shows the calculations for each of the six service availability indicator scores.

TABLE 1.9.7: CALCULATING THE SERVICE AVAILABILITY INDICATOR SCORES Domain n Target Score (%) (n / target) x 100 (maximum 100) Health infrastructure a b c d Facility density Inpatient bed density Maternity bed density Core health workforce density 1.33 18.33 8.28 15.33 2 25 10 23 (1.33 / 2) x 100 (18.33 / 25) x 100 (8.28 / 10) x 100 (15.33 / 23) x 100 66.5 73.3 82.8 66.7

Health workforce Service utilization e f Outpatient service utilization Inpatient service utilization 3.00 7.50 5 10 (3 / 5) x 100 (7.5 / 10) x 100 60.0 75.0

Step 3. Calculate service availability indices Lastly, use the service availability indicator scores to create the health infrastructure index, the health workforce index, the service utilization index and the overall service availability index. Table 1.9.8 shows these four index calculations using the example data.

Ov e Di ral str l i Di c t 1 str i Di c t 2 str i Di c t 3 str i Di c t 4 str i Di c t 5 str i Di c t 6 str i Di c t 7 str i Di c t 8 str Di ict str 9 ic t 10 District

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

TABLE 1.9.8: CALCULATING THE SERVICE AVAILABILITY INDEX Index Health infrastructure index Health workforce index Service utilization index Service availability index Indicator Average score of the three indicators: facility density, inpatient bed density, maternity bed density Core health worker density Average score of the two indicators: outpatient visits, hospital discharges Unweighted average of the three areas: infrastructure, workforce and utilization Score (%) (a + b + c) / 3 (66.5 + 73.3 + 82.8) / 3 = 74.2

66.7

( e + f) / 2 [((a + b + c)/3) + d + ((e + f) / 2)] / 3

(60.0 + 75.0) / 2 = 67.5

(74.2 + 66.7 + 67.5) / 3 = 69.5

The service availability indices can be displayed in a graph such as the one in Figure 1.9.2.

FIGURE 1.9.2: SERVICE AVAILABILITY INDICES 100 80 60 40 20 0 General service Health availability infrastructure Index Health workforce Service utilization 69.5 74.2 67.5

66.7

1.9.2 Calculating the general service readiness indicators and index Overview General service readiness is described by the following five domains of tracer indicators: • Basic amenities • Basic equipment • Standard precautions for infection prevention • Diagnostic capacity • Essential medicines.

Score

1. Overview Each domain consists of a set of tracer items. Table 1.9.9 lists the tracer indicators for each domain.

TABLE 1.9.9: GENERAL SERVICE READINESS ITEMS AND INDEX General service domains (a) Basic amenities Tracer items Domain score (mean availability of items) n / 7 × 100, where n is the total number of items available in the domain

• • • • • • •

Power (electricity for lights and communication from any power source with break less than 2hours/per day) Improved water source within 500 m of facility Room with auditory and visual privacy for patient consultations Access to adequate sanitation facilities for clients Communication equipment (phone or short-wave radio) Access to computer with e-mail and Internet Emergency transportation Adult scale Child scale Thermometer Stethoscope Blood pressure apparatus Light source Safe final disposal of sharps Safe final disposal of infectious wastes Appropriate storage of sharps waste (sharps box/container) Appropriate storage of infectious waste (waste receptacle with lid and plastic bin liner) Disinfectant Single-use, standard disposable or auto-disable syringes Soap and running water or alcohol-based hand rub Latex gloves Guidelines for standard precautions Haemoglobin Blood glucose Malaria diagnostic capacity Urine dipstick - protein Urine dipstick - glucose HIV diagnostic capacity Syphilis RDT Urine pregnancy test Amlodipine tablet or alternative calcium channel blocker Amoxicillin (syrup/suspension or dispersible tablets)

(b) Basic equipment

• • • • • •

n / 6 × 100 where n is the total number of items available in the domain

• • • • • • • • •

n / 9 × 100 where n is the total number of items available in the domain

(d) Diagnostic capacity

• • • • • • • •

n / 8× 100 where n is the total number of items available in the domain

(e) Essential medicines

• •

n / 25× 100 where n is the total number of items available in the domain

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

General service domains

Tracer items

Domain score (mean availability of items)

• • • • • • • • • • • • • • • • • • • • • • •

amoxicillin tablet Ampicillin powder for injection Aspirin (capsules/tablets) Beclometasone inhaler Beta blocker (e.g.bisoprolol, metaprolol, carvedilol, atenolol) Carbamazepine tablet Ceftriaxone injection Diazepam injection Enalapril tablet or alternative ACE inhibitor (e.g. lisonopril, Ramipril, perindopril) Fluoxetine tablet Gentamicin injection Glibenclamide tablet Haloperidol tablet Insulin regular injection Magnesium sulfate injectable Metformin tablet Omeprazole tablet or alternative (e.g. pantoprazole, rabeprazole) Oral rehydration solution Oxytocin injection Salbutamol inhaler Simvastatin tablet or other statin (e.g. atorvastatin, pravastatin, fluvastatin) Thiazide (e.g. hydrochlorothiazide) Zinc sulphate (tablet or syrup) (Mean score of the five domains) (a + b + c + d + e ) / 5

General service readiness index

Required data source Facility assessment information is needed to calculate general service readiness; the source for this information is the SARA survey.

1. Overview

1.10. Data archiving Data archiving includes the acquisition, preservation, documentation, cataloguing and dissemination of microdata. 8 Archives are useful for promoting research and instruction in the social sciences; ensuring the continued viability and usability of microdata in the future; and providing equitable access to these data within the framework of the national legislation in the interest of all citizens, by protecting confidentiality and following international recommendations and good practices. Fully documenting and archiving data sets helps ensure that important survey data and metadata are preserved for future reference and analysis. The data documentation, or metadata, helps researchers and other audiences to find the data, understand what the data are measuring and assess the quality of the data. • Finding the data. Names, abstracts, keywords and other important metadata elements help individuals and organizations locate the data sets and variables that meet their needs. • Understanding what the data are measuring and how the data have been created. Descriptions of the survey design and the methods used when collecting and processing the data, allow users to fully comprehend the context of the data. • Assessing the quality of the data. Information about the data collection standards, as well as any deviations from the planned standards, is important for gauging whether the data are useful for specific uses.

1.10.1

Elements of data documentation

There are three main types of material that constitute ideal documentation for a data set: explanatory material, contextual information and cataloguing material. This represents the minimum to create and preserve a data set, and can be described as the material required to ensure the long-term viability and functionality of a data set. Full understanding of the data set and its contents cannot be achieved without this material. Explanatory material

Information about the data collection methods This information describes the data collection process, whether it is a survey; the collection of administrative information; or the transcription of a document source. It should describe the questionnaires used, the methods employed and how these were developed. If applicable, details of the sampling design and sampling frames should be included. It is also useful to include information on any monitoring process undertaken during the data collection as well as details of quality controls.

Information about the structure of the data set Key to this type of information is a detailed document describing the structure of the data set and including information about relationships between individual files or records within the study. It should include, for example, key variables required for unique identification of subjects across files. It should also include the number of cases and variables in each file and the number of files in the data set. For relational models, a diagram showing the structure and the relations between the records and elements of the data set should be constructed.

Microdata refers to data on the characteristics of units of a population, such as individuals, households, facilities, or establishments, collected by census, survey or experiment.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Technical information This information relates to the technical framework and should include: • the computer system used to generate the files • the software packages with which the files were created • the medium on which the data were stored • a complete list of all data files present in the data set.

Variables, values, coding, and classification schemes The documentation should contain a full list describing all variables (or fields) in the data set, including a complete explanation and full details about the coding and classifications used for the information allocated to those fields. It is especially important to have blank and missing fields explained and accounted for. It is helpful to identify variables to which standard coding classifications apply, and to record the version of the classification scheme used – preferably with a bibliographic reference to that code.

Information about derived variables Many data producers derive new variables from original data. This may be as simple as grouping raw age data (age in years) according to groups of years appropriate for the needs of the survey, or it may be much more complex and require the use of sophisticated algorithms. When grouped or derived variables are created, it is important that the logic for the grouping or derivation be clear. Simple grouping, such as for age, can be included within the data dictionary. More complex derivations require other means of recording the information. The best method of describing these is by using flow charts or accurate Boolean statements. It is recommended that sufficient supporting information be provided to allow an easy link between the core variables used and the resultant, derived variables. It is also recommended that the computer algorithms used to create the derivations be saved together with information about the software.

Weighting The weighting of variables needs to be fully documented, explaining the construction of the variables with a clear indication of the circumstances in which weights should be used. This is particularly important when different weights need to be applied for different purposes.

Data source Details about the source the data is derived from should be included. For example, when the data source is made up of responses to survey questionnaires, each question should be carefully recorded in the documentation. Ideally, the text will include a reference to the generated variable(s). It is also useful to explain the conditions under which a question would be asked to a respondent, including if possible, the cases to which it applies, and ideally, a summary of response statistics.

Confidentiality and anonymization It is important to note if the data contain any confidential information on individuals, households, organizations or institutions. Whenever this occurs, it is recommended to record such information together with any agreement on how to use the data, for example, with survey respondents. Issues of confidentiality may restrict the analyses to be undertaken or the results to be published, particularly if the data are to be made available for secondary use. If the data were anonymized to prevent subjects' identification, it is recommended to record the anonymization procedure and its impact on the data, as such modification may restrict subsequent analysis.

1. Overview Contextual information Contextual information provides users with material about the context in which the data were collected, and how data were put to use. This type of information adds richness and depth to the documentation, and enables the secondary user to fully understand the background and processes behind the data collection exercise. This also forms a vital historical record for future researchers.

Description of the originating project Details should be provided about the history of the project or about the process that gave rise to the data set. This should offer information on the intellectual and substantive framework. For example, the description could cover topics such as: • why the data collection was felt necessary • the aims and objectives of the project • who or what was being studied • the geographical and temporal coverage • publications or policy developments it contributed to or that arose as a response • any other relevant information.

Provenance of the data set Information on the origin of the data set relates to aspects such as the history of the data collection process, changes and developments that occurred in the data themselves and the methodology, or any adjustments made. The following can also be provided: • details of data errors • problems encountered in the process of data collection, data entry, data checking and cleaning • conversion to a different software or operating system • bibliographic references to reports or publications that stem from the study • any other useful information on the life-cycle of the data set.

Serial and time-series data sets, new editions For repeated cross-sectional, panel or time-series data sets, it is helpful to obtain additional information describing, for example, changes in the question text, variable labelling or sampling procedures. Cataloguing material Cataloguing material serves two purposes. First, it serves as a bibliographic record of the data set. This allows for the data set to be properly acknowledged and cited in publications, and for the material to act as a formal record for long preservation purposes. Second, it is the basic instrument used for resource discovery, allowing the data set to be uniquely identified within the collection by providing appropriate information to help secondary users identify the study as being useful to their purpose.

1.10.2 Metadata standards Traditionally, data producers and archivists produced expansive, text-based codebooks. Today, various metadata alternatives, such the Data Documentation Initiative (DDI) and the Dublin Core Metadata Initiative (DCMI), have been developed for the documentation and cataloguing of microdata and related materials

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 according to international standards. These new type of 'codebooks' are based on Extensible Markup Language (XML), a type of regular text file that tags for meaning – rather than appearance – and can be viewed and edited using any standard text editor. XML files can be searched and queried like a regular database and can be edited. Data Documentation Initiative (DDI) The Data Documentation Initiative (DDI) is an effort to establish an international XML-based standard for microdata documentation. Its aim is to provide a straightforward means to record and communicate to others all the salient characteristics of microdata sets. By creating a consistent framework for microdata documentation, the DDI has several key features: interoperability, richer content, multi-purpose documentation, online analytical capability and search capability. The DDI elements are organized in five sections.

Section 1.0. Document description A study (survey, census or other) is not always documented and disseminated by the same agency as the one that produced the data. It is therefore important to provide information (metadata) not only on the study itself, but also on the documentation process. The document description consists of overview information describing the DDI-compliant XML document, or, in other words, "metadata about the metadata".

Section 2.0. Study description

The study description consists of overview information about the study. This section includes information about how the study should be cited; who collected, compiled and distributes the data; a summary (abstract) of the content of the data; and information on data collection methods and processing.

Section 3.0. Data file description This section is used to describe each data file in terms of content; record and variable counts; version; producer; and so on.

Section 4.0. Variable description This section presents detailed information on each variable, including literal question text; universe, variable and value labels; and derivation and imputation methods.

Section 5.0. Other material This section allows for the description of other materials related to the study. These can include resources such as documents (e.g. questionnaires, coding information, technical and analytical reports, interviewer's manuals), data processing and analysis programs, photos and maps. However, the DCMI (described below) provides a standard for documenting digital resources such as questionnaires and reports.

1. Overview Dublin Core Metadata Initiative (DCMI) The Dublin Core Metadata Initiative (DCMI) is an open forum to develop the Dublin Core metadata standard, which is a simple set of elements for describing digital resources. This standard is particularly useful to describe resources related to microdata such as questionnaires, reports, manuals, data processing scripts and programs. A major reason behind the success of the Dublin Core metadata standard is its simplicity. From the outset it has been the goal of the designers to keep the element set as small and simple as possible to allow the standard to be used by non-specialists. In its simplest form the Dublin Core consists of 15 metadata elements, all of which are optional and repeatable. The 15 elements are: 1. 2. 3. 4. 5. 6. 7. 8. 9. title subject (topic) description: an abstract, a table of contents, or a free-text account of the content type: the nature or genre of the content of the resource source relation: a reference to a related resource (rarely used) coverage: the extent or scope of the content of the resource (e.g. spatial location or time period) creator publisher

10. contributor 11. rights: a rights management statement for the resource 12. date 13. format 14. identifier 15. language.

1.10.3 Creating metadata for SARA Metadata can be created through a multitude of media including simple word processing programs and software application programs. This section provides guidance on creating metadata for SARA by identifying key elements to be included and by providing information on tools available to assist in creation of metadata. Required elements When creating a metadata document using a simple word processing program, the following elements need to be included. Much of this information will have been generated as part of the data processing steps.

Survey description DOCUMENT DESCRIPTION The document description serves as an introduction to the metadata as a whole. It provides background information such as the study title, document producer(s), date of production and version number. STUDY DESCRIPTION The study description serves to identify the study itself and to provide overview information, as well as the project scope, coverage and sampling, and information on data collection, editing, appraisal and access. This section also names producers and sponsors, and describes points of contact, and disclaimers and copyrights.

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 Data set(s) FILE DESCRIPTION The file description of a data set provides the data set contents, its producer and the version. It should also include an explanation of how missing data are coded or accounted for, as well as any other relevant notes. When applicable, a section on processing checks should be included. This element serves to provide information about the types of checks and operations that have been performed on the data file to make sure that the data are as correct as possible, e.g. consistency checking. VARIABLES The variables section of an archive consists of detailed descriptions of the actual data. The variables list is typically a table listing every variable in the data set and providing for each the variable number, name and label. This list also provides the literal question associated with the variable, the variable format (character or numeric, number of units), and the number of valid and invalid cases (see Table 1.10.3).

TABLE 1.10.3: VARIABLES LIST # 1 Name V_001 Label Facility Name Type Discrete Format Character-12 Valid 97 Invalid 0 Question Record the name of the facility

The variables description is more detailed than the variable list. It includes variable information (type, format, missing value coding), statistics (valid and invalid), literal question, and any notes (see Table 1.10.4).

TABLE 1.10.4: VARIABLES DESCRIPTION #1 V_001: Facility name Information Statistics Literal question Notes [Type= discrete] [Format=character] [Missing=*] [Valid=97 /-] [Invalid=0 /-] Record the name of the facility

External resources TYPES OF RESOURCES External resources encompass all of the documents contributing to the implementation of the survey or stemming from the results of the survey. Examples include: • questionnaires • reports • databases • photos, videos, etc. • maps or geospatial data • technical documents • analytical or administrative documents.

1. Overview RESOURCE INFORMATION Each external resource should be accompanied by relevant descriptive information. Identification • type of resource • title • authors: the individuals or organization primarily responsible for creating the resource • date: the date on which the resource was created or last modified • country: all countries within the scope of a resource • language • format • an ID number, if applicable: an unambiguous reference to the resource. Contributor and rights • contributor(s): individuals or organizations who have supported or contributed to the development of the resource (including funding agencies) • publisher(s): individuals or organizations responsible for disseminating the resource • rights: a clear and complete description of the usage rights, if relevant. Content • description: an account of the content of the resource • abstract • table of contents: a listing of all sections of the resource • subjects: key topics discussed in the resource. Available tools The Microdata Management Toolkit 9 developed by the World Bank Data Group is designed to address the technical issues facing data producers. It provides one of the most straightforward ways to create comprehensive metadata that adhere to international standards. The aim in developing the Toolkit was to promote the adoption of standards for international microdata documentation, dissemination and preservation, as well as to foster best practices by data producers in developing countries. The Toolkit consists of: • a Metadata Editor, which documents data in accordance with international standards; • an International Household Survey Network (IHSN) Report Center, which generates metadata reports from inputs into the Metadata Editor; • an Explorer, which allows users to view metadata and to re-export data in common formats; • a CD-Rom Builder, which generates user-friendly outputs (CD-ROM, web) for dissemination and archiving. Templates for SARA survey archiving are publicly available through the IHFAN web site at http://www.ihfan.org/home/index.php?editable=no&page_type=catalog. 9

The Microdata Management Toolkit is free and available for download along with a user manual at: http://www.ihsn.org/home/index.php?q=tools/toolkit

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 1.10.4 Data archiving Today, data archives are most always digital and are ideally web-based or are made publicly available through the Internet. While this can be accomplished through many different types of media, SARA makes use of the National Data Archive (NADA) which is a free, standardized application for publishing data archives. 10 National Data Archive (NADA) tool The International Household Survey Network (IHSN) developed the national data archive (NADA) as a complement to the Microdata Management Toolkit. NADA is a web-based survey cataloguing system that serves as a portal for researchers to browse, search, apply for access, and download relevant census or survey data and metadata. NADA makes use of the XML-based international standards such as the DDI and Dublin Core and is a powerful instrument that facilitates the process of releasing study metadata and microdata to the user community. NADA is a tool for informing users about the existence and characteristics of survey, census or other microdata sets, and for sharing metadata and (optional) disseminating microdata files. NADA does not provide tools for data tabulation or analysis. It aims to provide users with detailed and searchable documentation of microdata sets, along with information on policies and procedures for their access and use. NADA comes as a prepackaged but fully customizable web site. At the core of NADA is the data catalogue, which: • provides summary information on each survey; • provides access to reports, tables and other analytical output; • provides data access policies to the user community and facilitates access by serving as an implementing tool of the data access policy; • provides links to related survey metadata; • facilitates searches at the variable level and displays variable-level information; • provides authorized users with access to the data (via direct access or through online forms), with conditions for access clearly stated; • keeps a log of user requests; • links to the HTML output as provided by the CD-ROM Builder of the Microdata Management Toolkit; • includes an automatically-generated history of added/updated data sets via an RSS feed; • is easy to maintain and use. The data catalogue interface is interactive, allowing users to sort and search the catalogue by study elements and/or data variables, or find out detailed information through the survey's metadata. WHO has created a national data archive for SARA surveys, which can be http://apps.who.int/healthinfo/systems/datacatalog/index.php/catalog. This site serves as an example of how a data archive can be created using the NADA software. located at

NADA is available to download free of charge at: http://www.ihsn.org/home/index.php?q=tools/nada.

1. Overview

References 1. International Health Partnership and related initiatives (IHP+). Geneva, World Health Organization and Washington DC, The World Bank (http://www.internationalhealthpartnership.net/en/home, accessed 17 December 2011). 2. Monitoring, evaluation and review of national health strategies. A country-led platform for information and accountability. Geneva, World Health Organization, 2011. 3. Service availability mapping (SAM). Geneva, World Health Organization (http://www.who.int/healthinfo/systems/samintro/en/index.html, accessed 17 December 2011). 4. Service provision assessment (SPA) overview. Maryland, MEASURE DHS, ICF International (http://www.measuredhs.com/aboutsurveys/spa/start.cfm, accessed 17 December 2011). 5. Measuring medicine prices, availability, affordability and price components, 2nd ed. Geneva, World Health Organization and Health Action International, 2008 (http://www.haiweb.org/medicineprices/manual/documents.html and http://www.who.int/medicines/areas/access/medicines_prices08/en/, accessed 17 December 2011). 6. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva, World Health Organization, 2010 (http://www.who.int/healthinfo/systems/monitoring/en/index.htm, accessed 17 December 2011). 7. Creating a master facility list. Draft document. Geneva, World Health Organization, 2012 8. Data Quality Report Card (DQRC): guide to assessment of health facility data. Draft document. Geneva, World Health Organization, 2013 9. Health workforce target reference 10. Outpatient service utilization target reference 11. Inpatient service utilization target reference

Core instrument

2. Core instrument

SARA core instrument Version 2.2 July, 2014 The SARA core instrument is a questionnaire broken down into the following sections: • Section 1: Cover page − − − − • • • Interviewer visits Facility identification Geographic coordinates General information

Section 2: Staffing Section 3: Inpatient and observation beds Section 4: Infrastructure − − − − − − − − − − Communications Ambulance/transport for emergencies Power supply Basic client amenities Infection control Processing of equipment for reuse Health care waste management Supervision Basic equipment Infection control precautions

•

Section 5: Available services − − − − − − − − − − − − − − − − − Family planning Antenatal care Prevention of mother-to-child transmission of HIV Obstetric and newborn care Caesarean section Immunization Child preventative and curative care Adolescent health HIV counselling and testing HIV treatment HIV care and support Sexually transmitted infections Tuberculosis Malaria Non-communicable diseases Surgery Blood transfusion

• • •

Section 6: Diagnostics Section 7: Medicines and commodities Section 8: Interviewer’s observations

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Number

Question

Result

SECTION 1: COVER PAGE INTERVIEWER VISITS 001 002 Facility number Is this a supervisor validation check of a facility? 1 Date _______________ 2 _________________ DATA COLLECTION FOR FACILITY ASSESSMENT…………… SUPERVISOR VALIDATION .…………………………………………… FINAL VISIT 3 _______________ DAY MONTH YEAR INT. NUMBER 1 2

Interviewer Name

_______________

_________________

_______________

FACILITY IDENTIFICATION 003 004 005 006 007 Name of facility ____________________________________ Location of facility ____________________________________ Region/Province District Type of facility* * These should be adapted at country level prior to implementation* NATIONAL REFERRAL HOSPITAL ...................................... DISTRICT/PROVINCIAL HOSPITAL .................................... HEALTH CENTRE/CLINIC................................................... HEALTH POST ................................................................... MATERNAL/CHILD HEALTH CLINIC .................................. OTHER (SPECIFY) _______________________________ 008 Managing Authority GOVERNMENT/PUBLIC .................................................... NGO/NOT-FOR-PROFIT .................................................... PRIVATE-FOR-PROFIT ....................................................... MISSION/FAITH-BASED .................................................... OTHER (SPECIFY) _______________________________ 009 010 Urban/Rural Outpatient only URBAN ............................................................................. RURAL .............................................................................. YES ................................................................................... NO .................................................................................... 1 2 3 4 5 96 1 2 3 4 96 1 2 1 2

2. Core instrument

Number

Question

Result

GEOGRAPHIC COORDINATES COLLECT GEOGRAPHIC COORDINATES INFORMATION FOLLOWING THE INSTRUCTIONS*. SET DEFAULT SETTINGS FOR GPS: 1. 2. 3. SET COORDINATE FORMAT TO DECIMAL DEGREES (HDDD.DDDDD) SET “DATUM” TO WGS84 SET “UNITS” TO METRIC, “NORTH REF” TO MAGNETIC AND “ANGLE” TO DEGREE

MOVE TO MAIN ENTRANCE OF THE BUILDING. STAND WITHIN 30 METERS OF DOOR WHERE ENTRANCE IS IN PLAIN VIEW TO THE SKY. 1. 2. 3. 4. 5. 6. 7. 8. 9. TURN GPS RECEIVER ON AND WAIT UNTIL SATELLITE PAGE INDICATES "READY TO NAVIGATE" AND ACCURACY IS AT A RECOMMANDED LEVEL GO TO THE “MENU” PAGE AND SELECT "MARK" HIGHLIGHT THE WAYPOINT NUMBER AND PRESS "ENTER" HIGHLIGHT "WAYPOINT NUMBER" AND PRESS "ENTER" ENTER FACILITY CODE AND PRESS “ENTER” TO GO BACK TO THE “MARK” PAGE HIGHLIGHT "OK" AND PRESS "ENTER" TO REGISTER THE WAYPOINT GO TO THE MENU PAGE, HIGHLIGHT "WAYPOINT" AND PRESS "ENTER" HIGHLIGHT THE WAYPOINT AND PRESS “ENTER” TO OPEN ITS DETAILED INFORMATION COPY INFORMATION FROM WAYPOINT LIST PAGE IN THE FORM BELOW

BE SURE TO COPY THE WAYPOINT NAME (FACILITY NUMBER) FROM THE WAYPOINT LIST PAGE TO VERIFY THAT YOU ARE ENTERING THE CORRECT WAYPOINT INFORMATION ON THE DATA FORM 011 Waypoint name (Facility number) 012 013 Altitude Meters Latitude N/S……………… a DEGREES/DEC 014 Longitude E/W……………… a DEGREES/DEC b *Detailed information is available in the data collector’s guide

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Number

Question

Result INTERVIEWER CODE

Skip

GENERAL INFORMATION FACILITY NUMBER

FIND THE MANAGER, THE PERSON IN-CHARGE OF THE FACILITY, OR MOST SENIOR HEALTH WORKER RESPONSIBLE FOR OUTPATIENT SERVICES WHO IS PRESENT AT THE FACILITY. READ THE FOLLOWING GREETING: Good day! My name is _____________________. We are here on behalf of [IMPLEMENTING AGENCY] conducting a survey of health facilities to assist the government in knowing more about health services in [COUNTRY]. Now I will read a statement explaining the study. Your facility was selected to participate in this study. We will be asking you questions about various health services. Information about your facility may be used by the [MOH], organizations supporting services in your facility, and researchers, for planning service improvement or for conducting further studies of health services. Neither your name nor that of any other health worker respondents participating in this study will be included in the dataset or in any report; however, there is a small chance that any of these respondents may be identified later. Still, we are asking for your help to ensure that the information we collect is accurate. You may refuse to answer any question or choose to stop the interview at any time. However, we hope you will answer the questions, which will benefit the services you provide and the nation. If there are questions for which someone else is the most appropriate person to provide the information, we would appreciate if you introduce us to that person to help us collect that information. At this point, do you have any questions about the study? Do I have your agreement to proceed? _________________________________________ INTERVIEWER'S SIGNATURE INDICATING CONSENT OBTAINED 015 May I begin the interview? DAY MONTH 2 0 1 YEAR

YES ..................................................... 1 NO ...................................................... 2 :

5001

016

INTERVIEW START TIME (use the 24 hour-clock system)

2. Core instrument

Indicator code

Number Question

Result

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MODULE 1: SERVICE AVAILABILITY SECTION 2: STAFFING 200 I have a few questions on staffing for this facility. Please tell me how many staff with each of the following qualifications are currently assigned to, employed by, or seconded to this facility. Please count each staff member only once, on the basis of the highest technical or professional qualification. For doctors, I would also like to know, of the total number, how many are part-time in this facility. 01 02 03 04 05 08 11 12 Generalist (non-specialist) medical doctors Specialist medical doctors Non-physician clinicians/paramedical professionals Nursing professionals Midwifery professionals Pharmacists Laboratory technicians (medical and pathology) Community health workers

A) ASSIGNED/ EMPLOYED/ SECONDED (INCLUDING PART TIME)

B) PART TIME

SECTION 3: INPATIENT AND OBSERVATION BEDS S2

301

Excluding any delivery beds, how many overnight/inpatient beds in total does this facility have, both for adults and children? Of the overnight/inpatient beds in this facility, how many are dedicated maternity beds? THIS DOES NOT INCLUDE DELIVERY BEDS

# OF OVERNIGHT/ INPATIENT BEDS. . . . . # OF DEDICATED MATERNITY BEDS. . . . .

302

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

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MODULE 2: SERVICE READINESS SECTION 4: INFRASTRUCTURE This section will focus on questions related to infrastructure. COMMUNICATIONS I5

400

Does this facility have a functioning land line telephone that is available to call outside at all times client services are offered? CLARIFY THAT IF FACILITY OFFERS 24-HOUR EMERGENCY SERVICES, THEN THIS REFERS TO 24-HOUR AVAILABILITY.

YES ............................................................. 1 NO ............................................................. 2

401

Does this facility have a functioning cellular telephone or a private cellular phone that is supported by the facility? Does this facility have a functioning short-wave radio for radio calls? Does this facility have a functioning computer?

402

403

404

Is there access to email or internet within the facility today?

YES ............................................................. 1 NO ............................................................. 2

AMBULANCE/TRANSPORT FOR EMERGENCIES I7

405

Does this facility have a functional ambulance or other vehicle for emergency transportation for clients that is stationed at this facility or operates from this facility? Does this facility have access to an ambulance or other vehicle for emergency transport for clients that is stationed at another facility or that operates from another facility in near proximity? Is fuel for the ambulance or other emergency vehicle available today?

YES ............................................................. 1 NO ............................................................. 2 407

406

YES ............................................................. 1 NO ............................................................. 2

408 408

407

YES ............................................................. 1 NO ............................................................. 2 DON’T KNOW .......................................... 98

POWER SUPPLY I1

408

Does your facility have electricity from any source (e.g. electricity grid, generator, solar, or other) including for stand-alone devices (EPI cold chain)?

YES ............................................................. 1 NO ............................................................. 2 417

2. Core instrument

Indic ator code I1

Number 409

Question What is the electricity used for in the facility?

Result

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ONLY STAND-ALONE ELECTRIC MEDICAL DEVICES/APPLIANCES (e.g. EPI cold room, refrigerator, suction apparatus, etc.) ........ 1 ELECTRIC LIGHTING (EXCLUDING FLASHLIGHTS) AND COMMUNICATIONS ... 2 ELECTRIC LIGHTING, COMMUNICATIONS, AND 1 TO 2 ELECTRIC MEDICAL DEVICES/ APPLIANCES ............................................... 3 ALL ELECTRICAL NEEDS OF FACILITY ......... 4

410

What is the facility’s main source of electricity?

CENTRAL SUPPLY OF ELECTRICITY (e.g. national or community grid) ..................... 1 GENERATOR (FUEL OR BATTERY OPERATED GENERATOR) ............................................ 2 SOLAR SYSTEM ......................................... 3 OTHER ___________________________ 96 (SPECIFY)

411

Other than the main or primary source, does the facility have a secondary or backup source of electricity? IF YES: What is the secondary source of electricity?

NO SECONDARY SOURCE .......................... 0 CENTRAL SUPPLY OF ELECTRICITY (e.g. national or community grid) ..................... 1 GENERATOR (FUEL OR BATTERY OPERATED GENERATOR) ............................................ 2 SOLAR SYSTEM ......................................... 3 OTHER ___________________________ 96 (SPECIFY)

412

During the past 7 days, was electricity available at all times from the main or any backup source when the facility was open for services?

ALWAYS AVAILABLE (NO INTERRUPTIONS) ....................................... 1 OFTEN AVAILABLE (INTERRUPTIONS OF LESS THAN 2 HOURS PER DAY) ..................2 SOMETIMES AVAILABLE (FREQUENT OR PROLONGED INTERRUPTIONS OF MORE THAN 2 HOURS PER DAY) ..........................3

CHECK Q410 AND Q411: FACILITY HAS A GENERATOR ( “2” CIRCLED FOR EITHER QUESTION) FACILITY DOES NOT HAVE A GENERATOR (“2” NOT CIRCLED FOR BOTH QUESTIONS) Q415 413 Is the generator functional? YES ............................................................. 1 NO ............................................................. 2 DON’T KNOW .......................................... 98 415 415

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indic ator code

Number 414

Question Is there fuel or a charged battery available today?

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YES ............................................................. 1 NO ............................................................. 2 DON’T KNOW .......................................... 98

415

CHECK Q410 AND Q411: FACILITY HAS A SOLAR SYSTEM ( “3” CIRCLED FOR EITHER QUESTION) FACILITY DOES NOT HAVE A SOLAR SYSTEM (“3” NOT CIRCLED FOR BOTH QUESTIONS) Q417

416

Is the solar system functional?

YES, FUNCTIONING .................................... 1 PARTIALLY, BATTERY NEEDS SERVICING/REPLACEMENT........................ 2 NO, NOT FUNCTIONAL .............................. 3 DON’T KNOW .......................................... 98

BASIC CLIENT AMENITIES 417 On average, how many hours per day is this facility open? 4 HOURS OR LESS ...................................... 1 5 TO 8 HOURS............................................ 2 9 TO 16 HOURS.......................................... 3 17 TO 23 HOURS........................................ 4 24 HOURS .................................................. 5 I2

418

What is the most commonly used source of water for the facility at this time?

PIPED INTO FACILITY ................................. 1 PIPED ONTO FACILITY GROUNDS .............. 2 PUBLIC TAP/STANDPIPE ............................ 3 TUBEWELL/BOREHOLE .............................. 4 PROTECTED DUG WELL ............................. 5 UNPROTECTED DUG WELL ........................ 6 PROTECTED SPRING .................................. 7 UNPROTECTED SPRING ............................. 8 RAINWATER COLLECTION ......................... 9 BOTTLED WATER ..................................... 10 CART W/SMALL TANK/DRUM ................. 11 TANKER TRUCK ........................................ 12 SURFACE WATER ..................................... 13 OTHER ___________________________96 (SPECIFY) DON'T KNOW .......................................... 98 NO WATER SOURCE ................................ 00

420 420

420 420 420

420 420

419

Is a water outlet from this source available within 500 meters of the facility?

YES ............................................................. 1 NO ............................................................. 2

2. Core instrument

Indic ator code I3

Number 420

Question Is there a room with auditory and visual privacy available for patient consultations?

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AUDITORY PRIVACY ONLY ......................... 1 VISUAL PRIVACY ONLY............................... 2 BOTH AUDITORY AND VISUAL PRIVACY .... 3 NO PRIVACY............................................... 4

421

Is there a toilet (latrine) in functioning condition that is available for general outpatient client use? IF YES: What type of toilet? IF MULTIPLE TOILETS ARE AVAILABLE, CONSIDER THE MOST MODERN TYPE

FLUSH TOILET ............................................ 1 VENTILATED IMPROVED PIT LATRINE (VIP) ........................................................... 2 PIT LATRINE WITH SLAB ............................ 3 PIT LATRINE WITHOUT SLAB/OPEN PIT..... 4 COMPOSTING TOILET ................................ 5 BUCKET ...................................................... 6 HANGING TOILET/ HANGING LATRINE ...... 7 NO FACILITIES/BUSH/FIELD ....................... 8

INFECTION CONTROL T1

422

Does this facility have any guidelines on standard precautions for infection prevention? IF YES, ASK TO SEE THE DOCUMENT

YES, OBSERVED.......................................... 1 YES, REPORTED NOT SEEN ........................ 2 NO ............................................................. 3

PROCESSING OF EQUIPMENTS FOR REUSE 423 Please tell me if the following items used for processing of equipment for reuse are available and functional in the facility today. IF AVAILABLE, ASK TO SEE IT AND INDICATE IF IT IS FUNCTIONING OR NOT I8

A) AVAILABLE OBSERVED REPORTED NOT NOT SEEN AVAILABLE

B) FUNCTIONING YES NO DON’T KNOW

01 02 03 04 05

Electric autoclave (pressure & wet heat) Non-electric autoclave Electric dry heat sterilizer Electric boiler or steamer (no pressure) Non-electric pot with cover for boiling/steam Heat source for non-electric equipment

1→B 1→B 1→B 1→B 1 06

2→B 2→B 2→B 2→B 2 06 2→B

3 02 3 03 3 04 3 05 3 06 3 424

1 1 1 1

2 2 2 2

8 8 8 8

1→B

HEALTH CARE WASTE MANAGEMENT

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indic ator code I9

Number 424

Question Now I would like to ask you a few questions about waste management practices for sharps waste, such as needles or blades. How does this facility finally dispose of sharps waste (e.g., filled sharps boxes)? PROBE TO ARRIVE AT CORRECT RESPONSE NOTE: IF ANY OF THE RESPONSES 2-9 TAKE PLACE OUTSIDE THE FACILITY, THEN THE CORRECT RESPONSE TO CIRCLE WILL BE IN THE CATEGORY OF "REMOVE OFFSITE"

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BURN INCINERATOR 2-CHAMBER INDUSTRIAL (800-1000+° C) . 2 1-CHAMBER DRUM/BRICK ........................ 3 OPEN BURNING FLAT GROUND - NO PROTECTION ............. 4 PIT OR PROTECTED GROUND .................... 5 DUMP WITHOUT BURNING FLAT GROUND - NO PROTECTION ............. 6 COVERED PIT OR PIT LATRINE ................... 7 OPEN-PIT - NO PROTECTION ..................... 8 PROTECTED GROUND OR PIT .................... 9 REMOVE OFFSITE STORED IN COVERED CONTAINER........... 10 STORED IN OTHER PROTECTED ENVIRONMENT........................................ 11 STORED UNPROTECTED .......................... 12 OTHER ___________________________96 (SPECIFY) NEVER HAS SHARP WASTE ...................... 95

I10

425

Now I would like to ask you a few questions about waste management practices for medical waste other than sharps, such as used bandages. How does this facility finally dispose of medical waste other than sharps boxes? PROBE TO ARRIVE AT CORRECT RESPONSE NOTE: IF ANY OF THE RESPONSES 2-9 TAKE PLACE OUTSIDE THE FACILITY, THEN THE CORRECT RESPONSE TO CIRCLE WILL BE IN THE CATEGORY OF "REMOVE OFFSITE"

SAME AS FOR SHARPS ITEMS .................... 1 BURN INCINERATOR 2-CHAMBER INDUSTRIAL (800-1000+° C) . 2 1-CHAMBER DRUM/BRICK ........................ 3 OPEN BURNING FLAT GROUND - NO PROTECTION ............. 4 PIT OR PROTECTED GROUND .................... 5 DUMP WITHOUT BURNING FLAT GROUND - NO PROTECTION ............. 6 COVERED PIT OR PIT LATRINE ................... 7 OPEN-PIT - NO PROTECTION ..................... 8 PROTECTED GROUND OR PIT .................... 9 REMOVE OFFSITE STORED IN COVERED CONTAINER........... 10 STORED IN OTHER PROTECTED ENVIRONMENT........................................ 11 STORED UNPROTECTED .......................... 12 OTHER ___________________________96 (SPECIFY) NEVER HAS SHARP WASTE ...................... 95

2. Core instrument

Indic ator code

Number 426

Question CHECK Q424 AND Q425: INCINERATOR USED (EITHER "2" OR "3" CIRCLED)

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INCINERATOR NOT USED (NEITHER "2" NOR "3" CIRCLED) Q430

I9 I10

427

Is the incinerator functional today?

YES ............................................................. 1 NO ............................................................. 2 DON’T KNOW .......................................... 98 430 430

I9 I10

428

Is fuel for the incinerator available today?

YES ............................................................. 1 NO ............................................................. 2 DON’T KNOW .......................................... 98

SUPERVISION 430 When was the last time this facility received a supervision visit from the higher level (DHMT or other)? THIS MONTH ............................................. 1 IN THE LAST 3 MONTHS ............................ 2 MORE THAN 3 MONTHS AGO ................... 3 DON’T KNOW .......................................... 98 431 01 02 03 During the supervision visit, did the supervisor assess the following? Pharmacy (e.g. drug stock out, expiry, records, etc.) Staffing (e.g. staff available and training) Data (e.g. completeness, quality, and timely reporting) 500 500

YES 1 1 1

NO 2 2 2

GENERAL OUTPATIENT SECTION

BASIC EQUIPMENT 500 Please tell me if the following basic equipment and supplies used in the provision of client services are available and functional in this facility today. ASK TO SEE THE ITEMS E1

A) AVAILABLE OBSERVED REPORTED NOT NOT SEEN AVAILABLE

B) FUNCTIONING YES NO DON’T KNOW

01 02 03 04

Adult weighing scale Child weighing scale- 250 gram gradation Infant weighing scale – 100 gram gradation Measuring tape-height board/stadiometre

1→B 1→B 1→B 1→B

2→B 2→B 2→B 2→B

3 02 3 03 3 04 3 05

1 1 1 1

2 2 2 2

8 8 8 8

E2 E38 E38

E18

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indic ator code E3

Number 05 06 07 08 09 10 11 12 13 14 501

Question Thermometer Stethoscope Blood pressure apparatus (may be digital or manual sphygmomanometer with stethoscope) Light source (flashlight acceptable) Intravenous infusion kits Oxygen concentrators Oxygen cylinders Central oxygen supply Flowmeter for oxygen therapy (with humidification) Oxygen delivery apparatus (key connecting tubes and mask/nasal prongs) At any time during the past 3 months has oxygen been unavailable for any reason?

Result 3 06 3 07 3 08 3 09 3 10 3 11 3 12 3 13 3 14 3 501 1 1 1 1 1 2 2 2 2 2

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1→B 1→B 1→B 1→B 1 10

2→B 2→B 2→B 2→B 2 10 2→B 2→B 2→B 2→B 2→B

1 1 1 1

2 2 2 2

8 8 8 8

M27

E45

1→B 1→B 1→B 1→B 1→B

8 8 8 8 8

E45

YES ............................................................. 1 NO .............................................................2

INFECTION CONTROL PRECAUTIONS 600 Please tell me if the following resources/supplies used for infection control are available in the general outpatient area of this facility today. ASK TO SEE THE ITEMS I15

OBSERVED 1 1 1 1 1 1 1 1 1

REPORTED NOT SEEN 2 2 2 2 2 2 2 2 2

NOT AVAILABLE 3 3 3 3 3 3 3 3 3

01 02 03 04 05 06 07 08 09

Clean running water (piped, bucket with tap, or pour pitcher) Hand-washing soap/liquid soap Alcohol based hand rub Disposable latex gloves Waste receptacle (pedal bin) with lid and plastic bin liner Sharps container ("safety box") Environmental disinfectant (e.g., chlorine, alcohol) Disposable syringes with disposable needles Auto-disable syringes

I15 I15 I16 I12

I11 I13 I14 I14

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SECTION 5: AVAILABLE SERVICES This section will focus on questions related to available services.

A. REPRODUCTIVE, MATERNAL AND NEWBORN HEALTH FAMILY PLANNING SERVICES S7

700

Does this facility offer family planning services?

YES ............................................................. 1 NO ............................................................. 2 800

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE FAMILY PLANNING SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT FAMILY PLANNING SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. 701 Does this facility provide or prescribe any of the following modern methods of family planning: 01 02 03 04 05 06 07 08 09 10 11 12 702 Combined estrogen progesterone oral contraceptive pills Progestin-only contraceptive pills Combined estrogen progesterone injectable contraceptives Progestin-only injectable contraceptives Male condoms Female condoms Intrauterine contraceptive device (IUCD) Implants Cycle beads for standard days method Emergency contraceptive pills Male sterilization Female sterilization Does this facility provide or prescribe any of the following modern methods of family planning for unmarried adolescents: 01 02 03 04 703 Combined estrogen progesterone oral contraceptive pills Male condoms Emergency contraceptive pills Intrauterine contraceptive device (IUCD) Please tell me if the following documents are available in the facility today: IF AVAILABLE, ASK TO SEE THE DOCUMENT

YES 1 1 1 1 1 1 1 1 1 1 1 1

NO 2 2 2 2 2 2 2 2 2 2 2 2

S7_01

S7_02 S7_03

S7_04 S7_05 S7_06 S7_07 S7_08 S7_09 S7_10 S7_11 S7_12

YES 1 1 1 1 YES, OBSERVED YES, REPORTED NOT SEEN

NO 2 2 2 2

S12_02 S12_03 S12_02 S12_04 S12_02 S12_06 S12_02 S12_07

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code T2 T62

Number 01 02 704

Question National family planning guidelines Any family planning check-lists and/or jobaids Have you or any provider(s) of family planning services:

Result 1 1 YES 1 1 2 2 NO 2 2 3 3

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01 02 705

Received any family planning training in the last two years? Received any training in adolescent sexual and reproductive health in the last two years? Does this facility stock contraceptive commodities at this service site? Are any of the following reproductive health medicines and commodities available in this service site today? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE/COMMODITY IS VALID (NOT EXPIRED)

T16

YES ............................................................. 1 NO ............................................................. 2 OBSERVED AVAILABLE 800 NOT OBSERVED REPORTED AVAILABLE BUT NOT SEEN NOT AVAILABLE TODAY

706

AT LEAST ONE VALID

AVAILABLE NON VALID

NEVER AVAILABLE

M15

01 02 03 04 05 06 07 08

Combined estrogen progesterone oral contraceptive pills Progestin-only contraceptive pills Combined estrogen progesterone injectable contraceptives Progestin-only injectable contraceptives Male condoms Female condoms Implant (e.g. levonorgestrel, etonogestrel) Emergency contraceptive pills (e.g. levonorgestrel tablet, ulipristal acetate tablet, mifepristone tablet 10-25 mg) Intrauterine contraceptive device (IUCD) For each of the following items, please check in the facility records if there has been a stock-out in the past 3 months:

1 1 1 1 1 1 1 1 1 STOCK-OUT IN THE PAST 3 MONTHS

2 2 2 2 2 2 2 2 2 NO STOCKOUT IN PAST 3 MONTHS

3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 PRODUCT NOT OFFERED

5 5 5 5 5 5 5 5 5 FACILITY RECORD NOT AVAILABLE

M96 M16 M97 M16 M98 M17 M99 M108 M109

M105

09 707

NOT INDICATED

M99_A M108_A M109_A

01 02 03

Female condoms Implant (e.g.levonorgestrel, etonogestrel) Emergency contraceptive pills (e.g. levonorgestrel tablet, ulipristal acetate tablet, mifepristone tablet 10-25 mg

1 1 1

2 2 2

3 3 3

4 4 4

5 5 5

ANTENATAL CARE SERVICES S8

800

Does this facility offer antenatal care (ANC) services?

YES ............................................................. 1 NO ............................................................. 2 900

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ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE ANTENATAL CARE SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT ANTENATAL CARE SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. 801 Do ANC providers provide any of the following services to pregnant women as part of routine ANC services? 01 02 03 04 05 802 Iron supplementation Folic acid supplementation Intermittent preventive treatment in pregnancy (IPTp) for malaria Tetanus toxoid immunization Monitoring for hypertensive disorder of pregnancy Please tell me if the following documents are available in the facility today: IF AVAILABLE, ASK TO SEE THE DOCUMENT T4 T63 T19

YES 1 1 1 1 1 YES, OBSERVED 1 1 1 YES, REPORTED NOT SEEN 2 2 2

NO 2 2 2 2 2

S8_01 S8_02 S8_03

S8_04 S8_05

NO 3 3 3

01 02 03

National ANC guidelines Any ANC check-lists and/or job-aids IPTp guidelines, check-lists and/or job-aids (including wall charts) ACCEPTABLE IF PART OF ANC GUIDELINES.

803 T5

Have you or any provider(s) of ANC services: 01 02 Received any ANC training in the last two years? Received any training in IPTp in the last two years?

YES 1 1

NO 2 2

T21

PREVENTION OF MOTHER-TO-CHILD TRANSMISSION S20

900

Does this facility offer services for the prevention of mother-to-child transmission of HIV (PMTCT)?

YES ............................................................. 1 NO ............................................................. 2 1000

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE PMTCT SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT PMTCT SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. 901 As part of PMTCT services, please tell me if this facility provides the following services to clients: 01 02 Provide HIV counselling and testing services to HIV positive pregnant women for PMTCT Provide HIV counselling and testing services to infants born to HIV positive pregnant women for PMTCT Provide ARV prophylaxis to HIV positive pregnant women for PMTCT

YES 1 1 1

NO 2 2 2

S20_01

S20_02

S20_03

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code S20_04

Number 04 05 06

Question Provide ARV prophylaxis to newborns of HIV positive pregnant women for PMTCT Provide infant and young child feeding counselling for PMTCT Provide nutritional counselling for HIV positive pregnant women and their infants for PMTCT Provide family planning counselling to HIV positive pregnant women for PMTCT Please tell me if the following guidelines are available in the facility today: IF AVAILABLE, ASK TO SEE THE DOCUMENT

Result 1 1 2 2

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S20_05

S20_06

S20_07

07 902

1 YES, REPORTED NOT SEEN 2 2

YES, OBSERVED 1 1

NO 3 3

T37 T38

01 02 903

National guidelines for PMTCT Guidelines for infant and young child feeding counselling Have you or any provider(s) of PMTCT services:

YES 1 1

NO 2 2

T39

01 02 904

Received any training in PMTCT in the last two years? Received any training in infant and young child feeding in the last two years? Is the PMTCT service room or area a private room/area with auditory and visual privacy?

T40

I24

AUDITORY PRIVACY ONLY ......................... 1 VISUAL PRIVACY ONLY .............................. 2 BOTH AUDITORY AND VISUAL PRIVACY .... 3 NO PRIVACY............................................... 4

OBSTETRIC AND NEWBORN CARE SERVICES S9

1000

Does this facility offer delivery (including normal delivery, basic emergency obstetric care, and/or comprehensive emergency obstetric care) and/or newborn care services?

YES ............................................................. 1 NO ............................................................. 2 1100

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE OBSTETRIC AND NEWBORN CARE SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT OBSTETRIC AND NEWBORN CARE SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. 1001 Please tell me if the following interventions are routinely carried out by providers of delivery services in this facility: Administration of oxytocin injection immediately after birth to all women for the prevention of post-partum haemorrhage Monitoring and management of labour using partograph Immediate and exclusive breastfeeding

YES 1 1 1

NO 2 2 2

S9_13

S9_14

02 03

S9_15

2. Core instrument

Indicator code S9_16

Number 04

Question Hygienic cord care (cut with sterile item and apply disinfectant to tip and stump, and no application of other substances) Thermal protection (drying baby immediately after birth and wrapping) Please tell me if any of the following interventions for the management of complications during and after pregnancy and childbirth have been carried out in the last 12 months by providers of delivery services as part of their work in this facility. Parenteral administration of antibiotics (IV or IM) for mothers Parenteral administration of oxytocic for treatment of post-partum haemorrhage (IV or IM) Parenteral administration of magnesium sulphate for management of preeclampsia and eclampsia (IV or IM) Assisted vaginal delivery

Result 1 1 2 2

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S9_17

05 1002

YES 1

NO 2

S9_01 S9_18 S26_03 S9_02 S9_18 S26_03 S9_03 S9_18 S26_03 S9_04 S9_18 S26_03 S9_05 S9_18 S26_03 S9_06 S9_18 S26_03 S9_07 S9_19 S26_03 S26_01 S26_03 S26_02 S26_03 S9_09 S9_19 S9_10 S9_19 S9_11 S9_19 S9_12 S9_19

Manual removal of placenta

Removal of retained products of conception

Neonatal resuscitation with bag and mask

1 1 1 1 1 1 1

2 2 2 2 2 2 2

08 09 10

Caesarean section Blood transfusion Antibiotics for preterm or prolonged PROM (premature rupture of membranes) to prevent infection Corticosteroids in preterm labour KMC (Kangaroo mother care) for premature/very small babies Injectable antibiotics for neonatal sepsis

11 12 13

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code

Number 1003

Question Are the following documents available in the facility today: IF AVAILABLE, ASK TO SEE THE DOCUMENT

Result YES, OBSERVED 1 1 YES 1 YES, REPORTED NOT SEEN 2 2 NO 2

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NO 3 3

01 02 1004

Any national guideline for Essential childbirth care Any check-lists and/or job-aids for Essential childbirth care Have you or any provider(s) of delivery services: Received training in newborn resuscitation using the newborn bag and mask in the last two years Apart from newborn resuscitation, received training in essential childbirth care in the last two years I would like to know if the following basic equipment items are available in this service area today. For each equipment or item, please tell me if it is available today and functioning. ASK TO SEE THE ITEMS

T64

T65

1 A) AVAILABLE

2 B) FUNCTIONING

1005

NOT OBSERVED NOT SEEN AVAILABLE

REPORTED

YES

DON'T KNOW

01 02 03 04 05 06 07 08 09 10 11

Examination light (flashlight ok) Delivery pack Cord clamp Episiotomy scissors Scissors or blade to cut cord Suture material with needle Needle holder Manual vacuum extractor Vacuum aspirator or D&C kit Incubator Disposable latex gloves

1→B 1→B 1→B 1→B 1→B 1 07

2→B 2→B 2→B 2→B 2→B 2 07 2→B 2→B 2→B 2→B 2 12

3 02 3 03 3 04 3 05 3 06 3 07 3 08 3 09 3 10 3 11 3 12

1 1 1 1 1

2 2 2 2 2

8 8 8 8 8

1→B 1→B 1→B 1→B 1 12

1 1 1 1

2 2 2 2

8 8 8 8

E10

E11

E30

I20

2. Core instrument

Indicator code E13

Number 12 13 14 15 16 17 18 19 20 21 1006

Question Blank partograph Delivery bed Resuscitation table (with heat source) (for newborn resuscitation) Newborn bag and mask size 1 for term babies (for newborn resuscitation) Newborn bag and mask size 0 for pre-term babies (for newborn resuscitation) Electric suction pump (for suction apparatus) Suction catheter (for suction apparatus) for suctioning newborn Suction bulb, single use Suction bulb, sterilizable multi-use Speculum Does this facility stock any medicines for obstetric care in this service site? Are any of the following medicines and commodities available in this service site today? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE/COMMODITY IS VALID (NOT EXPIRED)

Result 1 13 2 13 3 13 3 14 3 15 3 16 3 17 3 18 3 19 3 20 3 21 3 1006 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2

Skip

E37

1→B 2→B 1→B 1→B 1→B 1→B 1→B 1→B 1→B 1→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B

8 8 8 8 8 8 8 8 8

E50

E12 E43 E12 E43 E9 E43 E9 E43 E9 E43 E9 E43 E44

YES ............................................................. 1 NO .............................................................2 OBSERVED AVAILABLE 1009 NOT OBSERVED REPORTED AVAILABLE BUT NOT SEEN NOT AVAILABLE TODAY

1007

AT LEAST ONE VALID

AVAILABLE NON VALID

NEVER AVAILABLE

M21 M72 M23 M110 M141 M71 M23 M106

01 02

Antibiotic eye ointment for newborn Gentamicin injection

1 1

2 2

3 3

4 4

5 5

03 04 05

Ampicillin powder for injection Hydralazine injection Metronidazole injection Azithromycin cap/tab or oral liquid Cefixime cap/tab Benzathine benzylpenicillin powder for injection

1 1 1 1 1 1

2 2 2 2 2 2

3 3 3 3 3 3

4 4 4 4 4 4

5 5 5 5 5 5

M73 M75 M76 M77

06 07 08

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code M79 M107 M70 M24 M26 M27 M69 M78 M78 M129 M22

Number 09 10 11 12 13 14 15 16 17 18

Question Nifedipine cap/tab (10mg) Methyldopa tablet Calcium gluconate injection Magnesium sulphate injectable Skin disinfectant Intravenous solution with infusion set Sodium chloride injectable solution Betamethasone injection Dexamethasone injection Oxytocin injection IF OXYTOCIN IS OBSERVED AVAILABLE (Q1007_18 is “1” OR “2”)

Result 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4

Skip 5 5 5 5 5 5 5 5 5 5

IF OXYTOCIN IS NOT OBSERVED AVAILABLE (Q1007_19 is “3”,”4”,OR” 5”) Q1009

1008

Is the oxytocin stored in cold storage?

YES ............................................................. 1 NO ............................................................. 2

CESAREAN SECTION 1009 CHECK Q1002_08: CESAREAN SECTION OFFERED CESAREAN SECTION NOT OFFERED Q1100 T51

1010

Do you have the national guidelines for Comprehensive Emergency Obstetric Care (CEmOC) available in this facility today? IF AVAILABLE, ASK TO SEE THE DOCUMENT

T52

1011

Have you or any provider(s) of delivery service received any training in Comprehensive Emergency Obstetric Care (CEmOC) in the last two years? Does this facility have a health professional who can perform caesarean section present in the facility or on call 24 hours a day (including weekends and on public holidays)? Does this facility have an anaesthetist (or doctor with anaesthetics training) present in the facility or on call 24 hours a day (including weekends and on public holidays)?

T53

1012

YES ............................................................. 1 NO .............................................................2

T54

1013

YES ............................................................. 1 NO .............................................................2

IMMUNIZATION S10

1100

Does this facility offer immunization services?

YES ............................................................. 1 NO ............................................................. 2 1200

2. Core instrument

Indicator code

Number

Question

Result

Skip

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE IMMUNIZATION SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT IMMUNIZATION SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. 1101 Is this facility providing immunization services today? Does this facility provide any of the following immunization services in the facility only, as outreach at fixed post only, or both? *VACCINES SCHEDULE SHOULD BE SPECIFIED AS PART OF COUNTRY ADAPTATION

YES ............................................................. 1 NO ............................................................. 2 BOTH IN THE FACILITY AND AS OUTREACH

1102

IN THE FACILITY ONLY

OUTREACH ONLY

SERVICE NOT OFFERED

S10_07 S10_08 S10_09

01 02 03 1103

Birth doses (e.g. hepB0, BCG, OPV0, …) Infant vaccines (under 1 year) Adolescent/adult vaccines (e.g. HPV, tetanus, flu) How often does this facility offer routine full child immunization services at the facility?

1 1 1

2 2 2

3 3 3

4 4 4

S10_10A S10_10B S10_10C S10_10D S10_10E

DAILY ......................................................... 1 WEEKLY ..................................................... 2 MONTHLY .................................................. 3 QUARTERLY ............................................... 4 OTHER ___________________________ 96 (SPECIFY)

S10_11A S10_11B S10_11C S10_11D S10_11E

1104

How often does this facility offer routine full child immunization services as outreach?

1105

Do you have the national guidelines for routine child immunization available in this facility today? IF AVAILABLE, ASK TO SEE THE DOCUMENT *NATIONAL GUIDELINE SHOULD BE SPECIFIED AS PART OF COUNTRY ADAPTATION

YES, OBSERVED.......................................... 1 YES, REPORTED NOT SEEN ........................ 2 NO .............................................................3

1106

Have you or any provider(s) of immunization service delivery received any training in any of the following child immunization services in the last two years? IF YES: Pease specify if it was through formal training or supportive supervision YES, FORMAL TRAINING

YES, SUPPORTIVE SUPERVISION

NO TRAINING

01 02

Immunization service delivery (Immunization in practice (IIP) or any similar) Vaccine management/handling and cold chain

1 1

2 2

3 3

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code T9

Number 03

Question Data reporting and monitoring of service delivery (e.g. Data Quality Self-Assessment (DQS)) Disease surveillance and reporting Injection safety and waste management RED (Reaching Every District) Training on new vaccine* prior to introduction

Result 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3

Skip

T9 T9 T9 T9

04 05 06 07

* NEW VACCINE SHOULD BE SPECIFIED AS PART OF COUNTRY ADAPTATION

1107

I would like to know if the following items for immunization are available in this service area today. For each item, please tell me if it is available today. ASK TO SEE THE ITEMS

OBSERVED 1 1 1 1 1 1 1

REPORTED NOT SEEN 2 2 2 2 2 2 2

NOT AVAILABLE 3 3 3 3 3 3 3

I14 I22 I21 E14 E14

01 02 03 04 05 06 07

Auto-disable syringes Sharps container/safety box Vaccine carrier(s)/cold box Set of ice packs for vaccine carriers (Note: 4-5 ice packs make one set) Immunization cards (or child health booklet) Official immunization tally sheets or integrated tally sheet Official immunization registers or equivalent Does this facility have a refrigerator available and functioning for the storage of vaccines? NOTE: FOR A REGRIGERATOR TO BE FUNCTIONAL IT MUST HAVE SUFFICIENT CAPACITY TO ACCOMMODATE ALL NEEDED VACCINES.

E41 E42

E15 E47

1108

AVAILABLE AND FUNCTIONAL ................... 1 AVAILABLE NOT FUNCTIONAL ................... 2 AVAILABLE DON’T KNOW IF FUNCTIONING ........................................... 3 NOT AVAILABLE ......................................... 4 ELECTRICITY (GRID OR GENERATOR)......... 1 SOLAR (WITH OR WITHOUT BATTERIES) ... 2 GAS ............................................................ 3 KEROSENE ................................................. 4 MIXED (ELECTRIC WITH GAS KEROSENE) .. 5 OTHER ..................................................... 96 1115

E40 E40_A E40_B E40_C E40_D E40_E E40_F E40

1109

What type of energy source is used for the vaccine refrigerator?

1110

Does this energy source supply power to the refrigerator for 24 hours a day and for 7 days in the week?

YES ............................................................. 1 NO ............................................................. 2

2. Core instrument

Indicator code

Number 1111

Question Which of the following devices for monitoring refrigerator temperature are available and functioning in the refrigerator today: ASK TO SEE THE ITEMS

Result A) AVAILABLE NOT REPORTED OBSERVED NOT SEEN AVAILABLE

Skip B) FUNCTIONNING YES NO DON'T KNOW

E39 E47 E39 E47 E49 E47

01 02 1112

Thermometer Continuous temperature recorder/logger Is the temperature of the refrigerator monitored twice daily? IF YES: PLEASE ASK TO SEE THE LOG USED TO RECORD THE TEMPERATURE

1→B 1→B

2→B 2→B

3 02 3 1112

1 1

2 2

8 8

YES, LOG OBSERVED .................................. 1 YES, LOG REPORTED NOT SEEN ................. 2 NO ............................................................ 3 YES ............................................................. 1 YES, PARTIALLY .......................................... 2 NO ............................................................. 3 OBSERVED IN RANGE ................................ 1 REPORTED IN RANGE BUT NOT SEEN ...... 2 OUT OF RANGE ......................................... 3 RECORD NOT AVAILABLE.......................... 4 FACILITY DOES NOT OFFER IMMUNIZATION SERVICES TODAY (Q1101 = “2”) AND DOES NOT HAVE A FUNCTIONAL REFRIGERATOR FOR THE STORAGE OF VACCINES (Q1108 = “2”, “3” OR “4”) Q1117 1115 1115

E49 E47

1113

Has the temperature log been completed for the last 30 days? PLEASE REVIEW LOG AND CHECK FOR COMPLETENESS (TEMPERATURE RECORDED 2 TIMES / DAY DURING THE LAST 30 DAYS)

E49 E47

1114

Has the temperature been out of the range 2 o to 8 C inclusive in the last 30 days? PLEASE CHECK THE TEMPERATURE RECORD AND VERIFY THE TEMPERATURE FOR THE LAST 30 WORKING DAYS IN ORDER TO ANSWER THE QUESTION

1115

CHECK Q1101 AND Q1108: FACILITY IS OFFERING IMMUNIZATION SERVICES TODAY (Q1101 =“1” ) OR HAS A FUNCTIONNING REFRIGERATOR FOR THE STORAGE OF VACCINES (Q1108 = “1”)

1116

Are any of the following vaccines available in this service site today? * THE LIST OF VACCINES BELOW SHOULD BE SPECIFIED AS PER NATIONAL SCHEDULE DURING COUNTRY ADAPTATION PROCESS

OBSERVED AVAILABLE

NOT OBSERVED

SELECT ONE OF EACH VACCINE AT RANDOM AND CHECK IF THE VACCINE IS VALID: 1. VIAL MONITOR (VVM) ON THE VACCINE VIAL HAS NOT TURNED AND 2. THE EXPIRY DATE HAS NOT PASSED M28 M29 M30 M31 M92 M93 M142 M143

AT LEAST ONE VALID

AVAILABLE NON VALID

REPORTED AVAILABLE BUT NOT SEEN

NOT AVAILABLE TODAY

NEVER AVAILABLE

01 02 03 04 05 06 07 08

Measles vaccine and diluent DPT-Hib+HepB (pentavalent) Oral polio vaccine BCG vaccine and diluent Rotavirus vaccine Pneumococcal vaccine IPV (Inactivated polio vaccine) HPV (Human papillomavirus vaccine)

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code

Number 1117

Question In the past three months were you unable to give any of the vaccines listed below because of unavailable stock? FOR EACH OF THE FOLLOWING ITEMS, PLEASE CHECK IN THE FACILITY RECORDS IF THERE HAS BEEN A STOCKOUT IN THE PAST 3 MONTHS * THE LIST OF VACCINES BELOW SHOULD BE SPECIFIED AS PER NATIONAL SCHEDULE DURING COUNTRY ADAPTATION PROCESS

Result

Skip

YES, STOCK OUT

NO STOCK OUT

NOT INDICATED

PRODUCT NOT OFFERED

FACILITY RECORD NOT AVAILABLE

M28_A M29_A M30_A M31_A M92_A M93_A M142_A M143_A

01 02 03 04 05 06 07 08

Measles vaccine and diluent DPT-Hib-HepB (pentavalent) vaccine Oral polio vaccine BCG vaccine and diluent Rotavirus vaccine Pneumococcal vaccine IPV (Inactivated polio vaccine) HPV (Human papillomavirus vaccine)

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5

B. CHILD AND ADOLESCENT HEALTH CHILD PREVENTATIVE AND CURATIVE CARE SERVICES S11

1200

Does this facility offer preventative and curative care services for children under 5?

YES ............................................................. 1 NO ............................................................. 2 1300

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE CHILD PREVENTATIVE AND CURATIVE CARE SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT CHILD PREVENTATIVE AND CURATIVE CARE SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. 1201 S11_01 S11_02 S11_03 S11_04 S11_04

Please tell me if this facility provides the following services: Diagnose and/or treat child malnutrition Provide vitamin A supplementation Provide iron supplementation Provide ORS to children with diarrhoea Provide zinc supplementation to children with diarrhoea Child growth monitoring Treatment of pneumonia Administration of amoxicillin for the treatment of pneumonia in children Treatment of malaria in children

YES 1 1 1 1 1 1 1 1

NO 2 2 2 2 2 2 2 2

01 02 03 04 05 06 07 08 09

S11_05 S11_06 S11_07

S11_08

2. Core instrument

Indicator code

Number 1202

Question Please tell me if the following documents are available in the facility today: IF AVAILABLE, ASK TO SEE THE DOCUMENT

Result YES, OBSERVED 1 1 1 YES 1 YES, REPORTED NOT SEEN 2 2 2 NO 2

Skip

NO 3 3 3

T10

01 02 03 1203

IMCI guidelines for the diagnosis and management of childhood illnesses National guidelines for growth monitoring Any check-lists and/or job-aids for IMCI Have you or any provider(s): Of curative care services for sick children received any training in the Integrated Management of Childhood Illnesses (IMCI) in the last two years? Of growth monitoring services for children received any training in growth monitoring in the last two years? Please tell me if the following basic equipment items are available and functional in this service area today. ASK TO SEE THE ITEMS

T11

T12

T13

1 A) AVAILABLE NOT REPORTED OBSERVED NOT SEEN AVAILABLE

2 B) FUNCTIONNING DON'T KNOW

1204

YES

E16

01 02

Length/height measuring equipment Growth charts

1→B 1 1300

2→B 2 1300

3 02 3 1300

E17

ADOLESCENT HEALTH SERVICES S12

1300

Does this facility offer adolescent health services?

YES ............................................................. 1 NO ............................................................. 2 1400

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE ADOLESCENT HEALTH SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT ADOLESCENT HEALTH SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. T14

1301

Do you have the national guidelines for service provision to adolescents available in this facility today? IF AVAILABLE, ASK TO SEE THE DOCUMENT

T15

1302

Have you or any providers of adolescent health services received any training on the provision of adolescent health services in the last two years?

C. COMMUNICABLE DISEASES HIV COUNSELLING & TESTING S17

1400

Does this facility offer HIV counselling and testing services?

YES ............................................................. 1 NO ............................................................. 2 1500

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code

Number

Question

Result

Skip

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE HIV COUNSELLING AND TESTING SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT HIV COUNSELLING AND TESTING SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. T30

1401

Do you have the national HIV counselling and testing guidelines available in this facility today? IF AVAILABLE, ASK TO SEE THE DOCUMENT

YES, OBSERVED.......................................... 1 YES, REPORTED NOT SEEN ........................ 2 NO ............................................................. 3 YES 1 NO 2

1402 T31

Have you or any provider(s) of HIV/AIDS counselling and testing services: Received any training in voluntary counselling and testing (VCT) in the last two years? Received any training in HIV/AIDS prevention, care, and management for adolescents in the last two years? Does this facility provide HIV counselling and testing services to minor adolescents? Is the HIV testing and counselling service room or area a private room/area with auditory and visual privacy?

01 02

T17

S12_01

1403

YES ............................................................. 1 NO ............................................................. 2 AUDITORY PRIVACY ONLY ......................... 1 VISUAL PRIVACY ONLY .............................. 2 BOTH AUDITORY AND VISUAL PRIVACY .... 3 NO PRIVACY............................................... 4

I23

1404

1405

Does this facility have HIV rapid test kits (with valid expiration date) in stock in this service site today? CHECK TO SEE IF VALID (NOT EXPIRED)

YES, OBSERVED.......................................... 1 YES, REPORTED NOT SEEN ........................ 2 NO ............................................................. 3 YES, OBSERVED.......................................... 1 YES, REPORTED NOT SEEN ........................ 2 NO ............................................................. 3

M17 M91

1406

Does this facility have condoms available in this service site today to give to clients receiving services? IF YES, ASK TO SEE CONDOMS

1407

Please tell me if the following resources/supplies used for infection control are available in this service area today. ASK TO SEE THE ITEMS

OBSERVED 1 1 1 1 1 1 1 1

REPORTED NOT SEEN 2 2 2 2 2 2 2 2

NOT AVAILABLE 3 3 3 3 3 3 3 3

I15

01 02 03 04 05 06 07 08

I15 I15 I16 I12

I11 I13

I14

2. Core instrument

Indicator code I14

Number 09

Question Auto-disable syringes

Result 1 2 3

Skip

HIV TREATMENT S19

1500

Does this facility offer HIV & AIDS antiretroviral prescription or antiretroviral treatment follow-up services?

YES ............................................................. 1 NO ............................................................. 2 1600

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE HIV TREATMENT SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT HIV TREATMENT SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. 1501 S19_01 S12_09 S19_02

Do providers in this facility: YES NO 2 2 Prescribe ART Prescribe ART to adolescents Does this facility provide treatment follow-up services for persons on ART, including providing community-based services? Do you have the national ART guidelines available in this facility today? IF AVAILABLE, ASK TO SEE THE DOCUMENT

01 02 1502

1 1

T35

1503

T36

1504

Have you or any provider(s) of ART received any training in ART prescription and management in the last two years?

YES ............................................................. 1 NO ............................................................. 2

HIV CARE AND SUPPORT S18

1600

Does this facility offer HIV & AIDS care and support services, including treatment of opportunistic infections and provisions of palliative care?

YES ............................................................. 1 NO ............................................................. 2 1700

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE HIV CARE AND SUPPORT SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT HIV CARE AND SUPPORT SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. 1601 S18_01

Please tell me if this facility provides the following services for HIV/AIDS clients: Prescribe treatment for any opportunistic infections or symptoms related to HIV/AIDS? This includes treating topical fungal infections. Provide or prescribe palliative care for patients, such as symptom or pain management, or nursing care for the terminally ill, or severely debilitated clients? Provide systemic intravenous treatment of specific fungal infections such as cryptococcal meningitis? Provide treatment for Kaposi's sarcoma?

YES 1

NO 2

S18_02

S18_03

1 1

2 2

S18_04

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code S18_05

Number 05

Question Provide nutritional rehabilitation services? e.g., client education and provision of nutritional supplements? Prescribe or provide fortified protein supplementation (FPS)? Care for paediatric HIV/AIDS patients? Prescribe or provide preventive treatment for TB (INH + Pyridoxine)? Primary preventive treatment for opportunistic infections, such as cotrimoxazole preventive treatment (CPT)? Provide or prescribe micronutrient supplementation, such as vitamins or iron? Family planning counselling for HIV/AIDS clients? Provide condoms for preventing further transmission of HIV? Do providers in this facility screen or test HIV clients for TB or have a system for diagnosis of TB among HIV positive clients? IF YES, ASK TO SEE A REGISTER OR RECORD OF HIVPOSITIVE CLIENTS TESTED FOR TB

Result 1 1 1 1 1 2 2 2 2 2

Skip

S18_06

06 07 08 09

S18_07 S18_08

S18_09

S18_10

10 11 12 1602

1 1 1

2 2 2

S18_11

S18_12

D14

YES, OBSERVED.......................................... 1 YES, REPORTED NOT SEEN ........................ 2 YES, REGISTER NOT MAINTAINED ............. 3 NO ............................................................. 4 YES, OBSERVED 1 1 YES, REPORTED NOT SEEN 2 2

1603

Please tell me if the following guidelines are available in the facility today: IF AVAILABLE, ASK TO SEE THE DOCUMENT

NO 3 3

T32

01 02 1604

National guidelines for the clinical management of HIV/AIDS Guidelines for palliative care Have you or any provider(s) of HIV care and support services received any training in the clinical management of HIV/AIDS in the last two years?

T33 T34

YES ............................................................. 1 NO ............................................................. 2

SEXUALLY TRANSMITTED INFECTIONS S21

1700

Does this facility offer diagnosis or treatment of STIs other than HIV?

YES ............................................................. 1 NO ............................................................. 2 1800

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE STI SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT STI SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. S21_01

1701

Do providers in this facility diagnose STIs?

YES ............................................................. 1 NO ............................................................. 2

S21_02

1702

Do providers in this facility prescribe treatment for STIs?

YES ............................................................. 1 NO ............................................................. 2

2. Core instrument

Indicator code T41

Number 1703

Question Do you have the national guidelines for the diagnosis and treatment of STIs available in this facility today? IF AVAILABLE, ASK TO SEE THE DOCUMENT

Result YES, OBSERVED.......................................... 1 YES, REPORTED NOT SEEN ........................ 2 NO ............................................................. 3 YES ............................................................. 1 NO ............................................................. 2

Skip

T42

1704

Have you or any provider(s) of STI services received any training in STI diagnosis and treatment in the last two years?

TUBERCULOSIS S16

1800

Does this facility offer diagnosis, treatment prescription, or treatment follow-up of tuberculosis?

YES ............................................................. 1 NO ............................................................. 2 1900

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE TUBERCULOSIS SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT TUBERCULOSIS SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. S16_01

1801

Do providers in this facility diagnose TB?

YES ............................................................. 1 NO ............................................................. 2 1803

1802 S16_03 S16_02 S16_04 S16_02 S16_05 S16_02 S16_06 S16_02 S16_07 S16_08

Which of the following methods are used at this facility for diagnosing TB: Clinical symptoms Sputum smear microscopy examination Culture Rapid test (GeneXpert MTB/RIF) Chest X-ray Does this facility prescribe drugs for TB patients? Does this facility provide drugs to TB patients? Does this facility manage and provide treatment follow-up for TB patients? Do providers in this facility screen or test TB patients for HIV or have a system for diagnosis of HIV among TB patients? IF YES, ASK TO SEE A REGISTER OR RECORD OF TB CLIENTS TESTED FOR HIV

YES 1 1 1 1 1

NO 2 2 2 2 2

01 02 03 04 05 1803

YES ............................................................. 1 NO ............................................................. 2 YES ............................................................. 1 NO ............................................................. 2 YES ............................................................. 1 NO ............................................................. 2 YES, OBSERVED.......................................... 1 YES, REPORTED NOT SEEN ........................ 2 YES, REGISTER NOT MAINTAINED ............. 3 NO ............................................................. 4 YES, OBSERVED YES, REPORTED NOT SEEN

S16_09

1804

S16_10

1805

D13

1806

1807

Please tell me if the following guidelines are available in the facility today: IF AVAILABLE, ASK TO SEE THE DOCUMENT

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code T22 T23 T24 T25

Number 01 02 03 04 1808

Question Diagnosis and treatment of TB Management of HIV and TB co-infection MDR-TB TB infection control Have any providers of TB services at this facility received training in the following topics in the last two years? Diagnosis and treatment of TB Management of HIV and TB co-infection MDR-TB TB infection control Does this facility stock any medicines for TB treatment?

Result 1 1 1 1 2 2 2 2 3 3 3 3

Skip

YES 1 1 1 1

NO 2 2 2 2

T26 T27 T28 T29

01 02 03 04 1809

YES, IN SERVICE SITE.................................. 1 YES, ELSEWHERE (E.G BULK STORE/PHARMACY)................................... 2 YES, IN BOTH LOCATIONS .......................... 3 NO, TB MEDS NOT STOCKED ..................... 4 1900 1900

1810

Are any of the following medicines available in this service site today? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE IS VALID (NOT EXPIRED)

OBSERVED AVAILABLE AT LEAST ONE VALID AVAILABLE NON VALID REPORTED AVAILABLE BUT NOT SEEN

NOT OBSERVED NOT AVAILABLE TODAY

NEVER AVAILABLE

M41 M41 M41 M41 M41 M41 M41

01 02 03 04 05 06 07 08 09 10

1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5

M41

MALARIA S15

1900

Does this facility offer diagnosis or treatment of malaria?

YES ............................................................. 1 NO ............................................................. 2 2000

2. Core instrument

Indicator code

Number

Question

Result

Skip

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE MALARIA SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT MALARIA SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. S15_01

1901

Do providers in this facility diagnose malaria?

YES ............................................................. 1 NO ............................................................. 2 1906

1902 S15_05 S15_02 S15_06 S15_02 S15_07

Which of the following methods are used at this facility for diagnosing malaria: Clinical symptoms Rapid diagnostic testing (RDT) Microscopy CHECK Q1902_02: IF FACILITY CONDUCTS MALARIA RDTS:

YES 1 1 1 IF FACILITY DOES NOT CONDUCT MALARIA RDTS:

NO 2 2 2

01 02 03

Q1906

D3 D34 D36

1903

Does this facility have malaria rapid diagnostic test kits (with valid expiration date) in stock in this service site today? CHECK TO SEE IF VALID (NOT EXPIRED)

YES, OBSERVED.......................................... 1 YES, REPORTED NOT SEEN ........................ 2 NO ............................................................. 3 YES ............................................................. 1 NO ............................................................. 2 LESS THAN 7 DAYS ..................................... 1 7 TO 14 DAYS ............................................. 2 MORE THAN 14 DAYS ................................ 3 1906

D36_A

1904

Has there been a stock-out of malaria RDT kits in the past 4 weeks? How many days of stock-out?

D36_B

1905

S15_03

1906

Do providers in this facility prescribe treatment for malaria? Do you have the national guidelines for the diagnosis and treatment of malaria available in this facility today? IF AVAILABLE, ASK TO SEE THE DOCUMENT

YES ............................................................. 1 NO ............................................................. 2 YES, OBSERVED.......................................... 1 YES, REPORTED NOT SEEN ........................ 2 NO ............................................................. 3 YES ............................................................. 1 NO ............................................................. 2 YES ............................................................. 1 NO ............................................................. 2 YES ............................................................. 1 NO ............................................................. 2

T18

1907

T20 D34 T20

1908

Have you or any provider(s) of malaria services received any training in malaria diagnosis with RDTs in the last two years? Have you or any provider(s) of malaria services received any training in malaria treatment in the last two years? Does this facility provide Intermittent preventive treatment for malaria?

1909

S15_04

1910

D. NON-COMMUNICABLE DISEASES

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code S22 S23 S24 S29

Number 2000

Question Does this facility offer diagnosis or management of non-communicable diseases, such as diabetes, cardiovascular disease, chronic respiratory disease, or cervical cancer?

Result YES ............................................................. 1 NO ............................................................. 2

Skip

2100

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE NON-COMMUNICABLE DISEASE SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT NCD SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. S22

2001

Do providers in this facility diagnose and/or manage diabetes in patients? Do you have the national guidelines for the diagnosis and management of diabetes available in this facility today? IF AVAILABLE, ASK TO SEE THE DOCUMENT

T43

2002

T44

2003

Have you or any provider(s) of diabetes services received any training in the diagnosis and management of diabetes in the last two years? Do providers in this facility diagnose and/or manage cardiovascular diseases such as hypertension in patients? Do you have the national guidelines for the diagnosis and management of cardiovascular diseases available in this facility today? IF AVAILABLE, ASK TO SEE THE DOCUMENT

S23

2004

T45

2005

T46

2006

Have you or any provider(s) of services for cardiovascular diseases received any training in the diagnosis and management of cardiovascular diseases such as hypertension in the last two years? Do providers in this facility diagnose and/or manage chronic respiratory diseases in patients? Do you have the national guidelines for the diagnosis and management of chronic respiratory disease available in this facility today? IF AVAILABLE, ASK TO SEE THE DOCUMENT

S24

2007

T47

2008

T48

2009

Have you or any provider(s) of chronic respiratory disease services received any training in the diagnosis and management of chronic respiratory diseases in the last two years?

YES ............................................................. 1 NO ............................................................. 2

2. Core instrument

Indicator code

Number 2010

Question Please tell me if the following basic equipment items are available and functional in this service area today. ASK TO SEE THE ITEMS

Result A) AVAILABLE NOT REPORTED OBSERVED NOT SEEN AVAILABLE

Skip B) FUNCTIONING DON'T KNOW

YES

E19

01 02 2011

Peak flow meters Spacers for inhalers Do providers in this facility diagnose cervical cancer in patients? Do you have the national guidelines for cervical cancer prevention and control? IF AVAILABLE, ASK TO SEE THE DOCUMENT

1→B 1→B

2→B 2→B

3 02 3 2011

1 1

2 2

8 8

E20

S29

T60

2012

T61

2013

Have you or any provider(s) received any training in cervical cancer prevention and control? Please tell me if the following basic equipment/items are available in this service area today. ASK TO SEE THE ITEMS

YES ............................................................. 1 NO ............................................................. 2 A) AVAILABLE REPORTED NOT OBSERVED NOT SEEN AVAILABLE

2014

B) FUNCTIONING YES NO DON'T KNOW

D37

01 02

Acetic acid Speculum

1 02 1→B

2 02 2→B

3 02 3 2100 1 2 8

E44

E. SURGERY SURGICAL SERVICES S25 S28

2100

Does this facility offer any surgical services (including minor surgery such as suturing, circumcision, wound debridement, etc.), or caesarean section?

YES ............................................................. 1 NO ............................................................. 2 2200

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE SURGICAL SERVICES ARE PROVIDED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT SURGICAL SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. 2101 S25_01 S25_02 S25_03 S25_04 S25_05

Please tell me if this facility provides the following services: Incision and drainage of abscesses Wound debridement Acute burn management Suturing Closed repair of fracture

YES 1 1 1 1 1

NO 2 2 2 2 2

01 02 03 04 05

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code S25_06 S25_07 S25_08 S25_09 S25_10 S25_11 S25_12

Number 06 07 08 09 10 11 12

Question Cricothyroidotomy Male circumcision Hydrocele reduction Chest tube insertion Closed repair of dislocated joint Biopsy of lymph node or mass or other Removal of foreign body (throat, eye, ear of nose) CHECK Q007: IF HOSPITAL:

Result 1 1 1 1 1 1 1 2 2 2 2 2 2 2

Skip

IF NOT HOSPITAL:

Q2102 S28_01 S28_02 S28_03 S28_04 S28_05 S28_06 S28_07 S28_08 S28_22 S28_09 S28_10 S28_11

13 14 15 16 17 18 19 20 21 22 23 24

Tracheostomy Tubal ligation Vasectomy Dilatation & Curettage Obstetric fistula repair Episiotomy, cervical and vaginal laceration Appendectomy Hernia repair (strangulated) Hernia repair (elective) Cystostomy Urethral stricture dilatation Laparotomy (uterine rupture, ectopic pregnancy, acute abdomen, intestinal obstruction, perforation, injuries) Congenital hernia repair Neonatal surgery (abdominal wall defect, colostomy imperforate anus, intussusceptions) Cleft palate repair Contracture release Skin grafting Open reduction and fixation for fracture Amputation Cataract surgery Club foot repair (casting or open club foot release)

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

S28_12 S28_13

25 26

S28_14 S28_23 S28_23 S28_17 S28_18 S28_19 S28_20

27 28 29 30 31 32 33

2. Core instrument

Indicator code S28_21

Number 34 2102

Question Drainage of osteomyelitis-septic arthritis Please tell me if the following surgical equipment and supplies are available and functional in this facility today. ASK TO SEE THE ITEMS

Result 1 A) AVAILABLE NOT REPORTED OBSERVED NOT SEEN AVAILABLE

Skip 2 B) FUNCTIONING DON'T KNOW

YES

E29 E27 E29 E27 E21

01 02 03 04 05 06 07 08 09 10

Resuscitator bag and mask- adult Resuscitator bag and mask- paediatric Needle holder Scalpel handle with blades Retractor Surgical scissors Nasogastric tubes Tourniquet Suction pump (manual or electric) with catheter CHECK Q007 AND Q1002_08: IF HOSPITAL OR HEALTH FACILITY OFFERS CESAREAN SECTION:

1→B 1→B 1→B 1→B 1→B 1→B 1→B 1→B 1→B

2→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B

3 02 3 03 3 04 3 05 3 06 3 07 3 08 3 09 3 10

1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2

8 8 8 8 8 8 8 8 8

E22

E23

E24

E25

E26

E28

IF NOT HOSPITAL AND CESAREAN SECTION NOT OFFERED:

Q2104 E29

11 12 13 14 15 16

Oropharyngeal airway- adult Oropharyngeal airway- paediatric Magills forceps- adult Magills forceps- paediatric Endotracheal tube neonatal – uncuffed size below 3 Endotracheal tube paediatric- uncuffed sizes 3.0 to 5.0

1→B 1→B 1→B 1→B 1→B 1→B

2→B 2→B 2→B 2→B 2→B 2→B

3 12 3 13 3 14 3 15 3 16 3 17

1 1 1 1 1 1

2 2 2 2 2 2

8 8 8 8 8 8

E29

100

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code E29

Number 17 18 19 20 21 22 23 24 25 26 27 28 29 30 2103

Question Endotracheal tube adult- cuffed sizes 5.5 to 9.0 Laryngoscope handle and blade- adult Laryngoscope handle and blade- paediatric Laryngoscope handle and blade- neonatal Anaesthesia machine Tubings and connectors (to connect endotracheal tube) Stylet Spinal needle Newborn bag and mask size 1 for term babies (for newborn resuscitation) Oxygen concentrators Oxygen cylinders Central oxygen supply Flowmeter for oxygen therapy (with humidification) Oxygen delivery apparatus (key connecting tubes and mask/nasal prongs) At any time during the past 3 months has oxygen been unavailable for any reason? Please tell me if any of the following materials or medicines are available in this service site today. I would like to see those that are available. CHECK TO SEE IF AT LEAST ONE OF EACH MATERIAL/MEDICINE IS VALID (NOT EXPIRED)

Result 1→B 1→B 1→B 1→B 1→B 1→B 1→B 1→B 1→B 1→B 1→B 1→B 1→B 1→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B 3 18 3 19 3 20 3 21 3 22 3 23 3 24 3 25 3 26 3 27 3 28 3 29 3 30 3 2103 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Skip 8 8 8 8 8 8 8 8 8 8 8 8 8 8

E29

E32

E29

E48

YES ............................................................. 1 NO ............................................................. 2 OBSERVED AVAILABLE NOT OBSERVED

2104

AT LEAST ONE VALID

AVAILABLE NON VALID

REPORTED AVAILABLE BUT NOT SEEN

NOT AVAILABLE TODAY

NEVER AVAILABLE

M63 M26 M64 M65 M148

01 02 03 04 05

Suture material (any type) Skin disinfectant Ketamine (injection) Lidocaine 1% or 2% (anaesthesia) Splints for extremities

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 4 4 4 4

5 5 5 5 5

101

2. Core instrument

Indicator code M149

Number 06

Question Material for cast CHECK Q007 AND Q1002_08: IF HOSPITAL OR HEALTH FACILITY OFFERS CESAREAN SECTION:

Result 1 2 3 4

Skip 5

IF NOT HOSPITAL AND CESAREAN SECTION NOT OFFERED:

Q2105 M84 M85 M86 M25 M87 M88 M89 M62 M90 T49

07 08 09 10 11 12 13 14 15 2105

Thiopental (powder) Suxamethonium bromide (powder) Atropine (injection) Diazepam (injection) Halothane (inhalation) Bupivacaine (injection) Lidocaine 5% (heavy spinal solution) Epinephrine (injection) Ephedrine (injection) Do you have materials on Integrated Management of Emergency and Essential Surgical care (IMEESC) (e.g. best practices, protocols, etc.) available in this facility today? IF AVAILABLE, ASK TO SEE THE DOCUMENT

1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5

YES, OBSERVED.......................................... 1 YES, REPORTED NOT SEEN ........................ 2 NO ............................................................. 3

T50

2106

Have you or any provider(s) of basic surgical services received any training in IMEESC in the last two years? Does this facility have a staff member trained in surgery, including caesarean section, (clinical officer, general physician, or surgeon) present in the facility or on call 24 hours a day (including weekends and on public holidays)? Does this facility have a staff member trained in anaesthesia (nurse, clinical officer, general physician, surgeon, or anaesthesiologist) present in the facility or on call 24 hours a day (including weekends and on public holidays)? I am interested in knowing if the following resources/supplies used for infection control are available in this service area today. ASK TO SEE THE ITEMS

T57

2107

T58

2108

YES ............................................................. 1 NO ............................................................. 2

2109

OBSERVED 1 1 1 1

REPORTED NOT SEEN 2 2 2 2

NOT AVAILABLE 3 3 3 3

I15

01 02 03 04

Clean running water (piped, bucket with tap, or pour pitcher) Hand-washing soap/liquid soap Alcohol based hand rub Disposable latex gloves

I15 I15 I16

102

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code I12

Number 05 06 07 08 09

Question Waste receptacle (pedal bin) with lid and plastic bin liner Sharps container ("safety box") Environmental disinfectant (e.g., chlorine, alcohol) Disposable syringes with disposable needles Auto-disable syringes

Result 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3

Skip

I11 I13

I14 I14

BLOOD TRANSFUSION S27

2200

Does this facility offer blood transfusion services?

YES ............................................................. 1 NO ............................................................. 2 3000

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE BLOOD IS COLLECTED, PROCESSED, TESTED, STORED, OR HANDLED PRIOR TO TRANSFUSION. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT BLOOD TRANSFUSION SERVICES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. M66

2201

Have there been any interruptions in blood availability during the past 3 months? Does this facility obtain blood from a national or regional blood centre? Does this facility obtain ANY blood from sources other than the national or regional blood centre? Does any place in this facility do blood screening for infectious diseases prior to transfusion? Please tell me if the blood that is transfused in the facility is "always", "sometimes", ”rarely”, or "never" screened for any of the following infectious diseases. HIV Syphilis Hepatitis B Hepatitis C Does this facility have a refrigerator available and functioning in this service area for the storage of blood?

YES ............................................................. 1 NO ............................................................. 2 YES ............................................................. 1 NO ............................................................. 2 YES ............................................................. 1 NO ............................................................. 2 YES ............................................................. 1 NO ............................................................. 2 2206

M67

2202

M67

2203

M67

2204

2205

ALWAYS

SOMETIMES

RARELY

NEVER

M67 M67 M67 M67 E31

01 02 03 04 2206

1 1 1 1

2 2 2 2

3 3 3 3

4 4 4 4

103

2. Core instrument

Indicator code E31

Number 2207

Question Is the temperature of the refrigerator monitored at least once every 24 hours? IF YES: PLEASE ASK TO SEE THE LOG USED TO RECORD THE TEMPERATURE

Result YES, LOG OBSERVED .................................. 1 YES, LOG REPORTED NOT SEEN ................. 2 NO ............................................................. 3 YES ............................................................. 1 YES, PARTIALLY .......................................... 2 NO ............................................................. 3 OBSERVED IN RANGE ................................ 1 REPORTED IN RANGE BUT NOT SEEN ....... 2 OUT OF RANGE .......................................... 3 RECORD NOT AVAILABLE........................... 4 YES, OBSERVED.......................................... 1 YES, REPORTED NOT SEEN ........................ 2 NO ............................................................. 3 YES ............................................................. 1 NO ............................................................. 2

Skip

2210

E31

2008

Has the temperature log been completed for the last 30 days? PLEASE REVIEW LOG AND CHECK FOR COMPLETENESS (TEMPERATURE RECORDED AT LEAST ONCE EVERY 24 HOURS DURING THE LAST 30 DAYS)

2210

E31

2209

Has the temperature been out of the range 2 o to 6 C inclusive in the last 30 days? PLEASE CHECK THE TEMPERATURE RECORD AND VERIFY THE TEMPERATURE FOR THE LAST 30 WORKING DAYS IN ORDER TO ANSWER THE QUESTION

T55

2210

Do you have any guidelines on the appropriate use of blood and safe transfusion practices? IF AVAILABLE, ASK TO SEE THE DOCUMENT

T56

2211

Have any provider(s) of blood transfusion services received any training in the appropriate use of blood and safe transfusion practices in the last two years?

104

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code

Number

Question

Result

Skip

SECTION 6: DIAGNOSTICS 3000 Does this facility conduct any diagnostic testing including any rapid diagnostic testing? YES ..........................................................1 NO ...........................................................2 4000

ASK TO BE SHOWN THE MAIN LABORATORY OR LOCATION IN THE FACILITY WHERE MOST TESTING IS DONE TO START DATA COLLECTION. INTRODUCE YOURSELF AND EXPLAIN THE PURPOSE OF THE SURVEY, THEN ASK THE FOLLOWING QUESTIONS. I would like to know if the following diagnostic tests and associated equipment are available today in this facility. 3100 D9 D6 D11 D4 D5 D20 D7

Does this facility offer any of the following tests on-site? Rapid syphilis testing HIV rapid testing Urine rapid tests for pregnancy Urine protein dipstick testing Urine glucose dipstick testing Urine ketone dipstick testing Dry Blood Spot (DBS) collection for HIV viral load or EID I would like to know if the following items for rapid diagnostic testing are available or not available today. CHECK TO SEE IF AT LEAST ONE OF EACH RDT IS VALID (NOT EXPIRED)

YES (ONSITE)

02 03 04 05 06 07 08 3101

1 1 1 1 1 1 1 OBSERVED AVAILABLE REPORTED AVAILABLE BUT NOT SEEN

2 2 2 2 2 2 2 NOT OBSERVED

AT LEAST ONE VALID

AVAILABLE NON VALID

NOT AVAILABLE TODAY

NEVER AVAILABLE

D3 D34 D36 D9 D6 D11 D4 D5 D20 D7

Malaria rapid diagnostic kit

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5

02 03 04 05 06 07 08

Syphilis rapid test kit HIV rapid test kit Urine pregnancy test kit Dipsticks for urine protein Dipsticks for urine glucose Dipsticks for urine ketone bodies Filter paper for collecting DBS CHECK Q3101_01: IF FACILITY CONDUCTS MALARIA RDTS (Q3101_01 = 1, 2, 3, OR 4):

IF FACILITY DOES NOT CONDUCT MALARIA RDTS (Q3101_01 = 5): Q3200

D36_A

3102

Has there been a stock-out of malaria RDT kits in the past 4 weeks?

YES ..........................................................1 NO ...........................................................2 3200

105

2. Core instrument Indicator code D36_B

Number 3103

Question How many days of stock-out?

Result LESS THAN 7 DAYS ..................................1 7 TO 14 DAYS ..........................................2 MORE THAN 14 DAYS .............................3

Skip

3200 D2 D1 D10 D3 D6 D23

Does this facility conduct the following tests onsite or offsite? Blood glucose tests using a glucometer Haemoglobin testing General microscopy/wet-mounts Malaria smear tests HIV antibody testing by ELISA I would like to know if the following general equipment items are available and functional today. ASK TO SEE THE ITEMS

YES, ONSITE

YES, OFFSITE

DON’T CONDUCT THE TEST

01 02 03 04 05 3201

1 1 1 1 1 A) AVAILABLE OBSERVED REPORTED NOT NOT SEEN AVAILABLE

2 2 2 2 2

3 3 3 3 3 B) FUNCTIONING YES NO DON'T KNOW

D3 D10 D35 D8 D31 D32 D33 D3 D10 D35 D8 D31 D32

Light microscope 1→B 2→B 3 02 1 2 8

Glass slides and cover slips 1→B 2→B

3 03 1 2 8

03 D2 D2

Refrigerator Glucometer Glucometer test strips (with valid expiration date) Colorimeter or haemoglobinometer HemoCue Wright-Giemsa stain or other acceptable malaria parasite stain (e.g. Field Stain A and B) ELISA washer ELISA reader

1→B 1→B 1→B 1→B 1→B 1→B 1→B 1→B

2→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B

3 04 3 05 3 06 3 07 3 08 3 09 3 10 3 11

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

8 8 8 8 8 8 8 8

04 05 06 07 08

D1 D3 D35 D6 D23 D6 D23

09 10

106

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 Indicator code D6 D23 D6 D23 T59 D35

Number 11 12 3202

Question Incubator Specific assay kit- HIV antibody testing by ELISA Does this facility have an accredited/certified microscopist? CHECK Q1800: TB SERVICES OFFERED

Result 1→B 1→B 2→B 2→B 3 12 3 3202 1 1 2 2

Skip 8 8

YES ..........................................................1 NO ...........................................................2

3300

TB SERVICES NOT OFFERED YES, ONSITE ............................................1 YES, OFFSITE ...........................................2 NO ...........................................................3

Q3400

3301

Does this facility do Ziehl-Neelsen testing for TB (AFB) onsite or offsite?

3303 3303

3302

I would like to know if the following equipment items for TB testing are available and functional today. ASK TO SEE THE ITEMS

A) AVAILABLE OBSERVED REPORTED NOT NOT SEEN AVAILABLE

B) FUNCTIONING YES NO DON'T KNOW

D8 D8 D8

01 02 03 3303

Fluorescence microscope (FM) Ziehl-Neelsen stain Auramine Rhodamine stain for fluorescent microscopy Does this facility conduct Xpert MTB/RIF diagnostic testing for TB onsite or offsite?

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 3303

1 1 1

2 2 2

8 8 8

YES, ONSITE ............................................1 YES, OFFSITE ...........................................2 NO ...........................................................3 3400 3400

3304

Please tell me if the following equipment items for Xpert MTB/RIF diagnostic testing for TB are available and functional today. ASK TO SEE THE ITEMS

A) AVAILABLE OBSERVED REPORTED NOT NOT SEEN AVAILABLE

B) FUNCTIONING YES NO DON'T KNOW

01 02 3400

GeneXpert 4 module unit with laptop TB rapid test cartridge Does this facility conduct liver function /renal function tests and/or white blood counts onsite or offsite? Does this facility conduct the following liver and renal function tests onsite or offsite? ALT testing Other liver function testing (such as bilirubin) Serum creatinine testing

1→B 1→B

2→B 2→B

3 02 3 3400

1 1

2 2

8 8

YES, ONSITE ............................................1 YES, OFFSITE ...........................................2 NO ...........................................................3 3500 DON’T CONDUCT THE TEST

3401 D19 D19 D18

YES, ONSITE

YES, OFFSITE

01 02 03

1 1 1

2 2 2

3 3 3

107

2. Core instrument Indicator code D18

Number 04

Question Other renal function testing (such as urea nitrogen) CHECK Q3401 liver function/renal function: IF "YES, ONSITE" CIRCLED FOR ANY TEST

Result 1 IF ONLY "YES, OFFSITE" OR "NO" ARE CIRCLED

Skip 2 3

Q3403 3402 Please tell me if the following equipment items and reagents for liver and kidney function testing are available and functional today. ASK TO SEE THE ITEMS D18 D19 D18 D19 D19 D18

A) AVAILABLE OBSERVED REPORTED NOT NOT SEEN AVAILABLE

B) FUNCTIONING YES NO DON'T KNOW

01 02 03 04 3403

Biochemistry analyzer Centrifuge Specific assay kit(s)- liver function test Specific assay kit(s)- renal function test Does this facility do full blood count and differential testing onsite or offsite?

1→B 1→B 1→B 1→B

2→B 2→B 2→B 2→B

3 02 3 03 3 04 3 3403

1 1 1 1

2 2 2 2

8 8 8 8

D15 D25

YES, ONSITE ............................................1 YES, OFFSITE ...........................................2 NO ...........................................................3 3405 3405

3404

Please tell me if the following equipment items and reagents for full blood count testing are available and functional today. ASK TO SEE THE ITEMS

A) AVAILABLE OBSERVED REPORTED NOT NOT SEEN AVAILABLE

B) FUNCTIONING YES NO DON'T KNOW

D15 D25 D15 D25 D16

01 02 3405

Haematology analyzer (for full blood count) Stains for full blood count and differential Does this facility do CD4 count (absolute and percentage) testing onsite or offsite?

1→B 1→B

2→B 2→B

3 02 3 3405

1 1

2 2

8 8

YES, ONSITE ............................................1 YES, OFFSITE ...........................................2 NO ...........................................................3 3500 3500

3406

Please tell me if the following equipment items for CD4 testing are available and functional today. ASK TO SEE THE ITEMS

A) AVAILABLE OBSERVED REPORTED NOT NOT SEEN AVAILABLE

B) FUNCTIONING YES NO DON'T KNOW

D16

01 02 3500

CD4 counter Specific assay kit- CD4 test Does this facility conduct blood group serology onsite or offsite?

1→B 1→B

2→B 2→B

3 02 3 3500

1 1

2 2

8 8

D16 D21 D22

YES, ONSITE ............................................1 YES, OFFSITE ...........................................2 NO ...........................................................3 3600

108

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 Indicator code

Number 3501

Question Does this facility conduct the following blood group serology tests onsite or offsite? ABO blood grouping testing Rhesus blood grouping testing Cross-match testing by direct agglutination Cross-match testing by indirect anti-globulin testing or other test with equivalent sensitivity CHECK Q3501 Blood typing and cross match: IF "YES, ONSITE" CIRCLED FOR ANY TEST

Result

Skip DON’T CONDUCT THE TEST

YES, ONSITE

YES, OFFSITE

D21 D21 D22 D22

01 02 03 04

1 1 1 1

2 2 2 2

3 3 3 3

IF ONLY "YES, OFFSITE" OR "NO" ARE CIRCLED Q3600

3502

Please tell me if the following equipment items and reagents for blood typing and cross match are available and functional today. ASK TO SEE THE ITEMS

A) AVAILABLE OBSERVED REPORTED NOT NOT SEEN AVAILABLE

B) FUNCTIONING YES NO DON'T KNOW

D21 D22 D22

01 02 03 3600

Centrifuge 37° C incubator Grouping sera CHECK Q007: IF HOSPITAL:

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 3600

1 1 1

2 2 2

8 8 8

D22

IF NOT HOSPITAL: DON’T CONDUCT THE TEST

Q4000

3601 D24 D32 D29 D31 D33 D30 D17

Does this facility conduct the following tests onsite or offsite? Serum electrolyte testing Urine microscopy testing Syphilis serology testing Gram stain testing CSF/ body fluid counts Cryptococcal antigen testing Molecular biological technique for HIV viral load or HIV early-infant diagnosis (PCR) Please tell me if the following equipment items and reagents are available and functional today: ASK TO SEE THE ITEMS

YES, ONSITE

YES, OFFSITE

01 02 03 04 05 06 07 3602

1 1 1 1 1 1 1 A) AVAILABLE OBSERVED REPORTED NOT NOT SEEN AVAILABLE

2 2 2 2 2 2 2

3 3 3 3 3 3 3 B) FUNCTIONING YES NO DON'T KNOW

D24

Specific assay kit- serum electrolyte test

1→B

2→B

3 02

109

2. Core instrument Indicator code D29 D31

Number 02 03 04

Question Specific assay kit- syphilis serology Gram stains White blood counting chamber Specific assay kit- cryptococcal antigen test Assay specific automated system for estimating HIV viral load Centrifuge Vortex mixer Pipettes Biochemistry analyzer Does this facility perform diagnostic x-rays, ultrasound, or computerized tomography? Please tell me if the following imaging equipment items are available and functional today. ASK TO SEE THE ITEMS

Result 1→B 1→B 1→B 1→B 1→B 1→B 1→B 1→B 1→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B 2→B 3 03 3 04 3 05 3 06 3 07 3 08 3 09 3 10 3 3603 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2

Skip 8 8 8 8 8 8 8 8 8

D30 D17

05 06 07 08 09 10 3603

D17 D24 D17 D17 D24

YES ............................................................ 1 NO ............................................................. 2 A) AVAILABLE OBSERVED REPORTED NOT NOT SEEN AVAILABLE

4000

3604

B) FUNCTIONING YES NO DON'T KNOW

E33 E35 E36 E34

01 02 03 04

X-ray machine Ultrasound equipment CT scan ECG

1→B 1→B 1→B 1→B

2→B 2→B 2→B 2→B

3 02 3 03 3 04 3 4000

1 1 1 1

2 2 2 2

8 8 8 8

110

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

Indicator code

Number

Question

Result

Skip

SECTION 7: MEDICINES AND COMMODITIES 4000 Does this facility stock medicines, vaccines, or contraceptive commodities? YES ............................................................ 1 NO ............................................................. 2 5000

ASK TO BE SHOWN THE MAIN LOCATION IN THE FACILITY WHERE MEDICINES AND OTHER SUPPLIES ARE STORED. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT STORAGE AND MANAGEMENT OF MEDICINES AND SUPPLIES IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS. I would like to know if the following medicines are available today in this facility. I would also like to observe the medicines that are available. If any of the medicines I mention is stored in another location in the facility, please tell me where in the facility it is stored so I can go there to verify. 4001 Are any of the following medicines for the treatment of infectious diseases available in the facility today? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE IS VALID (NOT EXPIRED) M43 M135 M35 M49 M2 M5 M23 M110 M6

OBSERVED AVAILABLE AT LEAST ONE VALID AVAILABLE NON VALID REPORTED AVAILABLE BUT NOT SEEN

NOT OBSERVED NOT AVAILABLE TODAY NEVER AVAILABLE

01 02 03 04 05 06

Co-trimoxazole cap/tab (Oral antibiotic) Fluconazole cap/tab Albendazole or Mebendazole cap/tab Metronidazole cap/tab Amoxicillin cap/tab Ceftriaxone injection

1 1 1 1 1 1

2 2 2 2 2 2

3 3 3 3 3 3

4 4 4 4 4 4

5 5 5 5 5 5

07 4002

Ciprofloxacin cap/tab Are any of the following medicines for the management of non-communicable diseases available in the facility today? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE IS VALID (NOT EXPIRED)

2 OBSERVED AVAILABLE

4 NOT OBSERVED

AT LEAST ONE VALID

AVAILABLE NON VALID

REPORTED AVAILABLE BUT NOT SEEN

NOT AVAILABLE TODAY

NEVER AVAILABLE

M50 M51 M52 M53

01 02 03 04 05 06 07 08 09 10

Metformin cap/tab Insulin regular injection Glucose 50% injection ACE inhibitor (e.g. enalapril, lisinopril, ramipril, perindopril) Thiazide (e.g. hydrochlorothiazide) Beta blocker (e.g.bisoprolol, metoprolol, carvedilol, atenolol) Calcium channel blocker (e.g. amlodipine) Aspirin cap/tab Beclomethasone inhaler Prednisolone cap/tab

1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5

M54 M55

M56 M57 M59 M60

111

2. Core instrument

Indicator code M61 M62 M114 M10 M115 M116 M95 M44 M118 M11

Number 11 12 13 14 15 16 17 18 19 20 21 22 23 4003

Question Hydrocortisone injection Epinephrine injection Furosemide cap/tab Glibenclamide cap/tab Gliclazide tablet or glipizide tablet Glyceryl trinitrate sublingual tablet Ibuprofen tablet Isosorbide dinitrate tablet Omeprazole tablet or alternative such as pantoprazole, rabeprazole Paracetamol cap/tab (adult oral formulation) Salbutamol inhaler Simvastatin tablet or other statin e.g. atorvastatin, pravastatin, fluvastatin Spironolactone tablets Are any of the following reproductive health medicines and commodities available in the facility today? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE/COMMODITY IS VALID (NOT EXPIRED)

Result 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 OBSERVED AVAILABLE AT LEAST ONE VALID AVAILABLE NON VALID REPORTED AVAILABLE BUT NOT SEEN

Skip 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 NOT OBSERVED NOT AVAILABLE TODAY NEVER AVAILABLE

5 5 5 5 5 5 5 5 5 5 5 5 5

M38 M44 M13 M14

M147

M15

01 02 03 04 05 06 07 08

Combined estrogen progesterone oral contraceptive pills Progestin-only contraceptive pills Combined estrogen progesterone injectable contraceptives Progestin-only injectable contraceptives Male condoms Female condoms Implant (e.g. levonorgestrel, etonogestrel) Emergency contraceptive pill (e.g. levonorgestrel tablet, ulipristal acetate tablet, mifepristone tablet 10-25 mg) Intrauterine contraceptive device (IUCD) For each of the following items, please check in the facility records if there has been a stock-out in the past 3 months: Female condoms Implant (e.g. levonorgestrel, etonogestrel)

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5

M96 M16 M97 M16 M98 M17 M99 M108 M109

M105

09 4004

1 STOCKOUT IN THE PAST 3 MONTHS

2 NO STOCKOUT IN PAST 3 MONTHS

3 NOT INDICATED

4 PRODUCT NOT OFFERED

5 FACILITY RECORD NOT AVAILABLE

M99_A M108_A

01 02

1 1

2 2

3 3

4 4

5 5

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Indicator code M109_A

Number 03

Question Emergency contraceptive pill (e.g. levonorgestrel tablet, ulipristal acetate tablet, mifepristone tablet 10-25 mg) Are any of the following maternal health medicines available in the facility today? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE IS VALID (NOT EXPIRED)

Result 1 2 3 4

Skip 5

4005

OBSERVED AVAILABLE AT LEAST ONE VALID AVAILABLE NON VALID REPORTED AVAILABLE BUT NOT SEEN

NOT OBSERVED NOT AVAILABLE TODAY NEVER AVAILABLE

M18 M19 M18 M19 M20 M69 M70 M24 M71 M23 M72 M23 M110 M141 M106

01 02 03 04 05 06 07 08 09

Iron tablets Folic acid tablets Iron and folic acid combined tablets Tetanus toxoid vaccine Sodium chloride injectable solution Calcium gluconate injection Magnesium sulphate injectable Ampicillin powder for injection Gentamicin injection

1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5

10 11

Hydralazine injection Metronidazole injection Misoprostol 200µg tablets Azithromycin cap/tab or oral liquid Cefixime cap/tab Benzathine benzylpenicillin powder for injection Betamethasone injection Dexamethasone injection

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5

M73 M74 M75 M76 M77

12 13 14 15 16 17

M78 M78 M129

M79 M107 M22

18 19 20

Nifedipine cap/tab (10mg) Methyldopa tablet Oxytocin injection

1 1 1

2 2 2

3 3 3

4 4 4

5 5 5

113

2. Core instrument

Indicator code

Number

Question IF OXYTOCIN IS OBSERVED AVAILABLE (Q4005_20 is “1” OR “2”)

Result IF OXYTOCIN IS NOT OBSERVED AVAILABLE (Q4005_20 is “3”,”4”,OR “5”)

Skip

4007 4006 Is the oxytocin stored in cold storage? YES ............................................................ 1 NO ............................................................. 2 4007 For each of the following items, please check in the facility records if there has been a stock-out in the past 3 months: Oxytocin injection Misoprostol 200µg tablets Magnesium sulphate injection Gentamicin injection Procaine benzylpenicillin injection Ceftriaxone injection Betamethasone injection Dexamethasone injection Are any of the following child health medicines available in the facility today? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE IS VALID (NOT EXPIRED) STOCKOUT IN THE PAST 3 MONTHS NO STOCKOUT IN PAST 3 MONTHS NOT INDICATED PRODUCT NOT OFFERED FACILITY RECORD NOT AVAILABLE

M22_A M74_A M24_A M72_A M80_A M5_A M78_A M78_B

01 02 03 04 05 06 07 08 4008

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 OBSERVED AVAILABLE

3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 NOT OBSERVED

5 5 5 5 5 5 5 5

AT LEAST ONE VALID

AVAILABLE NON VALID

REPORTED AVAILABLE BUT NOT SEEN

NOT AVAILABLE TODAY

NEVER AVAILABLE

M80 M110 M32 M36 M36 M34 M21 M7 M12 M33

Procaine benzylpenicillin injection

02 03 04 05 06 07 08 09

Oral Rehydration Salts (ORS) sachets Zinc sulphate tablets Zinc sulphate syrup or dispersible tablets Vitamin A (retinol) capsules Antibiotic eye ointment for newborn Co-trimoxazole syrup/suspension Paracetamol syrup/suspension Amoxicillin 250 mg or 500 mg dispersible tablet or syrup/suspension IF AMOXICILLIN DISPERSIBLE TABLETS ARE OBSERVED AVAILABLE (Q4008_09 is “1”)

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5

AMOXICILLIN DISPERSIBLE TABLETS NOT OBSERVED 4011

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Indicator code

Number 4009

Question Is the product stored so that identification labels and expiry dates and manufacturing dates are visible? Check the expiry dates of the stored product. Are they stored in first-to-expire, first-out (FEFO) order (i.e. the stock that will expire first is the closest to the front)? CHECK THE EXPIRY DATES OF THE STORED PRODUCT AT THE FRONT AND AT THE BACK OF THE SHELF. IF THE PRODUCT AT THE FRONT EXPIRES FIRST, ANSWER “YES”. IF THE PRODUCT AT THE BACK EXPIRES FIRST, ANSWER “NO”.

Result YES ............................................................ 1 NO ............................................................. 2 YES ............................................................ 1 NO ............................................................. 2

Skip

4010

4011

For each of the following items, please check in the facility records if there has been a stock-out in the past 3 months: Amoxicillin 250mg or 500mg dispersible tablet or syrup/suspension Oral rehydration salts (ORS) Zinc sulphate tablets Zinc sulphate syrup or dispersible tablets Does this facility stock any medicines for malaria treatment? Are any of the following malaria medicines and commodities available today in this facility? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE/COMMODITY IS VALID (NOT EXPIRED)

STOCKOUT IN THE PAST 3 MONTH S

NO STOCKOUT IN PAST 3 MONTHS

NOT INDICATED

PRODUCT NOT OFFERED

FACILITY RECORD NOT AVAILABLE

M33_A

01 02 03 04 4012

1 1 1 1

2 2 2 2

3 3 3 3

4 4 4 4

5 5 5 5

M32_A M36_A M36_B

YES ............................................................ 1 NO ............................................................. 2 OBSERVED AVAILABLE AT LEAST ONE VALID AVAILABLE NON VALID REPORTED AVAILABLE BUT NOT SEEN

4016

4013

NOT OBSERVED NOT AVAILABLE TODAY NEVER AVAILABLE

M81 M37 M136 M82 M39 M40

01 02 03 04 05 06 07 08 09

ACT Artemisinin monotherapy (oral) Artesunate rectal or injection dosage forms SP (Sulfadoxine + Pyrimethamine) Insecticide treated bed nets for patients and their families and households Insecticide treated bed net vouchers for patients and their families and households Chloroquine (oral) Quinine (oral) Primaquine (oral) CHECK Q4013_01: IF FACILITY STOCKS ACT (Q4013_01 = 1, 2, 3, OR 4):

1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5

M40

M138 M139 M140

IF FACILITY DOES NOT STOCK ACT (Q4013_01 = 5):

4016

115

2. Core instrument

Indicator code M37_A

Number 4014

Question Has there been a stock-out of ACT in the past 4 weeks? How many days of stock-out?

Result YES ............................................................ 1 NO ............................................................. 2 LESS THAN 7 DAYS .................................... 1 7 TO 14 DAYS ............................................ 2 MORE THAN 14 DAYS ............................... 3

Skip

4016

M37_B

4015

4016

Does this facility stock any medicines for tuberculosis treatment? Are any of the following TB medicines available today in this facility? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE IS VALID (NOT EXPIRED)

4018

4017

NOT OBSERVED NOT AVAILABLE TODAY NEVER AVAILABLE

M41 M41 M41 M41 M41 M41 M41

01 02 03 04 05 06 07 08 09 10 4018

Ethambutol Isoniazid Pyrazinamide Rifampicin Isoniazid + Rifampicin (2FDC) Isoniazid + Ethambutol (EH) (2FDC) Isoniazid + Rifampicin + Pyrazinamide (RHZ) (3FDC) Isoniazid + Rifampicin + Ethambutol (RHE) (3FDC) Isoniazid + Rifampicin + Pyrazinamide + Ethambutol (4FDC) Streptomycin injectable Does this facility stock any antiretroviral medicines? Are any of the following ARVs available today in this facility? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE IS VALID (NOT EXPIRED)

1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5

M41

4020

4019

NOT OBSERVED NOT AVAILABLE TODAY NEVER AVAILABLE

M45 M48 M46 M45 M48 M45 M48 M45 M48

01 02 03 04 05

Zidovudine (ZDV, AZT) Zidovudine (ZDV, AZT) syrup Abacavir (ABC) Lamivudine (3TC) Tenofovir Disoproxil Fumarate (TDF)

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 4 4 4 4

5 5 5 5 5

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Indicator code M45 M48 M47 M45 M48 M45 M48 M45 M48 M45 M48 M45 M48 M45 M48 M45 M48 M45 M48 M45 M48 M45 M48 M45

Number 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22

Question Nevirapine (NVP) Nevirapine (NVP) syrup Efavirenz (EFV) Emtricitabine (FTC) Lamivudine + Abacavir (3TC + ABC) Zidovudine + Lamivudine (AZT + 3TC) Zidovudine + Lamivudine + Abacavir (AZT + 3TC + ABC) Zidovudine + Lamivudine + Nevirapine (AZT + 3TC + NVP) Tenofovir + Emtricitabine (TDF + FTC) Tenofovir + Lamivudine (TDF + 3TC) Tenofovir + Lamivudine + Efavirenz (TDF + 3TC + EFV) Tenofovir + Emtricitabine + Efavirenz (TDF + FTC + EFV) Didanosine (DDI) Lamivudine (3TC) syrup Stavudine 30 or 40 (D4T) Stavudine syrup Efavirenz (EFV) syrup Delavirdine (DLV) Enfuvirtide (T-20) Stavudine + Lamivudine (D4T + 3TC) Stavudine + Lamivudine + Nevirapine (D4T + 3TC + NVP) Does this facility stock any protease inhibitors for the treatment of HIV/AIDS? Are any of the following protease inhibitors available in the facility today? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE IS VALID (NOT EXPIRED)

Result 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

Skip 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

M45

M45 M45 M45 M45

23 24 25 26 4020

4022

4021

NOT OBSERVED NOT AVAILABLE TODAY NEVER AVAILABLE

M48

01 02 03

Lopinavir (LPV) Indinavir (IDV) Nelfinavir (NFV)

1 1 1

2 2 2

3 3 3

4 4 4

5 5 5

117

2. Core instrument

Indicator code

Number 04 05 06 07 08 09 4022

Question Saquinavir (SQV) Ritonavir (RTV) Atazanavir (ATV) Fosamprenavir (FPV) Tipranavir (TPV) Darunavir (DRV) Are any of the following other medicines and commodities available in the facility today? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE/COMMODITY IS VALID (NOT EXPIRED)

Result 1 1 1 1 1 1 OBSERVED AVAILABLE AT LEAST ONE VALID AVAILABLE NON VALID REPORTED AVAILABLE BUT NOT SEEN

Skip 2 2 2 2 2 2 3 3 3 3 3 3 4 4 4 4 4 4 NOT OBSERVED NOT AVAILABLE TODAY NEVER AVAILABLE

5 5 5 5 5 5

M27 M27 M27 M42 M26

01 02 03 04 05 06 07 08

Normal saline IV solution Ringers lactate IV solution 5% dextrose IV solution IV treatment for fungal infections Skin disinfectant Gowns Eye protection (goggles, face shields) Medical (surgical or procedural) masks Absorbable suture material Non-absorbable suture material Ketamine (injection) Lidocaine 1% or 2% (anaesthesia) Diazepam (injection) CHECK Q007 AND Q1002_08: IF HOSPITAL OR HEALTH FACILITY OFFERS CESAREAN SECTION:

1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5 5

M63 M63 M64 M65 M25

09 10 11 12 13

IF NOT HOSPITAL AND CESAREAN SECTION NOT OFFERED: Q4100 1 1 1 1 1 1 1 1 OBSERVED AVAILABLE

M84 M85 M86 M87 M88 M89 M62 M90

14 15 16 17 18 19 20 21 4023

Thiopental (powder) Suxamethonium bromide (powder) Atropine (injection) Halothane (inhalation) Bupivacaine (injection) Lidocaine 5% (heavy spinal solution) Epinephrine (injection) Ephedrine (injection) Are any of the following mental health and neurological medicines available in the facility

2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 NOT OBSERVED

5 5 5 5 5 5 5 5

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Indicator code

Number

Question today? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE/COMMODITY IS VALID (NOT EXPIRED)

Result AT LEAST ONE VALID AVAILABLE NON VALID REPORTED AVAILABLE BUT NOT SEEN NOT AVAILABLE TODAY

Skip NEVER AVAILABLE

M1 M119 M120 M121 M122 M94 M123 M124 M125 M126 M127 M128 M144 M145

01 02 03 04 05 06 07 08 09 10 11 12 13 14 4024

Amitriptyline tablet Carbamazepine tablet Chlorpromazine injection Diazepam tablet Diazepam injection or diazepam rectal tubes Fluoxetine tablet Fluphenazine injection Haloperidol tablet Lithium tablet Phenobarbital tablet Phenytoin tablet Valproate sodium tablet Lorazepam injection Levodopa + carbidopa tablet Are any of the following palliative care medicines available in the facility today? CHECK TO SEE IF AT LEAST ONE OF EACH MEDICINE/COMMODITY IS VALID (NOT EXPIRED)

1 1 1 1 1 1 1 1 1 1 1 1 1 1 OBSERVED AVAILABLE AT LEAST ONE VALID

2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 4 4 NOT OBSERVED

5 5 5 5 5 5 5 5 5 5 5 5 5 5

AVAILABLE NON VALID

REPORTED AVAILABLE BUT NOT SEEN

NOT AVAILABLE TODAY

NEVER AVAILABLE

M129 M130 M131 M132 M133 M83 M44 M83 M44 M134 M146

01 02 03 04 05 06 07 08 09

Dexamethasone injection Haloperidol injection Hyoscine butylbromide injection Lorazepam tablet Metoclopramide injection Morphine granules, tablet Morphine injection Senna preparation (laxative) Loperamide tab/cap

1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5

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2. Core instrument

Indicator code

Number

Question

Result

Skip

SUPPLY CHAIN 4100 Who is the principal person responsible for managing the ordering of medical supplies at this facility? NURSE ....................................................... 1 CLINICAL OFFICER ..................................... 2 PHARMACY TECHNICIAN .......................... 3 PHARMACY ASSISTANT ............................. 4 PHARMACIST............................................. 5 MEDICAL ASSISTANT ................................. 6 OTHER __________________________ 96 (SPECIFY) 4101 Which of the following mechanisms is used to determine this facility’s resupply quantities? ASK FOR EACH OF THE BELOW 01 02 03 4102 The facility itself (pull distribution system) A higher level facility (push distribution system) Other ________________________ (SPECIFY) How are the facility’s resupply quantities determined? 1 1 1 2 2 2 3 3 3 YES NO DON’T KNOW

FORMULA (ANY CALCULATION) ................ 1 DON’T KNOW ............................................ 2 OTHER MEANS .......................................... 3

4103

What is the main source of your routine pharmaceutical commodity supplies? By this I mean who is the direct supplier to your facility?

NATIONAL MEDICAL STORES .................... 1 JOINT MEDICAL STORES ............................ 2 NGO/DONORS........................................... 3 PRIVATE SOURCES .................................... 4 OTHER __________________________ 96 (SPECIFY)

4104

How are your pharmaceutical commodity supplies from the main supplier of your routine pharmaceuticals delivered to this facility?

SUPPLIER DELIVERS TO FACILITY............... 1 FACILITY MUST ARRANGE DELIVERY TO FACILITY .................................................... 2 OTHER __________________________ 96 (SPECIFY)

4105 01 02 03 04

Who is responsible for transporting products from central medical stores to your facility? Local supplier delivers Higher level delivers This facility collects Other ________________________ (SPECIFY)

YES

1 1 1 1

2 2 2 2

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Indicator code

Number 4106

Question For the most recent order, how long did it take between ordering and receiving products?

Result LESS THAN 2 WEEKS.................................. 1 2 WEEKS TO 1 MONTH.............................. 2 BETWEEN 1 AND 2 MONTHS .................... 3 MORE THAN 2 MONTHS ........................... 4

Skip

We have now completed all of the questions in this module of the survey. Thank you for your participation.

121

2. Core instrument

Number Question SECTION 8: INTERVIEWER'S OBSERVATIONS 5000 5001 INTERVIEW END TIME (use the 24 hour-clock system) RESULT CODES (LAST VISIT):

Result :

Skip

COMPLETED .............................................. 1 RESPONDENT NOT AVAILABLE .................. 2 REFUSED .................................................... 3 PARTIALLY COMPLETED ............................ 4 OTHER ___________________________96 (SPECIFY)

COMMENTS ABOUT THE RESPONDENT: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ COMMENTS ON SPECIFIC QUESTIONS: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ _____________________________________________________________________________________ ______________________________________________________________________________________ ANY OTHER COMMENTS: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ SUPERVISOR'S OBSERVATIONS: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ NAME OF SUPERVISOR: ____________________________________ DATE: ______________________

122

3. Facility reporting data verification tool

123

3. Facility reporting data verification tool

Introduction Version 2.2, December 2014 The facility reporting data verification tool is a questionnaire used to verify the availability of specific services provided at the facility level followed by verification of source documents and reports. The tool further probes into listing out the discrepancies observed, if any. The questionnaire includes the following sections Maternal health • • Antenatal care first visit Institutional deliveries (deliveries at the health facility)

Immunization • • Pentavalent/DTP first, second and third doses in children under one year PCV first, second and third doses in children under one year

Service utilization • Total outpatient visits (OPD)

HIV indicators • • • • HIV counselling and testing coverage of pregnant women ARV prophylaxis for pregnant women ART coverage ART initiation

Tuberculosis • TB cases

Malaria • • Malaria case rate Malaria diagnosis testing

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Number

Question

Result

Skip

FACILITY REPORTING DATA VERIFICATION TOOL (RECORD REVIEW) FACILITY IDENTIFICATION DV_001 DV_002 DV_003 DV_004 DV_005 DV_006 Facility number Name of facility ____________________________________ Location of facility (Town/City/Village) Region/Province District Type of facility NATIONAL REFERRAL HOSPITAL ............................. 1 DISTRICT/PROVINCIAL HOSPITAL............................ 2 HEALTH CENTRE/CLINIC .......................................... 3 HEALTH POST .......................................................... 4 MATERNAL/CHILD HEALTH CLINIC ......................... 5 OTHER (SPECIFY) _____________________________________ DV_007 Managing authority 96 ____________________________________

GOVERNMENT/PUBLIC ........................................... 1 NGO/NOT-FOR-PROFIT ........................................... 2 PRIVATE-FOR-PROFIT .............................................. 3 MISSION/FAITH-BASED ........................................... 4 OTHER (SPECIFY) _____________________________________ 96

125

3. Facility reporting data verification tool

Number

Question

Result

Skip

A. ANTENATAL CARE FIRST VISIT (ANC1) DV_008 Does this facility provide antenatal care services? Does this facility report ANC data to a reporting system? Which of the following reporting system(s) does the facility report ANC data to: Health Management Information System Programme specific reporting system for MCH Non-governmental organizations or institutions Other reporting system YES ........................................................... 1 NO ............................................................ 2 DV_015 YES ........................................................... 1 NO ............................................................ 2 DV_015 YES 1 1 1 1 ________________ SPECIFY NO 2 2 2 2

DV_009

DV_010 01 02 03 04

SOURCE DOCUMENTS AND REPORTS DV_011A Which of the following documents are used at this facility to record the number of pregnant women receiving antenatal care: ANC register or Integrated ANC register ANC tally sheets Patient cards Other YES NO

01 02 03 04

1 1 1 1 ________________ SPECIFY

2 2 2 2

DV_011B

What is the source document used by this facility for monthly reporting of antenatal care services? We are primarily interested in the main document that is used for compiling the total number of ANC1 visits seen at this facility. Please report if any improvised documents are used.

ANC REGISTER OR INTEGRATED ANC REGISTER ................................................. 1 TALLY SHEETS .......................................... 2 PATIENT CARDS ....................................... 3 OTHER (SPECIFY) _______________________________96

BASED ON RESPONSE TO QUESTION DV_011B, PLEASE ASK THE PERSON IN THE FACILITY WHO REGULARLY PREPARES THE FACILITY MONTHLY REPORTS TO PROVIDE YOU WITH THE SOURCE DOCUMENT USED TO COMPILE AND SUMMARIZE INFORMATION FOR MONTHLY REPORTING (i.e. REGISTERS, TALLY SHEETS, ETC.) AS WELL AS THE MONTHLY REPORTS FOR MONTH1, MONTH2, AND MONTH3 FOR ANC. REVIEW SOURCE DOCUMENT FOR ANC1 AND ANSWER THE FOLLOWING QUESTIONS

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Number DV_012

Question Please confirm the availability of the source document for antenatal care visits for Month1 to Month3. If available, please recount the number of ANC1 visits recorded in the main source document for Month1 to Month3.

Result (A) SOURCE DOCUMENT AVAILABLE

Skip (B) RECOUNT NUMBER OF ANC1 IN SOURCE DOCUMENT

YES, YES, YES, AVAILABLE AVAILABL AVAILABLE AND E BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_013

4 02 4 03 4 DV_013

*PARTLY: the source document is available but some information is missing

REVIEW MONTHLY REPORT FOR ANC1 AND ANSWER THE FOLLOWING QUESTIONS DV_013 Please confirm the availability of the monthly report for antenatal care visits for Month1 to Month3. If available, please record the number of ANC1 visits recorded in the monthly report for Month1 to Month3. (A) MONTHLY REPORT AVAILABLE (B) RECORD NUMBER OF ANC1 IN MONTHLY REPORT

YES, YES, YES, AVAILABLE AVAILABL AVAILABLE AND BUT NO E BUT COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_014

4 02 4 03 4 DV_014

*PARTLY: the source document is available but some information is missing

DISCREPANCIES

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3. Facility reporting data verification tool

Number DV_014

Question What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report?

Result NO DISCREPANCY .....................................1 DATA ENTRY ERRORS................................2 ARITHEMATIC ERRORS .............................3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ..............4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE ..........................5 OTHER (SPECIFY) ________________________________ 96

Skip

B. INSTITUTIONAL DELIVERIES (DELIVERIES AT THE HEALTH FACILITY) DV_015 DV_016 Does this facility provide delivery services? Does this facility report institutional deliveries data to a reporting system? Which of the following reporting system(s) does the facility report institutional deliveries data to: Health Management Information System Programme specific reporting system for MCH Non-governmental organizations or institutions Other reporting system YES ........................................................... 1 NO ............................................................ 2 DV_022 YES ........................................................... 1 NO ............................................................ 2 DV_022 YES NO

DV_017

01 02 03 04

1 1 1 1 _______________ SPECIFY

2 2 2 2

SOURCE DOCUMENTS AND REPORTS DV_018A Which of the following documents are used at this facility to record the number of institutional deliveries: Delivery register or labour and delivery register Maternity tally sheets Patient cards Other YES NO

01 02 03 04

1 1 1 1 _______________ SPECIFY

2 2 2 2

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Number DV_018B

Question What is the source document used by this facility for monthly reporting of institutional deliveries? We are primarily interested in the main document that is used for compiling the total number of monthly deliveries conducted at the facility. Please report if any improvised documents are used.

Result DELIVERY REGISTER OR LABOUR AND DELIVERY REGISTER ................................. 1 MATERNITY TALLY SHEETS ...................... 2 PATIENT CARDS ....................................... 3 OTHER (SPECIFY) ________________________________96

Skip

BASED ON RESPONSE TO QUESTION DV_018B, PLEASE ASK THE PERSON IN THE FACILITY WHO REGULARLY PREPARES THE FACILITY MONTHLY REPORTS TO PROVIDE YOU WITH THE SOURCE DOCUMENT USED TO COMPILE AND SUMMARIZE INFORMATION FOR MONTHLY REPORTING (i.e. REGISTERS, TALLY SHEETS, ETC.) AS WELL AS THE MONTHLY REPORTS FOR MONTH1, MONTH2, AND MONTH3 FOR INSTITUTIONAL DELIVERIES. REVIEW SOURCE DOCUMENT FOR INSTITUTIONAL DELIVERIES AND ANSWER THE FOLLOWING QUESTIONS DV_019 Please confirm the availability of the source document for institutional deliveries for Month1 to Month3. If available, please recount the number institutional deliveries recorded in the main source document for Month1 to Month3. (A) Source document available (B) Recount number of institutional deliveries in source document

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_020

4 02 4 03 4 DV_020

*PARTLY: the source document is available but some information is missing

REVIEW MONTHLY REPORT FOR INSTITUTIONAL DELIVERIES AND ANSWER THE FOLLOWING QUESTIONS DV_020 Please confirm the availability of the monthly report for institutional deliveries for Month1 to Month3. If available, please record the number of institutional deliveries recorded in the monthly report for Month1 to Month3. (A) Monthly report available (B) Report number of institutional deliveries in monthly report

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3. Facility reporting data verification tool

Number

Question

Result YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT NO BUT COMPLETE PARTLY* DATA COMPLETE RECORDED NO

Skip

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_021

4 02 4 03 4 DV_021

*PARTLY: the source document is available but some information is missing

DISCREPANCIES DV_021 What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96

IMMUNIZATION INDICATORS DV_022 Does this facility provide immunization services? Does this facility report immunization data to a reporting system? Which of the following reporting system(s) does the facility report immunization data to: Health Management Information System Immunization/EPI programme Non-governmental organizations or institutions Other reporting system YES ........................................................... 1 NO ............................................................ 2 DV_045 YES ........................................................... 1 NO ............................................................ 2 DV_045 YES 1 1 1 1 ________________ SPECIFY NO 2 2 2 2

DV_023

DV_024 01 02 03 04

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Number

Question

Result NO

Skip

SOURCE DOCUMENTS AND REPORTS DV_025 Which of the following documents are used at this facility to record the number of children getting immunized: Child register or child immunization register Immunization tally sheets Child health cards or child immunization cards Other YES

01 02 03 04

1 1 1 1 ________________ SPECIFY

2 2 2 2

C. PENTAVALENT/DTP FIRST, SECOND AND THIRD DOSES (PENTA/DTP) IN CHILDREN UNDER 1 YEAR DV_026 What is the source document used by this facility for monthly reporting of DTP (Penta)? We are primarily interested in the main document that is used for compiling monthly summary statistics for DTP (Penta). Please report if any improvised documents are used. CHILD REGISTER OR CHILD IMMUNIZATION REGISTER ...................... 1 IMMUNIZATION TALLY SHEETS ............... 2 CHILD HEALTH/IMMUNIZATION CARDS .. 3 OTHER (SPECIFY) ________________________________ 96

BASED ON RESPONSE TO QUESTION DV_026, PLEASE ASK THE PERSON IN THE FACILITY WHO REGULARLY PREPARES THE FACILITY MONTHLY REPORTS TO PROVIDE YOU WITH THE SOURCE DOCUMENT USED TO COMPILE AND SUMMARIZE INFORMATION FOR MONTHLY REPORTING (i.e. REGISTERS, TALLY SHEETS, ETC.) AS WELL AS THE MONTHLY REPORTS FOR MONTH1, MONTH2, AND MONTH3 FOR DTP (PENTA). REVIEW SOURCE DOCUMENTS FOR DTP1 (PENTA1) AND ANSWER THE FOLLOWING QUESTIONS DV_027 Please confirm the availability of source documents for DTP1 (Penta1) for Month1 to Month3. If available, please Recount the number of DTP1 (Penta1) immunizations recorded in the main source document for Month1 to Month3. (A) Source documents available (B) Recount number of DPT1 immunizations in source documents

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→b 1→b 1→b

2→b 2→b 2→b

3 02 3 03 3 DV_028

4 02 4 03 4 DV_028

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3. Facility reporting data verification tool

Number

Question

Result

Skip

*PARTLY: the register is available but some information is missing

REVIEW MONTLHY REPORTS FOR DTP1 (PENTA1) AND ANSWER THE FOLLOWING QUESTIONS DV_028 Please confirm the availability of monthly reports for Month1 to Month3. If available, please report the number of DTP1 (Penta1) immunizations recorded in the EPI monthly reports for Month1 to Month3. (A) Monthly reports available (B) Report number of DPT1 immunizations in monthly reports

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_029

4 02 4 03 4 DV_029

DISCREPANCIES DV_029 What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96 REVIEW SOURCE DOCUMENTS FOR DTP2 (PENTA2) AND ANSWER THE FOLLOWING QUESTIONS DV_030 Please confirm the availability of source documents for DTP2 (Penta2) for Month1 to Month3. If available, please Recount the number of DTP2 (Penta2) immunizations recorded in the main source document for Month1 to Month3. (A) Source documents available (B) Recount number of DPT2 immunizations in source documents

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Number

Question

Result YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED NO

Skip

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_031

4 02 4 03 4 DV_031

*PARTLY: the register is available but some information is missing

REVIEW MONTLHY REPORTS FOR DTP2 (PENTA2) AND ANSWER THE FOLLOWING QUESTIONS DV_031 Please confirm the availability of monthly reports for Month1 to Month3. If available, please report the number of DTP2 (Penta2) immunizations recorded in the EPI monthly reports for Month1 to Month3. (A) Monthly reports available (B) Report number of DPT2 immunizations in monthly reports

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_032

4 02 4 03 4 DV_032

DISCREPANCIES DV_032 What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96 REVIEW SOURCE DOCUMENTS FOR DTP3 (PENTA3) AND ANSWER THE FOLLOWING QUESTIONS

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3. Facility reporting data verification tool

Number DV_033

Question Please confirm the availability of source documents for DTP3 (Penta3) for Month1 to Month3. If available, please Recount the number of DTP3 (penta3) immunizations recorded in the main source document for Month1 to Month3.

Result (A) Source documents available

Skip (B) Recount number of DPT3 immunizations in source documents

YES, YES, YES, AVAILABL AVAILABL AVAILABLE BUT NO E AND E BUT DATA COMPLETE PARTLY* COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_034

4 02 4 03 4 DV_034

*PARTLY: the register is available but some information is missing

REVIEW MONTLHY REPORTS FOR DTP3 (PENTA3) AND ANSWER THE FOLLOWING QUESTIONS DV_034 Please confirm the availability of monthly reports for Month1 to Month3. If available, please report the number of DTP3 (penta3) immunizations recorded in the EPI monthly reports for Month1 to Month3. (A) Monthly reports available (B) Report number of DPT3 immunizations in monthly reports

YES, YES, YES, AVAILABL AVAILABL AVAILABLE E AND E BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_035

4 02 4 03 4 DV_035

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Number

Question

Result

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DISCREPANCIES DV_035 What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96

D. PCV FIRST, SECOND, AND THIRD DOSES IN CHILDREN UNDER 1 YEAR BASED ON RESPONSE TO QUESTION DV_026, PLEASE ASK THE PERSON IN THE FACILITY WHO REGULARLY PREPARES THE FACILITY MONTHLY REPORTS TO PROVIDE YOU WITH THE SOURCE DOCUMENT USED TO COMPILE AND SUMMARIZE INFORMATION FOR MONTHLY REPORTING (i.e. REGISTERS, TALLY SHEETS, ETC.) AS WELL AS THE MONTHLY REPORTS FOR MONTH1, MONTH2, AND MONTH3 FOR PCV REVIEW SOURCE DOCUMENTS FOR PCV1 AND ANSWER THE FOLLOWING QUESTIONS DV_036 Please confirm the availability of source documents for PCV1 for Month1 to Month3. If available, please Recount the number of PCV1 immunizations recorded in the main source document for Month1 to Month3. (A) Source documents available (B) Recount number of PCV1 immunizations in source documents

YES, YES, YES, AVAILABL AVAILABL AVAILABLE E AND E BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_037

4 02 4 03 4 DV_037

*PARTLY: the register is available but some information is missing

REVIEW MONTLHY REPORTS FOR PCV1 AND ANSWER THE FOLLOWING QUESTIONS DV_037 Please confirm the availability of monthly reports for Month1 to Month3. If available, please report the number of PCV1 immunizations recorded in the EPI monthly reports for Month1 to Month3. (A) Monthly reports available (B) Report number of PCV1 immunizations in monthly reports

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3. Facility reporting data verification tool

Number

Question

Result YES, YES, YES, AVAILABL AVAILABL AVAILABLE BUT NO E AND E BUT DATA COMPLETE PARTLY* COMPLETE RECORDED NO

Skip

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_038

4 02 4 03 4 DV_038

DISCREPANCIES DV_038 What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96 REVIEW SOURCE DOCUMENTS FOR PCV2 AND ANSWER THE FOLLOWING QUESTIONS DV_039 Please confirm the availability of source documents for PCV2 for Month1 to Month3. If available, please Recount the number of PCV2 immunizations recorded in the main source document for Month1 to Month3. (A) Source documents available (B) Recount number of PCV2 immunizations in source documents

YES, YES, YES, AVAILABL AVAILABL AVAILABL E AND E BUT E BUT NO COMPLET PARTLY* DATA E COMPLET RECORDE E D 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_040

4 02 4 03 4 DV_040

*PARTLY: the register is available but some information is missing

REVIEW MONTLHY REPORTS FOR PCV2 AND ANSWER THE FOLLOWING QUESTIONS

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Number DV_040

Question Please confirm the availability of monthly reports for Month1 to Month3. If available, please report the number of PCV2 immunizations recorded in the EPI monthly reports for Month1 to Month3.

Result (A) Monthly reports available

Skip (B) Report number of PCV2 immunizations in monthly reports

YES, YES, YES, AVAILABL AVAILABL AVAILABLE E AND E BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_041

4 02 4 03 4 DV_041

DISCREPANCIES DV_041 What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96 REVIEW SOURCE DOCUMENTS FOR PCV3 AND ANSWER THE FOLLOWING QUESTIONS DV_042 Please confirm the availability of source documents for PCV3 for Month1 to Month3. If available, please Recount the number of PCV3 immunizations recorded in the main source document for Month1 to Month3. (A) Source documents available (B) Recount number of PCV3 immunizations in source documents

YES, YES, YES, AVAILABL AVAILABL AVAILABLE E AND E BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1

1→B

2→B

3 02

4 02

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3. Facility reporting data verification tool

Number 02

Question Month2 Month3 1→B 1→B

Result 2→B 2→B 3 03 3 DV_043 4 03 4 DV_043

Skip

*PARTLY: the register is available but some information is missing

REVIEW MONTLHY REPORTS FOR PCV3 AND ANSWER THE FOLLOWING QUESTIONS DV_043 Please confirm the availability of monthly reports for Month1 to Month3. If available, please report the number of PCV3 immunizations recorded in the EPI monthly reports for Month1 to Month3. (A) Monthly reports available (B) Report number of PCV3 immunizations in monthly reports

YES, YES, YES, AVAILABL AVAILABL AVAILABLE BUT NO E AND E BUT DATA COMPLETE PARTLY* COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 02 2→B 03 2→B

3 02 3 03 3 DV_043

4 4 4 DV_044

DISCREPANCIES DV_044 What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96

E. TOTAL OUTPATIENT VISITS (OPD) DV_045 Does this facility offer outpatient services? YES ........................................................... 1 NO ............................................................ 2 DV_052 DV_046 Does this facility report outpatient visit data to a reporting system? Which of the following reporting system(s) does the facility report OPD data to: YES ........................................................... 1 NO ............................................................ 2 DV_052 YES NO

DV_047

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Number 01 02 03

Question Health Management Information System Non-governmental organizations or institutions Other reporting system

Result 1 1 1 ________________ SPECIFY 2 2 2

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SOURCE DOCUMENTS AND REPORTS DV_048A 01 02 03 04

Which of the following documents are used at this facility to record the number of OPD visits: OPD register OPD tally sheets Patient cards Other

YES 1 1 1 1 ________________ SPECIFY

NO 2 2 2 2

DV_048B

What is the source document used by this facility for monthly reporting of OPD visits? We are primarily interested in the main document that is used for compiling monthly summary statistics for OPD visits. Please report if any improvised documents are used.

OPD REGISTER ......................................... 1 OPD TALLY SHEETS................................... 2 PATIENT CARDS ....................................... 3 OTHER (SPECIFY) ________________________________ 96

BASED ON RESPONSE TO QUESTION DV_048B, PLEASE ASK THE PERSON IN THE FACILITY WHO REGULARLY PREPARES THE FACILITY MONTHLY REPORTS TO PROVIDE YOU WITH THE SOURCE DOCUMENT USED TO COMPILE AND SUMMARIZE INFORMATION FOR MONTHLY REPORTING (i.e. REGISTERS, TALLY SHEETS, ETC.) AS WELL AS THE MONTHLY REPORTS FOR MONTH1, MONTH2, AND MONTH3 FOR OPD VISITS RECORDED IN THE FACILITY. REVIEW SOURCE DOCUMENT FOR OPD VISITS AND ANSWER THE FOLLOWING QUESTIONS DV_049 Please confirm the availability of the source document used at the facility to compile the number of OPD visits recorded for Month1 to Month3. If available, please recount the number of OPD visits recorded in the main source document for Month1 to Month3. (A) Source document available (B) Recount number of OPD visits in source document

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1

1→B

2→B

3 02

4 02

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3. Facility reporting data verification tool

Number 02

Question Month2 Month3 1→B 1→B

Result 2→B 2→B 3 03 3 DV_050 4 03 4 DV_050

Skip

*PARTLY: the source document is available but some information is missing

REVIEW MONTHLY REPORT FOR OUTPATIENT VISITS AND ANSWER THE FOLLOWING QUESTIONS DV_050 Please confirm the availability of the monthly report for number of OPD visits for Month1 to Month3. If available, please record the number of OPD visits as recorded in the monthly report for Month1 to Month3. (A) Monthly report available (B) Record number of Outpatient visits in monthly report

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_051

4 02 4 03 4 DV_051

*PARTLY: the source document is available but some information is missing

DISCREPANCIES DV_051 What are the reasons for discrepancy (if any) observed between the source documents and the monthly reports? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96

HIV INDICATORS F. HIV COUNSELLING AND TESTING COVERAGE OF PREGNANT WOMEN DV_052 Does this facility provide HIV counselling and testing services to pregnant women? YES ........................................................... 1 NO ............................................................ 2 DV_059

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Number DV_053

Question Does this facility report the number of pregnant women receiving HIV counselling and testing to a reporting system? Which of the following reporting system(s) does the facility report data on women who are receiving counselling and testing to: Health Management Information System National HIV/AIDS program Non-governmental organizations or institutions Other reporting system

Result YES ........................................................... 1

Skip

NO ............................................................ 2 DV_059 YES NO

DV_054

01 02 03 04

1 1 1 1 ________________ SPECIFY

2 2 2 2

SOURCE DOCUMENTS AND REPORTS DV_055A Which of the following documents are used at this facility to record the number of pregnant women receiving HIV counselling and testing: PMTCT register Tally sheets Patient cards (HIV care/ART card, maternal card) ANC register or integrated ANC register Delivery register or labour and delivery register Other YES NO

01 02 03 04 05 06

1 1 1 1 1 1 ________________ SPECIFY

2 2 2 2 2 2

DV_055B

What is the source document used by this facility for monthly reporting of HIV counselling and testing in pregnant women? We are primarily interested in the main document that is used for compiling the total number of monthly counselling and testing services provided to pregnant women at the facility. Please report if any improvised documents are used.

PMTCT REGISTER ..................................... 1 TALLY SHEET ............................................ 2 PATIENT CARDS ....................................... 3 ANC REGITER OR INTEGRATED ANC REGISTER ................................................. 4 DELIVERY REGISTER OR LABOUR AND DELIVERY REGISTER ................................. 5 OTHER (SPECIFY) ________________________________ 96

141

3. Facility reporting data verification tool

Number

Question

Result

Skip

BASED ON RESPONSE TO QUESTION DV_055B, PLEASE ASK THE PERSON IN THE FACILITY WHO REGULARLY PREPARES THE FACILITY MONTHLY REPORTS TO PROVIDE YOU WITH THE SOURCE DOCUMENT USED TO COMPILE AND SUMMARIZE INFORMATION FOR MONTHLY REPORTING (i.e. REGISTERS, TALLY SHEETS, ETC.) AS WELL AS THE MONTHLY REPORTS FOR MONTH1, MONTH2, AND MONTH3 FOR HIV COUNSELLING AND TESTING OF PREGNANT WOMEN RECORDED IN THE FACILITY. REVIEW SOURCE DOCUMENT FOR HIV COUNSELLING AND TESTING OF PREGNANT WOMEN AND ANSWER THE FOLLOWING QUESTIONS DV_056 Please confirm the availability of the source document used at the facility to compile the number of pregnant women receiving HIV counselling and testing for Month1 to Month3. If available, please recount the number of pregnant women receiving HIV counselling and testing as recorded in the main source document for Month1 to Month3. (A) Source document available (B) Recount number of pregnant women who received HIV counselling and testing in source document

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE BUT AND BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_057

4 02 4 03 4 DV_057

*PARTLY: the source document is available but some information is missing

REVIEW MONTHLY REPORT FOR HIV COUNSELLING AND TESTING OF PREGNANT WOMEN AND ANSWER THE FOLLOWING QUESTIONS DV_057 Please confirm the availability of the monthly report for number of pregnant women receiving HIV counselling and testing for Month1 to Month3. If available, please record the number of pregnant women who received HIV counselling and testing as recorded in the monthly report for Month1 to Month3. (A) Monthly report available (B) Record number of pregnant women who received HIV counselling and testing in monthly report

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Number

Question

Result YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED NO

Skip

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_058

4 02 4 03 4 DV_058

*PARTLY: the source document is available but some information is missing

DISCREPANCIES DV_058 What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96

G. ARV PROPHYLAXIS FOR PREGNANT WOMEN DV_059 Does this facility provide ARV prophylaxis for pregnant women? Does this facility report the number of pregnant women receiving ARV prophylaxis to a reporting system? Which of the following reporting system(s) does the facility report delivery of ARV prophylaxis to pregnant women to: Health Management Information System National HIV/AIDS program Non-governmental organizations or institutions Other reporting system YES ........................................................... 1 NO ............................................................ 2 DV_066 YES ........................................................... 1 NO ............................................................ 2 DV_066 YES NO

DV_060

DV_061

01 02 03 04

1 1 1 1 _________________ SPECIFY

2 2 2 2

SOURCE DOCUMENTS AND REPORTS

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3. Facility reporting data verification tool

Number DV_062A

Question Which of the following documents are used at this facility to record the number of pregnant women getting ARV prophylaxis: PMTCT register Tally sheets Patient cards (HIV care/ART card, maternal card) ANC register or integrated ANC register Delivery register or labour and delivery register Other

Result YES NO

Skip

01 02 03 04 05 06

1 1 1 1 1 1 ________________ SPECIFY

2 2 2 2 2 2

DV_062B

What is the source document used by this facility for monthly reporting of number of pregnant women getting ARV prophylaxis? We are primarily interested in the main document that is used for compiling monthly summary statistics for ARV prophylaxis administered to pregnant women. Please report if any improvised documents are used.

BASED ON RESPONSE TO QUESTION DV_062B, PLEASE ASK THE PERSON IN THE FACILITY WHO REGULARLY PREPARES THE FACILITY MONTHLY REPORTS TO PROVIDE YOU WITH THE SOURCE DOCUMENT USED TO COMPILE AND SUMMARIZE INFORMATION FOR MONTHLY REPORTING (i.e. REGISTERS, TALLY SHEETS, ETC.) AS WELL AS THE MONTHLY REPORTS FOR MONTH1, MONTH2, AND MONTH3 FOR ARV PROPHYLAXIS FOR PREGNANT WOMEN RECORDED IN THE FACILITY. REVIEW SOURCE DOCUMENT FOR ARV PROPHYLAXIS FOR PREGNANT WOMEN AND ANSWER THE FOLLOWING QUESTIONS DV_063 Please confirm the availability of the source document used at the facility to compile the number of pregnant women receiving ARV prophylaxis for Month1 to Month3. If available, please recount the number of pregnant women receiving ARV prophylaxis as recorded in the main source document for Month1 to Month3. (A) Source document available (B) Recount number of pregnant women receiving ARV prophylaxis in source document

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Number

Question

Result YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE BUT AND BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED NO

Skip

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_064

4 02 4 03 4 DV_064

*PARTLY: the source document is available but some information is missing

REVIEW MONTHLY REPORT FOR ARV PROPHYLAXIS FOR PREGNANT WOMEN AND ANSWER THE FOLLOWING QUESTIONS DV_064 Please confirm the availability of the monthly report for number of pregnant women receiving ARV prophylaxis for Month1 to Month3. If available, please record the number of pregnant women receiving ARV prophylaxis as recorded in the monthly report for Month1 to Month3. (A) Monthly report available (B) Record number of pregnant women receiving ARV prophylaxis in monthly report

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_065

4 02 4 03 4 DV_065

*PARTLY: the source document is available but some information is missing

DISCREPANCIES

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3. Facility reporting data verification tool

Number DV_065

Question What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report?

Result NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96

Skip

H. ART COVERAGE DV_066 Does this facility provide ART? YES ........................................................... 1 NO ............................................................ 2 DV_073 DV_067 Does this facility report the number of patients on ART to a reporting system? Which of the following reporting system(s) does the facility report delivery of ART: Health Management Information System National HIV/AIDS program Non-governmental organizations or institutions Other reporting system YES ........................................................... 1 NO ............................................................ 2 DV_073 YES NO

DV_068

01 02 03 04

1 1 1 1 ________________ SPECIFY

2 2 2 2

SOURCE DOCUMENTS AND REPORTS DV_069A Which of the following documents are used at this facility to record the number of patients on ART: Pre-ART register ART tally sheets Patient cards (HIV care/ART cards) ART register Other YES NO

01 02 03 04 05

1 1 1 1 1 ________________ SPECIFY

2 2 2 2 2

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Number DV_069B

Question What is the source document used by this facility for monthly reporting of number of patients on ART? We are primarily interested in the main document that is used for compiling the total number of patients on ART seen at this facility. Please report if any improvised documents are used.

Result PRE-ART REGISTER ................................... 1 ART TALLY SHEET ..................................... 2 PATIENT CARDS ....................................... 3 ART REGISTER .......................................... 4 OTHER (SPECIFY) ________________________________ 96

Skip

BASED ON RESPONSE TO QUESTION DV_069B, PLEASE ASK THE PERSON IN THE FACILITY WHO REGULARLY PREPARES THE FACILITY MONTHLY REPORTS TO PROVIDE YOU WITH THE SOURCE DOCUMENT USED TO COMPILE AND SUMMARIZE INFORMATION FOR MONTHLY REPORTING (i.e. REGISTERS, TALLY SHEETS, ETC.) AS WELL AS THE MONTHLY REPORTS FOR MONTH1, MONTH2, AND MONTH3 FOR ART RECORDED IN THE FACILITY. REVIEW SOURCE DOCUMENT FOR ART AND ANSWER THE FOLLOWING QUESTIONS DV_070 Please confirm the availability of the source document for use at the facility to compile the number of PATIENTS ON ART for Month1 to Month3. If available, please recount the number of PATIENTS ON ART recorded in the main source document for Month1 to Month3. (A) Source document available (B) Recount number of PATIENTS ON ART in source document

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_071

4 02 4 03 4 DV_071

*PARTLY: the source document is available but some information is missing

REVIEW MONTHLY REPORT FOR ART AND ANSWER THE FOLLOWING QUESTIONS DV_071 Please confirm the availability of the monthly report for number of PATIENTS ON ART for Month1 to Month3. If available, please record the number of PATIENTS ON ART as recorded in the monthly report for Month1 to Month3. (A) Monthly report available (B) Record number of PATIENTS ON ART in monthly report

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED

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3. Facility reporting data verification tool

Number 01

Question Month1 Month2 Month3 1→B 1→B 1→B

Result 2→B 2→B 2→B 3 02 3 03 3 DV_072 4 02 4 03 4 DV_072

Skip

*PARTLY: the source document is available but some information is missing

DISCREPANCIES DV_072 What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96

I. ART INITIATION DV_073 Does this facility provide ART? YES ........................................................... 1 NO ............................................................ 2 DV_080 DV_074 Does this facility report the number of patients on ART to a reporting system? Which of the following reporting system(s) does the facility report delivery of ART to: Health Management Information System National HIV/AIDS program Non-governmental organizations or institutions Other reporting system YES ........................................................... 1 NO ............................................................ 2 DV_080 YES NO

DV_075

01 02 03 04

1 1 1 1 ________________ SPECIFY

2 2 2 2

SOURCE DOCUMENTS AND REPORTS (PATIENTS NEWLY INITIATED ON ART) DV_076A Which of the following documents are used at this facility to record the number of patients newly initiated on ART: ART register ART tally sheets YES NO

01 02

1 1

2 2

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Number 03 04 05

Question Patient cards (HIV care/ART card) Drug supply management forms Other

Result 1 1 1 ________________ SPECIFY 2 2 2

Skip

DV_076B

What is the source document used by this facility for monthly reporting of patients newly initiated on ART? We are primarily interested in the main document that is used for compiling the total number of patients newly initiated on ART at the facility. Please report if any improvised documents are used.

ART REGISTER .......................................... 1 ART TALLY SHEET ..................................... 2 PATIENT CARDS ....................................... 3 DRUG SUPPLY MANAGEMENT FORMS .... 4 OTHER (SPECIFY) ________________________________ 96

BASED ON RESPONSE TO QUESTION DV_076B, PLEASE ASK THE PERSON IN THE FACILITY WHO REGULARLY PREPARES THE FACILITY MONTHLY REPORTS TO PROVIDE YOU WITH THE SOURCE DOCUMENT USED TO COMPILE AND SUMMARIZE INFORMATION FOR MONTHLY REPORTING (i.e. REGISTERS, TALLY SHEETS, ETC.) AS WELL AS THE MONTHLY REPORTS FOR MONTH1, MONTH2, AND MONTH3 FOR ART INITIATION RECORDED IN THE FACILITY. REVIEW SOURCE DOCUMENT FOR ART AND ANSWER THE FOLLOWING QUESTIONS DV_077 Please confirm the availability of the source document used at the facility to compile the number of patients newly initiated on ART for Month1 to Month3. If available, please recount the number of patients newly initiated on ART recorded in the main source document for Month1 to Month3 (A) Source document available (B) Recount number of patients newly initiated on ART in source document

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE BUT AND BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_078

4 02 4 03 4 DV_078

*PARTLY: the source document is available but some information is missing

REVIEW MONTHLY REPORT FOR ART AND ANSWER THE FOLLOWING QUESTIONS

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3. Facility reporting data verification tool

Number DV_078

Question Please confirm the availability of the monthly report for number of patients newly initiated on ART for Month1 to Month3. If available, please record the number of patients newly initiated on ART as recorded in the monthly report for Month1 to Month3.

Result (A) Monthly report available

Skip (B) Record number of patients newly initiated on ART in monthly report

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_079

4 02 4 03 4 DV_079

*PARTLY: the source document is available but some information is missing

DISCREPANCIES DV_079 What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96

TUBERCULOSIS J. TB CASES DV_080 Does this facility provide TB diagnosis and/or treatment? Does this facility report the total number of TB cases (all types) to a reporting system? Which of the following reporting system(s) does the facility report total number of TB cases (all types) to: Health Management Information System YES ........................................................... 1 NO ............................................................ 2 DV_088 YES ........................................................... 1 NO ............................................................ 2 DV_088 YES NO

DV_081

DV_082

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Number 02 03 04

Question National TB programme Non-governmental organizations or institutions Other reporting system

Result 1 1 1 _________________ SPECIFY 2 2 2

Skip

SOURCE DOCUMENTS AND REPORTS (NOTIFIED TB CASES) DV_083A Which of the following documents are used at this facility to record the total number of TB cases (all types): TB register Presumptive TB register (TB suspects) Patient cards (TB treatment cards) TB laboratory register Outpatient register Electronic patient record system Other YES NO

01 02 03 04 05 06 07

1 1 1 1 1 1 1 ________________ SPECIFY

2 2 2 2 2 2 2

DV_083B

What is the source document used by this facility for monthly reporting of notified TB cases? We are primarily interested in the main document that is used for compiling monthly/quarterly summary statistics for total number of TB cases (all types). Please report if any improvised documents are used.

TB REGISTER ............................................ 1 PRESUMPTIVE TB REGISTER .................... 2 PATIENT CARDS ....................................... 3 TB LABORATORY REGISTER ...................... 4 OUTPATIENT REGISTER ............................ 5 ELECTRONIC PATIENT RECORD SYSTEM .. 6 OTHER (SPECIFY) ________________________________ 96

DV_083C

Does this facility report notified TB cases on a monthly or quarterly basis?

MONTHLY ................................................ 1 QUARTERLY.............................................. 2

BASED ON RESPONSE TO QUESTION DV_083B, PLEASE ASK THE PERSON IN THE FACILITY WHO REGULARLY PREPARES THE FACILITY MONTHLY REPORTS TO PROVIDE YOU WITH THE SOURCE DOCUMENT USED TO COMPILE AND SUMMARIZE INFORMATION FOR MONTHLY/QUARTERLY REPORTING (i.e. REGISTERS, TALLY SHEETS, ETC.) AS WELL AS THE MONTHLY OR QUARTERLY REPORTS FOR TOTAL NUMBER OF TB CASES (ALL TYPES). REVIEW SOURCE DOCUMENT FOR TB CASES AND ANSWER THE FOLLOWING QUESTIONS

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3. Facility reporting data verification tool

Number DV_084

Question Please confirm the availability of the source document used at the facility to compile the number of notified cases of TB for Month1 to Month3. If available, please recount the number of notified cases of TB as recorded in the main source document for Month1 to Month3. IF QUARTERLY REPORTING, PLEASE ONLY FILL IN LINE 01 AND ENTER THE TOTAL NUMBER FOR THE QUARTER

Result (A) Source document available

Skip (B) Recount number of notified cases of TB in source document

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_085

4 02 4 03 4 DV_085

*PARTLY: the source document is available but some information is missing

REVIEW MONTHLY REPORT FOR TB CASES AND ANSWER THE FOLLOWING QUESTIONS DV_085 Please confirm the availability of the monthly report for number of notified cases of TB for Month1 to Month3. If available, please record the number of notified cases of TB as recorded in the monthly report for Month1 to Month3. IF QUARTERLY REPORTING, PLEASE ONLY FILL IN LINE 01 AND ENTER THE TOTAL NUMBER FOR THE QUARTER YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

(A) Monthly report available

(B) Record number of notified cases of TB in monthly report

Month1 Month2

1→B 1→B

2→B 2→B

3 02 3 03

4 02 4 03

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Number 03

Question Month3 1→B

Result 2→B 3 DV_086 4 DV_086

Skip

*PARTLY: the source document is available but some information is missing

DISCREPANCIES DV_086 What are the reasons for the discrepancy (if any) observed between the main source document and the monthly/quarterly report? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96

MALARIA K. MALARIA CASE RATE DV_087 Does this facility provide malaria diagnosis? YES ........................................................... 1 NO ............................................................ 2 DV_095 DV_088 Does this facility report malaria cases to a reporting system? Which of the following reporting system(s) does the facility report malaria cases to: Health Management Information System National malaria programme Non-governmental organizations or institutions Other reporting system YES ........................................................... 1 NO ............................................................ 2 DV_095 YES NO

DV_089

01 02 03 04

1 1 1 1 _________________ SPECIFY

2 2 2 2

SOURCE DOCUMENTS AND REPORTS DV_090A Which of the following documents are used at this facility to record the number of malaria cases: OPD register Tally sheets Patient cards YES NO

01 02 03

1 1 1

2 2 2

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Number 04

Question Other

Result 1 ________________ SPECIFY 2

Skip

DV_090B

What is the source document used by this facility for monthly reporting of malaria cases? We are primarily interested in the main document that is used for compiling monthly summary statistics for malaria cases. Please report if any improvised documents are used.

OPD REGISTER ......................................... 1 TALLY SHEETS........................................... 2 PATIENT CARDS ....................................... 3 OTHER (SPECIFY) ________________________________ 96

BASED ON RESPONSE TO QUESTION DV_090B, PLEASE ASK THE PERSON IN THE FACILITY WHO REGULARLY PREPARES THE FACILITY MONTHLY REPORTS TO PROVIDE YOU WITH THE SOURCE DOCUMENT USED TO COMPILE AND SUMMARIZE INFORMATION FOR MONTHLY REPORTING (i.e. REGISTERS, TALLY SHEETS, ETC.) AS WELL AS THE MONTHLY REPORTS FOR MONTH1, MONTH2, AND MONTH3 FOR MALARIA CASES RECORDED IN THE FACILITY. REVIEW SOURCE DOCUMENT FOR MALARIA CASE RATE AND ANSWER THE FOLLOWING QUESTIONS DV_091 Please confirm the availability of the source document for malaria cases for Month1 to Month3. If available, please recount the number of malaria cases as recorded in the main source document for Month1 to Month3. (A) Source document available (B) Recount number of malaria cases in source document

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_092

4 02 4 03 4 DV_092

*PARTLY: the source document is available but some information is missing

REVIEW MONTHLY REPORT FOR MALARIA CASE RATE AND ANSWER THE FOLLOWING QUESTIONS DV_092 Please confirm the availability of the monthly report for malaria cases for Month1 to Month3. If available, please record the number of malaria cases recorded in the monthly report for Month1 to Month3. (A) Monthly report available (B) Record number of malaria cases in monthly report

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Number

Question

Result YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED NO

Skip

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_093

4 02 4 03 4 DV_093

*PARTLY: the source document is available but some information is missing

DISCREPANCIES DV_093 What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96

L. MALARIA DIAGNOSIS TESTING DV_094 Does this facility provide malaria diagnosis? YES ........................................................... 1 NO ............................................................ 2 END DV_095 Does this facility report malaria cases to a reporting system? Which of the following reporting system(s) does the facility report malaria cases to: Health Management Information System National malaria programme Non-governmental organizations or institutions YES ........................................................... 1 NO ............................................................ 2 END YES NO

DV_096

01 02 03

1 1 1

2 2 2

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3. Facility reporting data verification tool

Number 04

Question Other reporting system

Result 1 ________________ SPECIFY 2

Skip

SOURCE DOCUMENTS AND REPORTS DV_097A Which of the following documents are used at this facility to record the number of malaria cases: OPD register Tally sheets Patient cards Other YES NO

01 02 03 04

1 1 1 1 ________________ SPECIFY

2 2 2 2

DV_097B

BASED ON RESPONSE TO QUESTION DV_097B, PLEASE ASK THE PERSON IN THE FACILITY WHO REGULARLY PREPARES THE FACILITY MONTHLY REPORTS TO PROVIDE YOU WITH THE SOURCE DOCUMENT USED TO COMPILE AND SUMMARIZE INFORMATION FOR MONTHLY REPORTING (i.e. REGISTERS, TALLY SHEETS, ETC.) AS WELL AS THE MONTHLY REPORTS FOR MONTH1, MONTH2, AND MONTH3 FOR MALARIA CASES RECORDED IN THE FACILITY. REVIEW SOURCE DOCUMENT FOR MALARIA CASES THAT WERE TESTED AND ANSWER THE FOLLOWING QUESTIONS DV_098 Please confirm the availability of the source document for suspected cases that were tested for malaria by RDT for Month1 to Month3. If available, please recount the number of suspected malaria cases that were tested by RDT as recorded in the main source document for Month1 to Month3. (A) Source document available (B) Recount number of suspected malaria cases that were tested by RDT in source document

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2

1→B 1→B

2→B 2→B

3 02 3 03

4 02 4 03

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Number 03

Question Month3 Please confirm the availability of the source document for suspected cases that were tested for malaria by microscopy for Month1 to Month3. If available, please recount the number of suspected malaria cases that were tested by microscopy as recorded in the main source document for Month1 to Month3. 1→B

Result 2→B 3 DV_099 4 DV_099

Skip

DV_099

(A) Source document available

(B) Recount number of suspected malaria cases that were tested by microscopy in source document

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_100

4 02 4 03 4 DV_100

*PARTLY: the source document is available but some information is missing

REVIEW MONTHLY REPORT FOR SUSPECTED MALARIA CASES THAT WERE TESTED AND ANSWER THE FOLLOWING QUESTIONS DV_100 Please confirm the availability of the monthly report for suspected cases tested for malaria by RDT for Month1 to Month3. If available, please record the number of suspected malaria cases that were tested by RDT as recorded in the monthly report for Month1 to Month3. (A) Monthly report available (B) Record number of suspected malaria cases that were tested by RDT in monthly report

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2

1→B 1→B

2→B 2→B

3 02 3 03

4 02 4 03

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Number 03

Question Month3 Please confirm the availability of the monthly report for suspected cases tested for malaria by microscopy for Month1 to Month3. If available, please record the number of suspected malaria cases that were tested by microscopy as recorded in the monthly report for Month1 to Month3. 1→B

Result 2→B 3 DV_101 4 DV_101

Skip

DV_101

(A) Monthly report available

(B) Record number of suspected malaria cases tested for malaria by microscopy in monthly report

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_102

4 02 4 03 4 DV_102

*PARTLY: the source document is available but some information is missing

DISCREPANCIES DV_102 What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96 REVIEW SOURCE DOCUMENT FOR MALARIA CASES THAT TESTED POSITIVE AND ANSWER THE FOLLOWING QUESTIONS DV_103 Please confirm the availability of the source document for malaria RDTs that were positive for Month1 to Month3. If available, please recount the number of malaria RDTs that were positive as recorded in the source document for Month1 to Month3. (A) Source document available (B) Recount number of malaria RDTs that were positive in source document

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Number

Question

Result YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED NO

Skip

Month1 Month2 Month3 Please confirm the availability of the source document for malaria microscopy tests that were positive for Month1 to Month3. If available, please recount the number of malaria microscopy tests that were positive as recorded in the source document for Month1 to Month3.

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_104

4 02 4 03 4 DV_104 (B) Record number of malaria microscopy tests that were positive in source document

DV_104

(A) Source document available

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_105

4 02 4 03 4 DV_105

*PARTLY: the source document is available but some information is missing

REVIEW MONTHLY REPORT FOR MALARIA CASES THAT TESTED POSITIVE AND ANSWER THE FOLLOWING QUESTIONS DV_105 Please confirm the availability of the monthly report for malaria RDTs that were positive for Month1 to Month3. If available, please record the number of malaria RDTs found positive as recorded in the monthly report for Month1 to Month3. (A) Monthly report available (B) Record number of malaria RDTs that were positive in monthly report

159

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Number

Question

Result YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED NO

Skip

Month1 Month2 Month3 Please confirm the availability of the monthly report for malaria microscopy tests that were positive for Month1 to Month3. If available, please record the number of malaria microscopy tests that were positive as recorded in the monthly report for Month1 to Month3.

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_106

4 02 4 03 4 DV_106 (B) Record number of malaria microscopy tests that were positive in monthly report

DV_106

(A) Monthly report available

YES, YES, YES, AVAILABLE AVAILABLE AVAILABLE AND BUT BUT NO COMPLETE PARTLY* DATA COMPLETE RECORDED 01

Month1 Month2 Month3

1→B 1→B 1→B

2→B 2→B 2→B

3 02 3 03 3 DV_107

4 02 4 03 4 DV_107

*PARTLY: the source document is available but some information is missing

DISCREPANCIES DV_107 What are the reasons for the discrepancy (if any) observed between the main source document and the monthly report? NO DISCREPANCY .................................... 1 DATA ENTRY ERRORS ............................... 2 ARITHEMATIC ERRORS............................. 3 INFORMATION FROM ALL SOURCE DOCUMENTS NOT COMPILED CORRECTLY …………………………….. ............. 4 SOURCE DOCUMENT AND/OR MONTHLY REPORT NOT AVAILABLE.......................... 5 OTHER (SPECIFY) ________________________________ 96

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4.1 Indicators ID numbers In order to more easily identify which questions in the questionnaire correspond to the indicators in this document, an ID number has been given for each indicator and the corresponding questions in the questionnaire are labelled with the same ID number. This can be useful for a number of purposes including: • Identifying which questions corresponds to each indicator; • Determining which questions to remove from the questionnaire if certain indicators are not to be included in the survey; and • Identifying items for inclusion in the analysis portion of the survey implementation. The ID numbers have been assigned to each indicator using a two part system: First the indicator is given a letter based on the category of indicator. Second, the indicator is given a unique number. Table 4.1.1 below gives the categories used for the indicator types:

TABLE 4.1.1: INDICATOR CATEGORIES Indicator type Service availability Infrastructure Equipment Medicines and commodities Diagnostics Training Domains Indices Abbreviation S I E M D T DO IN

4.2

SARA general service availability indicators

An important note regarding service availability: although this information is collected through the SARA questionnaire, these indicators should not be calculated for a sample of facilities. Data must be available for ALL facilities in an administrative unit in order to calculate service availability. All service availability measures require data that link the numerator (e.g. number of facilities) to the denominator - population size. A sample survey would not allow computation of the service availability indicators, as it is not clear what the corresponding population size to be used as the denominator should be. The information needed to calculate service availability can be gathered from multiple sources in addition to the SARA, namely the HMIS and other routine information systems, and should be collated for all facilities before calculating the service availability indicators. If the SARA is implemented as a census, then it can be used to calculate service availability.

163

4. Indicators index Service Availability is described by three areas of tracer indicators:

4.2.1 Health infrastructure • Facility density per 10 000 population: the facility density is primarily an indicator of outpatient service access. • Inpatient bed density per 10 000 population: inpatient bed density provides an indicator of the inpatient services access. Paediatric beds (cots) are included, but maternity beds are excluded. • Maternity bed density per 1000 pregnant women: maternity bed density provides an indicator of access to delivery services. Data on maternity beds can be used calculate the density of maternal beds per 1000 pregnant women per year. The denominator is estimated from the population data. The indicator does not include delivery beds.

4.2.2 Health workforce • Health workforce density: core medical professionals per 10 000 population: physicians, non-physician clinicians, registered nurses, and midwives. This includes part-time physicians who are given the value of 0.5 in the scoring.

4.2.3

Service utilization

In populations with poor or suboptimal health infrastructure the service utilization rate is an indicator of access. • Number of outpatient visits per capita per year: the number of visits for ambulant care, not including immunization, over the total population. • Number of hospital discharges per 100 population (excluding deliveries): this indicator provides additional information on the availability and access to inpatient services. These indicators must all be expressed as a percentage score compared with a target or benchmark. Table 4.1.2 below shows the benchmark and computation of each indicator. If the tracer indicator score exceeds the benchmark, it will be scored as 100%.

TABLE 4.1.2: SERVICE AVAILABILITY INDICATORS Indicator Health infrastructure (a) (b) (c) Facilities Inpatient beds Maternity beds N per 10 000 population N per 10 000 population N per 1000 pregnant women 2 25 10 Target Score Score = N/target N/2 * 100 (max.100) N/25 * 100 (max.100) N/10 * 100 (max.100)

Health workforce (d) Core health workforce N per 10 000 population 23 N/23 * 100 (max.100) Service utilization (e) (f) Utilization Utilization Outpatient visits per person/year Hospital discharges per 100/year 5 10 N/ 5 * 100 (max.100) N/ 10 * 100 (max.100)

164

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2 The rationale for the targets can be summarized as follows: (a) Facility density: usually there is a country target, such as at least one facility per 5000 population, or 2 per 10 000. A major limitation is that this indicator does not take into account the size of the facilities. The indicator is scored as N of facilities / 2 * 100% (max. 100). (b) Inpatient beds: the global average is 27 per 10 000, lower- and upper middle-income countries have 18 and 39 hospital beds per 10 000 respectively. An arbitrary benchmark of 25 per 10 000 is selected. The indicator is scored as N / 25 * 100% (max. 100). (c) Maternity beds: under the assumption that there should be sufficient beds for all pregnant women with an occupancy rate of 80% (to account for the uneven spread of demand over time) and a mean duration of stay of 3 days, the target should be (1000/.8) * (3/365) = 10 per 1000 pregnant women. The indicator is scored as N / 10 * 100% (max. 100). An estimation for the number of pregnant women in the population can be derived from the CBR (crude birth rate) for the country of interest and the following equations ∗: ii = Estimated live births expected per month = (a / 12) i = Estimated number of live births = (CBR per 1,000 * total population)

iii = Estimated number of pregnancies ending in stillbirths or miscarriages = (a * 0.15) iv = Estimated pregnancies expected in the year = (a + c) v = Estimated number of women pregnant in a given month = (0.70 * d) vi = Estimated % of total population who are pregnant at a given period = (e / total population * 100) (d) Health workers: WHO has published a figure of 23 per 10 000 population. The indicator is scored as N/23*100% (max. 100). (e) Outpatient service utilization: in the OECD countries, the average number of physician consultations per person per year is about 6. The proposed benchmark is 5 visits per person per year. The indicator is scored as (N of outpatient visits per person per year)/ 5 * 100% (max. 100). (f) Inpatient service utilization: in the OECD countries, which have an ageing population, there are about 15 discharges per 100 population per year. 10 discharges per 100 people per year is proposed as a benchmark. The indicator is scored as (N of hospital discharges per 100 people per year)/ 10 * 100% (max. 100). The service availability index is calculated using the above mentioned indicators. First, indices are calculated for health services infrastructure, health workforce, and service utilization. The calculations for creating those indices are as follows in Table 4.1.3. Please refer Table 4.1.2 for the definitions of indicators a-f. The service availability index is the un-weighted average of the three areas: infrastructure, health workforce, and utilization: [((a + b + c)/3) + d + ((e + f) / 2)] / 3, and is a percentage score.

∗ Equation from UNFPA: http://www.unfpa.org/emergencies/manual/9a5.htm

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4. Indicators index TABLE 4.1.3: SERVICE AVAILABILITY INDICES Indicator Health Services Infrastructure Index Average score of the three indicators: facility density, inpatient beds, maternity beds Core health workers Average score of the two indicators: outpatient visits, hospital discharges Un-weighted average of the three areas: infrastructure, workforce, and utilization Target 100 Score ((a) + (b) + (c)) / 3

Health Workforce Index Service Utilization Index

100 100

d ((e) + (f)) / 2 [((a + b + c)/3) + d + ((e + f) / 2)] / 3

Service Availability Index

100

Table 4.1.4 below gives the ID numbers for the service availability indicators and indices.

TABLE 4.1.4: SERVICE AVAILABILITY INDICATOR ID NUMBERS Indicator Facilities Inpatient beds Maternity beds Core health workforce Outpatient service utilization In-patient service utilization Health infrastructure index Core health workforce index Service utilization index Service availability index ID Number S1 S2 S3 S4 S5 S6 IN1 IN2 IN3 IN4

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4.3

SARA general service readiness indicators Tracer indicator Power

TABLE 4.3.1: TRACER INDICATORS FOR GENERAL SERVICE READINESS Domain Basic amenities DO1 Domain score = Mean score of items as percentage N/7*100 Improved water source within 500 meters of facility I2

ID I1

Definition Facility routinely has electricity for lights and communication (at a minimum) from any power source during normal working hours; there has not been a break in power for more than 2 hours per day during the past 7 days. Improved water source uses uniform definitions for safe water sources promoted by UNICEF. These include the following: Piped, public tap, standpipe, tubewell/borehole, protected dug well, protected spring, rain water. NOTE: The type of base for the standpipe or tubewell is not considered for this question. Private room or screened off area available in main service area (usually the general outpatient service area), a sufficient distance from sites where providers/clients routinely may be, so that a normal conversation could be held without being overheard, and without the client being observed. The toilet/latrine is classified using uniform criteria for improved sanitation promoted by UNICEF. These include the following: Flush/pour flush to piped sewer system or septic tank or pit latrine, pit latrine (ventilated improved pit (VIP) or other) with slab, composting toilet Functioning communication equipment. This will not include private cell phones unless the facility reimburses for cost of phone calls. This will not include payphones outside of the facility.

Data collection notes Reported availability.

Observed availability.

Room with auditory and visual privacy for patient consultations

Observed availability.

Access to adequate sanitation facilities for clients

Reported availability accepted.

Communication equipment (phone or SW radio)

Reported availability accepted

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4. Indicators index Domain

Tracer indicator Facility has access to computer with email/internet access

ID I6

Definition Facility has a functioning computer and has access to email/internet with internet working on the day of the survey. Facility has a functioning vehicle with fuel that is routinely available that can be used for emergency transportation or access to a vehicle in near proximity that can be used for emergency transportation

Data collection notes Reported availability accepted

Emergency transportation

Reported availability accepted

REFERENCES: Progress on sanitation and drinking water 2010 update http://www.wssinfo.org/fileadmin/user_upload/resources/1278061137-JMP_report_2010_en.pdf Guidance for Selecting and Using Core Indicators for Cross-Country Comparisons of Health Facility Readiness to Provide Services http://ihfan.org/home/docs/attachments/WP-07-97_Guidance_HF_Core_Indicators.pdf Basic equipment DO2 Domain score = Mean score of items as percentage N/6*100 Adult scale Child scale E1 E2

Weight gradation minimum 250 grams. A digital standing scale where adult holds child and gradations go to 250 grams is acceptable

Thermometer Stethoscope Blood pressure apparatus

E3 E4 E5

Digital BP machine or manual sphygmomanometer with stethoscope Spotlight source that can be used for patient examinations. A functional flashlight is accepted.

Light source

Items observed and functioning in the main service area (usually the general outpatient department) or in the immediate vicinity where it is reasonable to assume that they can be used for the services being provided in the main service area. Note: if items are in service specific areas but are readily available for use for general outpatient clients, this is acceptable

REFERENCES: Guidance for Selecting and Using Core Indicators for Cross-Country Comparisons of Health Facility Readiness to Provide Services http://ihfan.org/home/docs/attachments/WP-07-97_Guidance_HF_Core_Indicators.pdf

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Tracer indicator Safe final disposal of sharps

ID I9

Definition Safe final disposal of sharps includes incineration, open burning in protected area, dump without burning in protected area, or remove offsite with protected storage. If method is incineration, incinerator functioning and fuel available. Safe final disposal of infectious wastes includes incineration, open burning in protected area, dump without burning in protected area, or remove offsite with protected storage. If method is incineration, incinerator functioning and fuel available. A puncture-resistant, rigid, leakresistant container designed to hold used sharps safely during collection, disposal and destruction. Sharps containers should be made of plastic, metal, or cardboard and have a lid that can be closed. Sharps containers should be fitted with a sharps aperture, capable of receiving syringes and needle assemblies of all standard sizes, together with other sharps. Boxes must be clearly marked with the international biohazard warning not less than 50mm diameter, printed in black or red on each of the front and back faces of the box. . Waste receptacle (pedal bin) with lid and plastic bin liner. Chlorine-based or other country specific used for environmental disinfection

Data collection notes Observed final disposal/holding site for sharps and verify no unprotected sharps are observed.

Safe final disposal of infectious wastes

I10

Observed final disposal/holding site for infectious wastes and verify no unprotected waste is observed.

Appropriate storage of sharps waste

I11

Observed availability in all three main service areas: general OPD, HIV testing area, and surgery area

Appropriate storage of infectious waste Disinfectant

I12 I13

Observed availability anywhere in the facility

Single use —standard disposable or auto-disable syringes Soap and running water or alcohol based hand rub Latex gloves Guidelines for standard precautions

I14

I15 I16 T1

If equivalent non latex gloves are available this is acceptable.

Observed available in all three main service areas: general OPD, HIV testing area, and surgery area. Observed availability anywhere in their facility

REFERENCES: Practical Guidelines for Infection Control in Health Care Facilities. Geneva http://whqlibdoc.who.int/wpro/2003/a82694.pdf

169

4. Indicators index Domain Diagnostic capacity DO4 Domain score = Mean score of items as percentage N/8*100

Tracer indicator Haemoglobin

ID D1

Definition This may include colorimeter OR haemoglobinometer OR hemocue. Glucometer and glucometer test strips RDT kit or smear with microscope, slides, and Wright Giemsa stain Dipsticks for urine protein (with valid expiration date) Dipsticks for urine glucose (with valid expiration date) RDT kit or ELISA test with ELISA washer, ELISA reader, incubator, specific assay kit RDT kit RDT kit

Data collection notes Able to conduct the test onsite (in the facility) and functioning equipment and reagents needed to conduct the test are observed onsite on the day of the survey. These may be in a laboratory or in the service area where the test is conducted.

Blood glucose Malaria diagnostic capacity

D2 D3

Urine dipstick- protein Urine dipstick- glucose HIV diagnostic capacity

D4 D5 D6

Syphilis rapid test Urine test for pregnancy REFERENCES:

D9 D11

Consolation on technical and operation recommendations for clinical laboratory testing harmonization and standardization http://www.who.int/healthsystems/round9_9.pdf Essential medicines DO5 Domain score = Mean score of items as percentage N/25*100 Amlodipine tablet or alternative calcium channel blocker Amoxicillin syrup/suspension or dispersible tablet Amoxicillin tablet Ampicillin powder for injection Aspirin cap/tab Beclometasone inhaler Beta blocker (e.g.bisoprolol, metoprolol, carvedilol, atenolol) Carbamazepine tablet Ceftriaxone injection Diazepam injection Enalapril tablet or alternative ACE inhibitor e.g. lisinopril, ramipril, perindopril Fluoxetine tablet Gentamicin injection Glibenclamide tablet Haloperidol tablet Insulin regular injection Magnesium sulphate injectable M56

M33

Observed in pharmacy or in area where they are routinely stored, at least one with valid expiration date. Respiratory antibiotic

M2 M71 M57 M59 M55

M119 M5 M25 M53

2nd line injectable antibiotic

M94 M72 M10 M124 M51 M24

Oral treatment type 2 diabetes

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Tracer indicator Metformin tablet Omeprazole tablet or alternative such as pantoprazole, rabeprazole Oral rehydration solution Oxytocin injection Salbutamol inhaler Simvastatin tablet or other statin e.g. atorvastatin, pravastatin, fluvastatin Thiazide (e.g. hydrochlorothiazide) Zinc sulphate tablets, dispersible tablets or syrup

ID M50 M11

Definition Gastro-esophogeal reflux

Data collection notes

M32 M22 M13 M14

Chronic asthma attacks High cholesterol

M54 M36

REFERENCES: WHO (2013). WHO Model List of Essential Medicines. http://apps.who.int/iris/bitstream/10665/93142/1/EML_18_eng.pdf?ua=1 Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and their Measurement Strategies. Geneva: World Health Organization. Available at: http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf

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4. Indicators index

4.4

SARA service specific availability and readiness indicators Tracer indicator ID Definition Data collection notes

TABLE 4.4.1: TRACER INDICATORS FOR REPRODUCTIVE, MATERNAL, NEWBORN, CHILD, AND ADOLESCENT HEALTH SERVICE AVAILABILITY AND READINESS Domain Family planning services

SERVICE AVAILABILITY % of facilities offering: Family planning services Provision of combined oral contraceptive pills Provision of progestin-only contraceptive pills Provision of combined injectable contraceptives Provision of progestin-only injectable contraceptives Provision of male condoms Provision of female condoms Provision of intrauterine contraceptive device Provision of implant Provision of cycle beads for standard days method Provision of emergency contraceptive pills Male sterilization Female sterilization S7 S7_01 S7_02 S7_03 S7_04 S7_05 S7_06 S7_07 S7_08 S7_09 S7_10 S7_11 S7_12

SERVICE READINESS IN6 % of facilities providing family planning services with tracer items on the day of the assessment Staff and guidelines DO6 Guidelines on family planning Family planning check-lists and/or job-aids Staff trained in FP T2

Country adapt to which guidelines are required/accepted

Guidelines observed in service area.

T62

At least one staff member providing the service trained in the last two years in some aspect of FP

Interview response from in-charge of service area day of survey.

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Tracer indicator Blood pressure apparatus

ID E5

Definition Digital BP machine or manual sphygmomanometer with stethoscope

Data collection notes Observed availability, reported functionality, and in service area or adjacent area.

Medicines and commodities DO8

Combined estrogen progesterone oral contraceptive pills Progestin-only contraceptive pills Injectable contraceptives

M15

M96 M16

Observed in service area OR where routinely stored; in stock with at least one valid. Can be either combined estrogen progesterone injectable contraceptives or progestin-only injectable contraceptives Male

Condoms

M17

AUXILIARY INDICATORS % of facilities providing family planning services with: Other family planning commodities in stock Combined estrogen progesterone injectable contraceptives Progestin-only injectable contraceptives Female condoms Implants Emergency contraceptive M97

M98 M99 M108 M109

Observed in service area OR where routinely stored; in stock with at least one valid.

E.g.levonorgestrel or etonogestrel implant E.g.Levonorgestrel tablet or ulipristal acetate tablet or mifepristone tablet 10-25 mg

Intrauterine contraceptive device (IUCD) Stock-outs (in past 3 months) Female condoms Implants Emergency contraceptive

M105 M99_A M108_A M109_A

E.g.levonorgestrel or etonogestrel implant E.g.Levonorgestrel tablet or ulipristal acetate tablet or mifepristone tablet 10-25 mg

REFERENCES: Family Planning: A Global Handbook for Providers http://whqlibdoc.who.int/publications/2011/9780978856373_eng.pdf Essential Medicines for Reproductive Health: Guiding Principles for Their Inclusion on National Medicines Lists http://whqlibdoc.who.int/hq/2006/a91388.pdf Antenatal care services

SERVICE AVAILABILITY % of facilities offering: Antenatal care services Iron supplementation Folic acid supplementation S8 S8_01 S8_02

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4. Indicators index Domain

Tracer indicator Intermittent Preventive Treatment in pregnancy (IPTp) for malaria Tetanus toxoid vaccination Monitoring for hypertensive disorder of pregnancy

ID S8_03

Definition

Data collection notes

S8_04 S8_05

SERVICE READINESS IN7 % of facilities providing antenatal care services with tracer items on the day of the assessment Staff and guidelines DO9 Guidelines on ANC T4

Country adapt to which guidelines are required/accepted

Guidelines observed in service area.

ANC check-lists and/or jobaids Staff trained in ANC

T63 T5

At least one staff member providing the service trained in some aspect of ANC in the last two years Digital BP machine or manual sphygmomanometer with stethoscope This may include colorimeter, haemoglobinometer, hemocue, or any other country specific method. This includes urine protein dipsticks.

Interview response from in-charge of service area day of survey. Observed availability, reported functionality, and in service area or adjacent area. Able to conduct the test on-site (in the facility) and functioning equipment and reagents needed to conduct the test are observed on-site on the day of the survey. In the area where ANC tests are conducted or anywhere in the facility where laboratory testing is routinely conducted. Observed in service area OR where routinely stored; in stock with at least one valid.

Equipment DO10

Blood pressure apparatus

Diagnostics DO11

Haemoglobin

Urine dipstick- protein

Medicines and commodities DO12

Iron tablets Folic acid tablets Tetanus toxoid vaccine *IPT drug *ITNs

M18 M19 M20 M39 M40

Iron and folic acid may be combined

Sulfadoxine + Pyrimethamine(SP) ITNs or vouchers available for distribution

REFERENCES: Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice http://whqlibdoc.who.int/publications/2006/924159084X_eng.pdf *Only in high prevalence areas Basic obstetric care

SERVICE AVAILABILITY % of facilities offering: Delivery services OBSTERIC SIGNAL FUNCTIONS Parenteral administration of antibiotics for mothers S9_01 S9

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Tracer indicator Parenteral administration of oxytocic drug Parenteral administration of anticonvulsants Assisted vaginal delivery Manual removal of placenta Manual removal of retained products Mean availability of obstetric signal functions offered NEWBORN SIGNAL FUNCTIONS Antibiotics for preterm or prolonged PROM to prevent infection Neonatal resuscitation with bag and mask Corticosteroids in preterm labour KMC (Kangaroo mother care) for premature/very small babies Injectable antibiotics for neonatal sepsis Mean availability of newborn signal functions offered ROUTINE PRACTICES Administration of oxytocin for the prevention of postpartum haemorrhage

ID S9_02 S9_03 S9_04 S9_05 S9_06 S9_18

Definition

Data collection notes

S9_09

S9_07 S9_10 S9_11

S9_12 S9_19

S9_13

Routine administration of oxytocin injection immediately after birth to all women for the prevention of post-partum haemorrhage

Monitoring and management of labour using partograph Immediate and exclusive breastfeeding Hygienic cord care

S9_14

S9_15 S9_16

Cut with sterile item and apply disinfectant to tip and stump, and no application of other substances

Thermal protection (drying baby immediately after birth and wrapping)

S9_17

SERVICE READINESS IN8 % of facilities providing facility-based delivery services with tracer items on the day of the assessment Staff and guidelines DO13 Guidelines for essential childbirth care Check-lists and/or job-aids for essential childbirth care T6

Country adapt to which guidelines are required/accepted

Guidelines observed in service area.

T64

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4. Indicators index Domain

Tracer indicator Staff trained in essential childbirth care

ID T7

Definition At least one staff member providing the service trained in essential childbirth care in the last two years (other than training on newborn resuscitation using bag and mask) At least one staff member providing the service trained in newborn resuscitation using bag and mask in the last two years Facility has a functioning vehicle with fuel that is routinely available that can be used for emergency transportation or access to a vehicle in near proximity that can be used for emergency transportation This is usually either a dry heat sterilizer or an autoclave. If the machine is not electric, then make sure that the heat source is available and (If relevant) functioning (e.g., wood or gas is present for the autoclave). Functioning spotlight source that can be used for patient examinations. A functional flashlight is accepted. Delivery pack OR cord clamp, episiotomy scissors, scissors/blade to cut cord, suture material with needle, AND needle holder Suction bulb (single use or sterilizable multi-use) or electric suction pump AND suction catheter for suctioning newborn

Data collection notes Interview response from in-charge of service area day of survey.

Staff trained in newborn resuscitation

T65

Equipment DO14

Emergency transport

Reported availability and functionality.

Sterilization equipment

Observed availability anywhere in the facility reported functionality.

Examination light

Observed availability, reported functionality, and in service area or adjacent area.

Delivery pack

Suction apparatus (mucus extractor)

Manual vacuum extractor Vacuum aspirator or D&C kit (with speculum) Neonatal bag and mask

E10 E11 E12

Newborn bag and mask (size 1 for term babies AND size 0 for pre-term babies) Blank partographs Sterile latex or equivalent Observed in service area OR where routinely stored; in stock with at least one Observed in service area.

Delivery bed Partograph Gloves Medicines and commodities DO15 Antibiotic eye ointment for newborn Injectable uterotonic

E37 E13 I20 M21 M22

Oxytocin

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Tracer indicator Injectable antibiotic

ID M23

Definition Broad-spectrum injectable antibiotic treatment of sepsis in mother and newbornSpecific combinationAmpicillin + gentamicin OR penicillin + gentamicin OR ceftriaxone OR as per country specific formulation Magnesium sulphate 50% injection or alternative strength Normal saline or Ringers Lactate, and Dextrose 5%

Data collection notes valid.

Magnesium sulphate (injectable) Skin disinfectant Intravenous solution with infusion set REFERENCES:

M24

M26 M27

Guidelines for Monitoring the Availability and Use of Obstetric Services http://www.childinfo.org/files/maternal_mortality_finalgui.pdf Monitoring Emergency Obstetric Care: a handbook http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf Comprehensive obstetric care

SERVICE AVAILABILITY % of HOSPITALS and LOWER-LEVEL FACILITIES offering: Caesarean section Blood transfusion Comprehensive emergency obstetric care S26_01 S26_02 S26_03

Offers all 7 obstetric signal functions + caesarean section and blood transfusion

SERVICE READINESS IN23 % of HOSPITALS AND FACILITIES PROVIDING CAESAREAN SECTION with tracer items on the day of the assessment Staff and guidelines DO62 Guidelines for CEmOC T51

Country adapt to which guidelines are required/accepted At least one staff member providing the service trained in CEmOC within the past 2 years Health worker who can perform caesarean section present in the facility or oncall 24 hours a day Anaesthetist present in the facility or on-call 24 hours a day

Guidelines observed in service area.

Staff trained in CEmOC

T52

Interview response from in-charge of service area day of survey.

Staff trained in surgery

T53

Staff trained in anaesthesia

T54

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4. Indicators index Domain Equipment DO63

Tracer indicator Anaesthesia equipment

ID E29

Definition • Anaesthesia machine to deliver aesthetic gases and oxygen • Tubings and connectors to connect to the endotracheal tube • Resuscitator bag and maskadult and paediatric • Intubation set adult and paediatric: (Oropharyangeal airway, endotracheal tubes, laryngoscope, Magill’s forceps, stylet)

Data collection notes Observed availability, reported functionality, and in service area.

Resuscitation table

E50

Resuscitation table with heat source for newborn resuscitation

Incubator Oxygen

E30

E45

Oxygen cylinders OR concentrators OR central oxygen supply AND (functioning flowmeter for oxygen therapy AND oxygen delivery apparatus (key connecting tubes and mask/nasal prongs) AND oxygen available at all times during the 3 past months ABO blood group test, Rhesus blood group test, and centrifuge Cross match (should use methods that demonstrate ABO incompatibility and incompatibility due to other clinically significant antibodies and should include an indirect anti-globulin test or a test of equivalent sensitivity), centrifuge, 37°C incubator, and grouping sera No interruption of blood availability in last three months Blood obtained ONLY from national or regional blood bank, OR blood obtained from other sources but screened for HIV, Syphilis, Hepatitis B, and Hepatitis C. Observed in service area; in stock with at least one valid. Able to conduct the test on-site (in the facility) and functioning equipment and reagents needed to conduct the test are observed on-site on the day of the survey. This may be in a laboratory or in the service area where the test is conducted.

Spinal needle Diagnostics DO64 Blood typing

E32 D21

Cross match testing

D22

Medicines and commodities DO65

Blood supply sufficiency

M66

Reported availability.

Blood supply safety

M67

Lidocaine 5% Epinephrine (injectable) Halothane (inhalation) Atropine (injectable)

M89 M62 M87 M86

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Tracer indicator Thiopental (powder) Suxamethonium bromide (powder) Ketamine (injectable)

ID M84 M85 M64

Definition

Data collection notes

REFERENCES: Guide to Infrastructure and Supplies at Various Levels of Health Care Facilities: Emergency and Essential Surgical and Anaesthesia Procedures http://www.who.int/surgery/publications/GuideAnestheticInfrastFormatted06.pdf Guidelines for Monitoring the Availability and Use of Obstetric Services http://www.childinfo.org/files/maternal_mortality_finalgui.pdf Monitoring Emergency Obstetric Care: a handbook http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf Immunization

SERVICE AVAILABILITY % of facilities offering: Routine immunization services Birth doses S10 S10_07

As per national schedule. Immunization service delivery provided at the facility, as outreach or both As per national schedule. Immunization service delivery provided at the facility, as outreach or both As per national schedule. Immunization service delivery provided at the facility, as outreach or both Routine child immunization services are offered in the facility on daily, weekly, monthly, quarterly or other basis. Routine child immunization services are offered as outreach on a daily, weekly, monthly, quarterly or other basis.

Infant vaccines

S10_08

Adolescent/adult vaccines

S10_09

Frequency routine child immunization

Frequency all child immunization services offered in the facility

S10_10A S10_10B S10_10C S10_10D S10_10E S10_11A S10_11B S10_11C S10_11D S10_11E

Frequency all child immunization services offered as outreach

SERVICE READINESS IN9 % of facilities providing routine immunization services with tracer items on the day of the assessment Staff and guidelines DO16 Guidelines for child immunization T8

Country adapt to which guidelines are required/accepted for routine child immunization

Guidelines observed in service area.

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4. Indicators index Domain

Tracer indicator Staff trained in child immunization

ID T9

Definition At least one staff member providing the service trained in some aspect of immunization service delivery in the last two years by formal training

Data collection notes Interview response from in-charge of service area day of survey.

Equipment DO17

Cold box/vaccine carrier with ice packs Refrigerator

E14 E15

Observed in service area or adjacent site. Functioning refrigerator with sufficient storage capacity to accommodate all needed vaccines. A puncture-resistant, rigid, leak-resistant container designed to hold used sharps safely during collection, disposal and destruction. Sharps containers should be made of plastic, metal, or cardboard and have a lid that can be closed. Sharps containers should be fitted with a sharps aperture, capable of receiving syringes and needle assemblies of all standard sizes, together with other sharps. Boxes must be clearly marked with the international bio-hazard warning not less than 50mm diameter, printed in black or red on each of the front and back faces of the box. Thermometer or recorder/logger The temperature is monitored twice daily and has not been out of the range o 2 to 8 C inclusive in the last 30 days /record verification) In stock In stock Observed availability, and functionality, and in service area or adjacent site. Observed in service area

Sharps container/safety box

I21

Auto-disable syringes Temperature monitoring device in refrigerator Adequate refrigerator temperature

I22 E39

Observed availability, and functionality, and in service area or adjacent site. Observed in records in the services area OR where routinely stored

E49

Immunization cards Immunization tally sheets Medicines and commodities DO18 *Vaccines to be specified as per the national schedule

E41 E42 M28 M29 M30 M31 M93 M92

Observed in service area OR where routinely stored. Observed in service area OR where routinely stored. Observed in service area OR where routinely stored; in stock with at least one valid (not expired and VVM not turned) on day of assessment

Measles vaccine DPT-Hib+HepB vaccine Oral polio vaccine BCG vaccine Pneumococcal vaccine Rotavirus vaccine

Country specific vaccine combination

If part of the national schedule If part of the national schedule

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Tracer indicator IPV (Inactivated Poliovirus Vaccine) HPV (Human Papillomavirus)

ID M142 M143

Definition If part of the national schedule If part of the national schedule

Data collection notes

AUXILIARY INDICATORS % of facilities providing routine immunization services with: Stock-outs (in past 3 months) *Vaccines to be specified as per the national schedule

Measles vaccine DPT-Hib+HepB vaccine Oral polio vaccine BCG vaccine Pneumococcal vaccine Rotavirus vaccine IPV HPV

M28_A M29_A M30_A M31_A M93_A M92_A M142_A M143_A E47

Country specific vaccine combination

Check vaccine stock records. Inability to give vaccine anytime in past three months due to unavailable stock

If part of the national schedule If part of the national schedule

Cold Chain

Cold chain minimum requirements

The minimum adequate cold chain requirements are available (there is a functional refrigerator, there is a temperature monitoring device, and the temperature has been maintained between 2 and 8 C checked for the last 30 days. Energy provided to the vaccine refrigerator through any source that supplies power to the refrigerator 24hours a day and for 7 days in the week Grid or generator Solar Gas Kerosene Mixed Other

Energy source and power supply for vaccine refrigerator

E40

Types of power used for cold chain refrigeration

E40_A E40_B E40_C E40_D E40_E E40_F

REFERENCES: Immunization Essentials: A Practical Field Guide http://www.who.int/pmnch/topics/tools/20081021_usaidimmunization/en/index.htm Child health services: preventative and curative care

SERVICE AVAILABILITY % of facilities offering: Preventive and curative care for children under 5 Malnutrition diagnosis and treatment Vitamin A supplementation Iron supplementation S11 S11_01 S11_02 S11_03

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4. Indicators index Domain

Tracer indicator ORS and zinc supplementation Growth monitoring Treatment of pneumonia Administration of amoxicillin for the treatment of pneumonia in children Treatment of malaria in children

ID S11_04 S11_05 S11_06 S11_07

Definition

Data collection notes

S11_08

SERVICE READINESS IN10 % of facilities providing child curative care services with tracer items on the day of the assessment Staff and guidelines DO19 Guidelines for IMCI T10

Country adapt to which guidelines are required/accepted Country adapt to which guidelines are required/accepted At least one staff member providing the service trained in some aspect of IMCI in the last two years At least one staff member providing the service trained in some aspect of growth monitoring in the last two years Weight gradations at minimum 250 grams and 100 grams Wooden boards or metal beams with a mounted rule that permits measurement of crown-to-heel length (infants under 2 y, lying down) or height (older children, standing up) in centimetres. Gradations at 1 or 5 mm.

Guidelines observed in service area.

Guidelines for growth monitoring Staff trained in IMCI

T11

T12

Interview response from in-charge of service area day of survey.

Staff trained in growth monitoring

T13

Equipment DO20

Child and infant scale

E38

Length/height measuring equipment

E16

Observed availability, reported functionality, and in service area or adjacent area.

Thermometer Stethoscope Growth chart Diagnostics DO21 Haemoglobin (Hb)

E3 E4 E17 D1

Observed in service area or adjacent area. This may include colorimeter, haemoglobinometer, hemocue, or any other country specific method. Microscope, slides, covers Able to conduct the test on-site (in the facility) and functioning equipment and reagents needed to conduct the test are observed on-site on the

Test parasite in stool (general microscopy)

D10

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Tracer indicator Malaria diagnostic capacity

ID D3

Definition Malaria rapid test or smear (microscope, slides, and stain)

Data collection notes day of the survey. In area where tests for child health are carried out or anywhere in the facility where laboratory testing is routinely conducted. Observed in service area OR where routinely stored; in stock with at least one valid.

Medicines and commodities DO22

Oral rehydration solution packet Amoxicillin (dispersible tablet 250 or 500 mg OR syrup/suspension) Co-trimoxazole syrup/suspension Paracetamol syrup/suspension Vitamin A capsules Me-/albendazole cap/tab Zinc sulphate tablets, dispersible tablets or syrup

M32 M33

Any child dosage or formulation.

M7 M12 M34 M35 M36

REFERENCES: Handbook: IMCI integrated management of childhood illness http://whqlibdoc.who.int/publications/2005/9241546441.pdf Training Course on Child Growth Assessment http://www.who.int/childgrowth/training/en/ Adolescent health ‡

SERVICE AVAILABILITY % of facilities offering: Adolescent health services HIV testing and counselling services to adolescents Family planning services to adolescents S12 S12_01 S12_02

Facility provides condoms and at least one other method of family planning to adolescents

Provision of combined oral contraceptive pills to adolescents Provision of male condoms to adolescents Provision of emergency contraceptive pills to adolescents Provision of intrauterine contraceptive device (IUCD) to adolescents Provision of ART to adolescents

S12_03

S12_04 S12_06

S12_07

S12_09

SERVICE READINESS IN11 % of facilities providing adolescent health services with tracer items on the day of the assessment

183

4. Indicators index Domain Staff and guidelines DO23

Tracer indicator Guidelines for service provision to adolescents Staff trained in provision of adolescent health services

ID T14

Definition Country adapt to which standards/guidelines are required/accepted. At least one staff providing services for adolescents trained in adolescent health in the last two years. At least one staff providing family planning services trained in adolescent sexual and reproductive health in the last two years. At least one staff providing HIV testing and counselling services trained in HIV prevention, care, and management in the last two years. RDT kit or ELISA test with ELISA washer, ELISA reader, incubator, specific assay kit

Data collection notes Guidelines observed in service area. Interview response from in-charge of service area day of survey.

T15

Staff providing family planning services trained in adolescent sexual and reproductive health Staff providing HIV testing and counselling services trained in HIV/AIDS prevention, care, and management for adolescents Diagnostics DO77 HIV diagnostic capacity

T16

T17

Able to conduct the test on-site (in the facility) and functioning equipment and reagents needed to conduct the test are observed on-site on the day of the survey. In area where tests for HIV are carried out or anywhere in the facility where laboratory testing is routinely conducted. Observed in service area OR where routinely stored; in stock with at least one valid.

Medicines and commodities DO24 REFERENCES:

Condoms

M17

Male

Quality assessment guidebook: a guide to assessing health services for adolescent clients http://whqlibdoc.who.int/publications/2009/9789241598859_eng.pdf Adolescent job aid: a handy desk reference tool for primary level health workers http://whqlibdoc.who.int/publications/2010/9789241599962_eng.pdf Orientation programme on adolescent health for health-care providers http://www.who.int/child_adolescent_health/documents/9241591269/en/index.html Adolescent friendly health services: An agenda for change http://whqlibdoc.who.int/hq/2003/WHO_FCH_CAH_02.14.pdf Protecting young people from HIV and AIDS: the role of health services http://whqlibdoc.who.int/publications/2004/9241592478.pdf Priority medicines for mothers D070 % of facilities offering delivery services that have: Oxytocin injectable Sodium chloride injectable solution Calcium gluconate injectable M22 M69 M70

Observed in pharmacy or in area where they are routinely stored, at least one with valid expiration date.

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Tracer indicator Magnesium sulphate injectable Ampicillin powder for injection Gentamicin injectable Metronidazole injectable Misoprostol cap/tab Azithromycin cap/tab or oral liquid Cefixime cap/tab Benzathine benzylpenicillin powder for injection Betamethasone or Dexamethasone injectable Nifedipine cap/tab Hydralazine injection Methyldopa tablet

ID M24

Definition Magnesium sulphate 50% injection or alternative strength

Data collection notes

M71 M72 M73 M74 M75 M76 M77 M78 M79 M106 M107

Immediate release 10mg capsule formulation

REFERENCES: Priority medicines for mothers and children 2011 http://www.who.int/medicines/publications/A4prioritymedicines.pdf

Priority medicines for children DO71 % of facilities providing child health curative care services that have: Amoxicillin (dispersible tablet 250 or 500 mg OR syrup/suspension) Ampicillin powder for injection Ceftriaxone powder for injection Gentamicin injectable Procaine benzylpenicillin powder for injection Oral Rehydration Salts (ORS) sachets Zinc sulphate tablets, dispersible tablets or syrup Artemisinin combination therapy (ACT) Artesunate rectal or injectable forms Vitamin A capsules M33

Any child dosage or formulation.

M71 M5 M141 M80 M32 M36 M81 M82 M34

Observed in pharmacy or in area where they are routinely stored, at least one with valid expiration date.

185

4. Indicators index Domain

Tracer indicator Morphine granule, injectable or cap/tab Paracetamol syrup/ suspension

ID M83 M12

Definition

Data collection notes

REFERENCES: Priority medicines for mothers and children 2011 http://www.who.int/medicines/publications/A4prioritymedicines.pdf

Life-saving commodities for women and children % of facilities that have: COMMODITIES IN STOCK Family planning Female condoms Implants Emergency contraceptives M99 M108 M109

E.g. levonorgestrel or etonogestrel implant E.g. levonorgestrel, ulipristal acetate, or mifepristone 1025 mg tablet Injectable 200 μg tablets Injectable (50% or alternative strength) Procaine benzylpenicillin (PBP) or gentamicin and ceftriaxone Betamethasone or dexamethasone Newborn bag and mask (size 1 for term babies AND size 0 for pre-term babies), suction device (suction catheter and electric suction bulb, or mucus aspirator bulb – single use or multi-use sterilizable) 250 mg or 500 mg dispersible tablets or syrup/suspension Tablets, dispersible tablets or syrup

Observed available in pharmacy or where they are routinely stored, at least one with valid expiration date;

Maternal health

Oxytocin Misoprostol Magnesium sulphate

M22 M74 M24 M110

Newborn health

Injectable antibiotics

Antenatal corticosteroids Skin disinfectant Resuscitation equipment

M78 M26 E43

Child health

Amoxicillin Oral rehydration salts Zinc sulphate

M33 M32 M36

STOCK OUTS % of facilities that had a stock out in the previous 3 months Female condoms Implants M99_A M108_A

E.g. levonorgestrel, etonogestrel (or other as per country official standard) Levonorgestrel tablet, ulipristal acetate tablet, mifepristone tablet 10-25 mg (or other as per country official standard)

Emergency contraceptive

M109_A

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Tracer indicator Oxytocin injection Misoprostol 200µg tablets Magnesium sulphate injection Gentamicin injection Procaine benzylpenicillin injection Ceftriaxone injection Betamethasone injection Dexamethasone injection Amoxicillin (dispersible tablet 250 or 500 mg OR syrup/suspension) Oral rehydration salts (ORS) Zinc sulphate tablets Zinc sulphate syrup or dispersible tablets

ID M22_A M74_A M24_A

Definition

Data collection notes

Magnesium sulphate 50% injection or alternative strength

M72_A M80_A M5_A M78_A M78_B M33_A

M32_A M36_A M36_B

REFERENCES: UN Commission on Life-Saving Commodities http://www.everywomaneverychild.org/resources/un-commission-on-life-saving-commodities/life-saving-commodities

NOTES : Malaria : * Only for high prevalence regions. Adolescent health : ‡ This is an optional indicator. In countries with adolescent health programs, definitions need to be further refined to reflect countryspecific context and content of the programs. Indicators may not be comparable across countries. Staff training : † During a pretest of the core SARA questionnaire, it was suggested that indicators regarding trained staff may be subject to data quality issues given the current methodology i.e., the phrasing of the questionnaire, and the respondent of the questions on trained staff. Results should be interpreted with caution. Alternate questions are being planned to be tested, and the definition will be updated accordingly.

187

4. Indicators index

TABLE 4.4.2: TRACER INDICATORS FOR COMMUNICABLE DISEASE SERVICE AVAILABILITY AND READINESS Domain Malaria

Tracer indicator

Definition

Data collection notes

SERVICE AVAILABILITY % of facilities offering: Malaria services Malaria diagnosis Malaria diagnostic testing S15 S15_01 S15_02

Facility uses laboratory diagnostic test (RDT or microscopy) to diagnose malaria

Malaria diagnosis by clinical symptoms Malaria diagnosis by RDT Malaria diagnosis by microscopy Malaria treatment IPT

S15_05 S15_06 S15_07 S15_03 S15_04

Only for high prevalence areas

SERVICE READINESS IN12 % of facilities providing malaria services with tracer items on the day of the assessment Staff and guidelines DO26 Guidelines for diagnosis and treatment of malaria *Guidelines for IPT T18

Country adapt to which guidelines are required/accepted Country adapt to which guidelines are required/accepted At least one staff member providing the service trained in some aspect of malaria diagnosis and treatment in the last two years. At least one staff member providing the service trained in some aspect of IPT in the last two years. Malaria rapid test or smear (microscope, slides, stain, and accredited/certified microscopist)

Guidelines observed in service area.

T19

Staff trained in malaria diagnosis and treatment

T20

Interview response from incharge of service area day of survey.

*Staff trained in IPT

T21

Diagnostics DO27

Malaria diagnostic capacity

Able to conduct the test on-site (in the facility) and functioning equipment and reagents needed to conduct the test are observed on-site on the day of the survey. In area where tests for malaria are carried out or anywhere in the facility where laboratory testing is routinely conducted. Observed in service area OR where routinely stored; in stock with at least one valid.

Medicines and commodities DO28

First-line antimalarial in stock

M37

Artemisinin-based Combination Therapy (ACT) or other country specific Sulfadoxine + Pyrimethamine (SP)

Paracetamol cap/tab *IPT drug

M38 M39

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Tracer indicator *ITN

ID M40

Definition ITNs or vouchers available for distribution

Data collection notes

AUXILIARY INDICATORS % of facilities providing malaria services with: Staff Diagnostics Accredited/certified microscopist Capacity to conduct malaria microscopy Capacity to conduct RDT T59 D35

Microscope, slides, stain, and accredited/certified microscopist Staff trained in malaria diagnosis with RDTs, and RDTs available (observed and nonexpired) at the facility on the day of the assessment Observed in service area OR where routinely stored; in stock with at least one valid. Facility had a stock out of malaria RDTs in the past four weeks

D34

Availability of RDT

D36

Stock outs

RDT stock out

D36_A

Length of RDT stock out ACT stock out Length of ACT stock out Medicines Artemisinin monotherapy (oral) Artesunate rectal or injection dosage forms Chloroquine (oral) Quinine (oral) Primaquine (oral) REFERENCES:

D36_B M37_A M37_B M136 M82 M138 M139 M140

Facility had a stock out of ACT in the past four weeks Facilities are not expected to have this medicine

Facilities are not expected to have this medicine

World Malaria Report http://www.who.int/malaria/world_malaria_report_2010/worldmalariareport2010.pdf Guidelines for the treatment of malaria, second edition http://whqlibdoc.who.int/publications/2010/9789241547925_eng.pdf Tuberculosis

SERVICE AVAILABILITY % of facilities offering: TB services TB diagnosis TB diagnostic testing S16 S16_01 S16_02

Facility uses laboratory diagnostic test (sputum smear microscopy, culture, rapid test) or chest X-ray to diagnose TB

189

4. Indicators index Domain

Tracer indicator TB diagnosis by clinical symptoms TB diagnosis by sputum smear microscopy examination TB diagnosis by culture TB diagnosis by rapid test (GeneXpert MTB/RIF) TB diagnosis by chest X-ray Prescription of drugs to TB patients Provision of drugs to TB patients Management and treatment follow-up for TB patients

ID S16_03 S16_04 S16_05 S16_06 S16_07 S16_08 S16_09 S16_10

Definition

Data collection notes

SERVICE READINESS IN13 % of facilities providing tuberculosis services with tracer items on the day of the assessment Staff and guidelines DO29 Guidelines for diagnosis and treatment of TB Guidelines for management of HIV & TB co-infection Guidelines related to MDR-TB treatment (or identification of need for referral) Guidelines for TB infection control Staff trained in TB diagnosis and treatment T22

Country adapt to which guidelines are required/accepted Country adapt to which guidelines are required/accepted Country adapt to which guidelines are required/accepted Country adapt to which guidelines are required/accepted At least one staff member providing the service trained in TB diagnosis and treatment in the last two years. At least one staff member providing the service trained in HIV & TB co-infection in the last two years. At least one staff member providing the service trained in MDR-TB in the last two years. At least one staff member is a referral person in charge of TB infection control and has received training in the last two years. Light or fluorescent microscope, slides, and ZN stain OR fluorescent microscope, slides, and auramine-rhodamine stain RDT kit or ELISA test with ELISA washer, ELISA reader, incubator, specific assay kit

Guidelines observed in service area.

T23

T24

T25

T26

Interview response from incharge of service area day of survey.

Staff trained in management of HIV & TB co-infection

T27

Staff trained in client MDR-TB treatment or identification of need for referral Staff trained in TB Infection Control

T28

T29

Diagnostics DO30

TB microscopy

HIV diagnostic capacity

Able to conduct the test off-site OR ability to conduct the test on-site (in the facility) and functioning equipment and reagents needed to conduct the test are observed on-site on the day of the survey.

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Tracer indicator System for diagnosis of HIV among TB clients

ID D13

Definition Record or register showing TB clients who have been tested for HIV Isoniazid, Pyrazinamide, Rifampicin, and Ethambutol, or combinations to meet firstline TB treatment

Data collection notes Observed availability and in service area or adjacent area. Observed in service area OR where routinely stored; in stock with at least one valid.

Medicines and commodities DO31 REFERENCES:

First-line TB medications

M41

Treatment of Tuberculosis: Guidelines for national programmes, 4th edition http://whqlibdoc.who.int/publications/2010/9789241547833_eng.pdf The Global Plan to Stop TB 2011-2015: Transforming the fight towards elimination of tuberculosis http://www.stoptb.org/assets/documents/global/plan/TB_GlobalPlanToStopTB2011-2015.pdf HIV: counselling and testing

SERVICE AVAILABILITY % of facilities offering: HIV counselling and testing S17

SERVICE READINESS IN14 % of facilities providing HIV counselling and testing services with tracer items on the day of the assessment Staff and guidelines DO32 Guidelines on HIV counselling and testing Staff trained in HIV counselling and testing T30

Country adapt to which guidelines are required/accepted At least one staff member providing the service trained in some aspect of VCT in the last two years.

Guidelines observed in service area. Interview response from incharge of service area day of survey.

T31

Equipment DO33

Visual and auditory privacy

I23

Private room or screened off area available in HIV/AIDS counselling area, a sufficient distance from sites where providers/clients routinely may be, so that a normal conversation could be held without being overheard, and without the client being observed. RDT kit or ELISA test with ELISA washer, ELISA reader, incubator, specific assay kit

Observed in service area.

Diagnostics DO34

HIV diagnostic capacity

Medicines and commodities DO35

Condoms

M91

Male

Able to conduct the test on-site (in the facility) and functioning equipment and reagents needed to conduct the test are observed on-site on the day of the survey. In area where tests for HIV are carried out or anywhere in the facility where laboratory testing is routinely conducted. Observed in service area or immediate vicinity; in stock with at least one valid.

191

4. Indicators index Domain REFERENCES: A Handbook for Improving HIV Testing and Counselling Services http://whqlibdoc.who.int/publications/2010/9789241500463_eng.pdf HIV/AIDS care and support services

Tracer indicator

Definition

Data collection notes

SERVICE AVAILABILITY % of facilities offering: HIV/AIDS care and support services Treatment of opportunistic infections Provision of palliative care Intravenous treatment of fungal infections Treatment for Kaposi’s sarcoma Nutritional rehabilitation services Prescribe/provide fortified protein supplementation Care for paediatric HIV/AIDS patients Provide/prescribe preventative treatment for TB Primary preventative treatment for opportunistic infections Provide/prescribe micronutrient supplementation Family planning counselling Provide condoms S18 S18_01 S18_02 S18_03 S18_04 S18_05 S18_06 S18_07 S18_08 S18_09

S18_10

S18_11 S18_12

SERVICE READINESS IN15 % of facilities providing HIV/AIDS care and support services with tracer items on the day of the assessment Staff and guidelines DO36 Guidelines for clinical management of HIV & AIDS Guidelines for palliative care T32

Country adapt to which guidelines are required/accepted Country adapt to which guidelines are required/accepted At least one staff member providing the service trained in some aspect of treatment of opportunistic infections in the last two years Record or register showing HIV+ clients who have been tested for TB Normal saline or Ringers Lactate, and Dextrose 5%

Guidelines observed in service area.

T33

Staff trained in clinical management of HIV & AIDS

T34

Interview response from incharge of service area day of survey.

Diagnostics D037 Medicines and commodities

System for diagnosis of TB among HIV + clients Intravenous solution with infusion set

D14

Observed availability and in service area or adjacent area. Observed in service area OR where routinely stored;

M27

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Tracer indicator IV treatment fungal infections Co-trimoxazole cap/tab First-line TB treatment medications

ID M42 M43 M41

Definition Country-specific treatment of choice Oral adult formulation Isoniazid, Pyrazinamide, Rifampicin, and Ethambutol, or combinations to meet firstline TB treatment Country-specific treatment of choice for high level oral pain medication (e.g., codeine, demerol, diclofenac, ibuprofen, paracetamol, morphine) Male

Data collection notes in stock with at least one valid.

Palliative care pain management

M44

Condoms REFERENCES:

M17

Essential Prevention and Care Interventions for Adults and Adolescents Living with HIV in Resource-Limited Settings http://www.who.int/hiv/pub/toolkits/Essential%20Prevention%20and%20Care%20interventions%20Jan%2008.pdf HIV/AIDS: Antiretroviral prescription and client management

SERVICE AVAILABILITY % of facilities offering: ARV prescription or ARV treatment follow-up services Antiretroviral prescription Treatment follow-up services for persons on ART S19 S19_01 S19_02

SERVICE READINESS IN16 % of facilities providing antiretroviral prescription and client management services with tracer items on the day of the assessment Staff and guidelines DO39 Guidelines for antiretroviral therapy Staff trained in ART prescription and management T35

Country adapt to which guidelines are required/accepted At least one staff member providing the service trained in some aspect of ART in the last two years Haematological counter, stains CD4:CD4 counter and specific assay kit VL: Assay specific automated system, centrifuge, vortex mixer, pipettes Specific assay kit, centrifuge, biochemistry analyzer Specific assay kit, centrifuge, biochemistry analyzer

Guidelines observed in service area. Interview response from incharge of service area day of survey. Able to conduct the test off-site OR ability to conduct the test on-site (in the facility) and functioning equipment and reagents needed to conduct the test are observed on-site on the day of the survey. In area where tests for HIV are carried out or anywhere in the facility where laboratory testing is routinely conducted. Observed in service area OR where routinely stored; in stock with at least one valid.

T36

Diagnostics DO40

Full blood count CD4 or Viral load

D15 D16 D17

Renal function test (serum creatinine testing or other) Liver function test (ALT or other)

D18 D19

Medicines and commodities DO41

Three first-line antiretrovirals

M45

Country-specific first line treatment regimen

193

4. Indicators index Domain REFERENCES: Antiretroviral Therapy for HIV Infection in Adults and Adolescent http://www.who.int/hiv/pub/guidelines/artadultguidelines.pdf

Tracer indicator

Definition

Data collection notes

HIV/AIDS: Preventing mother-to-child transmission (PMTCT)

SERVICE AVAILABILITY % of facilities offering: Preventing mother-to-child transmission (PMTCT) services Counselling and testing for HIV+ pregnant women Counselling and testing for infants born to HIV+ women ARV prophylaxis to HIV+ pregnant women ARV prophylaxis to infants born to HIV+ women Infant and young child feeding counselling Nutritional counselling for HIV+ women and their infants Family planning counselling to HIV+ women S20 S20_01 S20_02 S20_03 S20_04 S20_05 S20_06 S20_07

SERVICE READINESS IN17 % of facilities providing prevention of mother-to-child transmission (PMTCT) services with tracer items on the day of the assessment Staff and guidelines DO42 Guidelines for PMTCT T37

Guidelines observed in service area.

Guidelines for infant and young child feeding counselling Staff trained in PMTCT

T38

T39

Interview response from incharge of service area day of survey.

Staff trained in infant and young child feeding

T40

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Tracer indicator Visual and auditory privacy

ID I24

Definition Private room or screened off area available in PMTCT area, a sufficient distance from sites where providers/clients routinely may be, so that a normal conversation could be held without being overheard, and without the client being observed.

Data collection notes Observed in service area.

Diagnostics DO44

HIV diagnostic capacity for adults Dried blood spot (DBS) filter paper for diagnosing HIV in newborns

RDT kit or ELISA test with ELISA washer, ELISA reader, incubator, specific assay kit DBS filter paper (with valid expiration date)

Able to conduct the test on-site (in the facility) and functioning equipment and reagents needed to conduct the test are observed on-site on the day of the survey. In area where tests for PMTCT are carried out or anywhere in the facility where laboratory testing is routinely conducted. Observed in service area OR where routinely stored; in stock with at least one valid.

Medicines and commodities DO45

Zidovudine (AZT) syrup Nevirapine (NVP) syrup Maternal ARV prophylaxis

M46 M47 M48

Option A: AZT, NVP, and 3TC Option B: AZT + 3TC + LPV or AZT + 3TC + ABC or AZT + 3TC + EFV or TDF + 3TC (or FTC) + EFV

REFERENCES: Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infections in Infant http://whqlibdoc.who.int/publications/2010/9789241599818_eng.pdf Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice http://whqlibdoc.who.int/publications/2006/924159084X_eng.pdf Sexually transmitted infections (STI)

SERVICE AVAILABILITY % of facilities offering: STI services STI diagnosis STI treatment S21 S21_01 S21_02

195

4. Indicators index Domain

Tracer indicator ID Definition Data collection notes SERVICE READINESS IN18 % of facilities providing sexually transmitted infection services with tracer items on the day of the assessment Staff and guidelines DO46 Guidelines for diagnosis and treatment of STIs Staff trained in STI diagnosis and treatment T41

Country adapt to which guidelines are required/accepted At least one staff providing the service trained in STI diagnosis and treatment in the last two years RDT kit

Guidelines observed in service area. Interview response from incharge of service area day of survey. Able to conduct the test on-site (in the facility) and functioning equipment and reagents needed to conduct the test are observed on-site on the day of the survey. In area where tests for STIs are carried out or anywhere in the facility where laboratory testing is routinely conducted. Observed in service area OR where routinely stored; in stock with at least one valid.

T42

Diagnostics DO47

Syphilis rapid test

Medicines and commodities DO48

Condoms Metronidazole cap/tab Ciprofloxacin cap/tab Ceftriaxone injection

M17 M49 M6 M5

Male

REFERENCES: Sexually transmitted and other reproductive tract infections: a guide to essential practice http://whqlibdoc.who.int/publications/2005/9241592656.pdf

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TABLE 4.4.3: TRACER INDICATORS FOR NON-COMMUNICABLE DISEASE SERVICE AVAILABILITY AND READINESS Domain Diabetes

Tracer indicator

Definition

Data collection notes

SERVICE AVAILABILITY % of facilities offering: Diabetes diagnosis and/or management S22

SERVICE READINESS IN19 % of facilities providing diabetes services with tracer items on the day of the assessment Staff and guidelines DO49 Guidelines for diabetes diagnosis and treatment T43

Country adapt to which guidelines are required/accepted (can be NCD guidelines which contain information on diabetes) At least one staff providing the service trained in diabetes diagnosis and treatment in the last two years (can be an NCD training including a section on diabetes) Digital BP machine or manual sphygmomanometer with stethoscope

Guidelines observed in service area.

Staff trained in diabetes diagnosis and treatment

T44

Interview response from incharge of service area day of survey.

Equipment DO50

Blood pressure apparatus

Adult scale Measuring tape (height board/ stadiometre) Diagnostics DO51 Blood glucose Urine dipstick- protein Urine dipstick- ketones

E1 E18 D2 D4 D20

Observed availability, reported functionality, and in service area or adjacent area.

Able to conduct the test on-site (in the facility) and functioning equipment and reagents needed to conduct the test are observed on-site on the day of the survey. In area where tests for NCDs are carried out or anywhere in the facility where laboratory testing is routinely conducted. Observed in service area OR where routinely stored; in stock with at least one valid.

Medicines and commodities DO52

Metformin cap/tab Glibenclamide cap/tab Insulin regular injectable Glucose 50% injectable Gliclazide tablet or glipizide tablet

M50 M10 M51 M52 M115

REFERENCES: Definition, Diagnosis and Classification of Diabetes Mellitus http://whqlibdoc.who.int/hq/1999/who_ncd_ncs_99.2.pdf Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia http://www.who.int/diabetes/publications/Definition%20and%20diagnosis%20of%20diabetes_new.pdf

197

4. Indicators index Domain

Tracer indicator

Definition

Data collection notes

Cardiovascular disease

SERVICE AVAILABILITY % of facilities offering: Cardiovascular disease diagnosis and/or management S23

SERVICE READINESS IN20 % of facilities providing cardiovascular disease services with tracer items on the day of the assessment Staff and guidelines DO53 Guidelines for diagnosis and treatment of chronic cardiovascular conditions Staff trained in diagnosis and management of chronic cardiovascular conditions T45

Country adapt to which guidelines are required/accepted (can be NCD guidelines which contain information on CVD) At least one staff providing the service trained in diagnosis and management of chronic cardiovascular conditions in the last two years (can be an NCD training including a section on CVD). Digital BP machine or manual sphygmomanometer with stethoscope Oxygen cylinders OR concentrators OR central oxygen supply with functioning flowmeter for oxygen therapy (with humidification) AND oxygen delivery apparatus (key connecting tubes and mask/nasal prongs), available at any time during the 3 past months

Guidelines observed in service area.

T46

Interview response from incharge of service area day of survey.

Equipment DO54

Stethoscope Blood pressure apparatus

E4 E5

Observed availability, reported functionality, and in service area or adjacent area.

Adult scale Oxygen

E1 E45

Medicines and commodities DO55

ACE inhibitor (e.g. enalapril, lisinopril, ramipril, perindopril) Hydrochlorothiazide tablet or other thiazide diuretic tablet Beta blocker (e.g.bisoprolol, metoprolol, carvedilol, atenolol) Calcium channel blockers (e.g. amlodipine) Aspirin cap/tabs Metformin cap/tabs

M53

M54

Observed in service area OR where routinely stored; in stock with at least one valid.

M55

M56 M57 M50

REFERENCES: Prevention of cardiovascular disease: guideline of assessment and management of cardiovascular risk http://www.who.int/cardiovascular_diseases/guidelines/Full%20text.pdf WHO CVD-risk management package for low – and medium-resource settings http://whqlibdoc.who.int/publications/2002/9241545852.pdf

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Tracer indicator

Definition

Data collection notes

Chronic respiratory disease (CRD)

SERVICE AVAILABILITY % of facilities offering: Chronic respiratory disease diagnosis and/or management S24

SERVICE READINESS IN21 % of facilities providing chronic respiratory disease services with tracer items on the day of the assessment Staff and guidelines DO56 Guidelines for diagnosis and management of CRD T47

Country adapt to which guidelines are required/accepted (can be NCD guidelines which contain information on CRD) At least one staff providing the service trained in diagnosis and management of CRD in the last two years (can be an NCD training including a section on CRD).

Guidelines observed in service area.

Staff trained in diagnosis and management of CRD

T48

Interview response from incharge of service area day of survey.

Equipment DO57

Stethoscope Peak flow meter Spacers for inhalers Oxygen

E4 E19 E20 E45

Observed availability, reported functionality, and in service area or adjacent area. Oxygen cylinders OR concentrators OR central oxygen supply with functioning flowmeter for oxygen therapy (with humidification) AND oxygen delivery apparatus (key connecting tubes and mask/nasal prongs), available at any time during the 3 past months Observed in service area OR where routinely stored; in stock with at least one valid.

Medicines and commodities DO58

Salbutamol inhaler Beclomethasone inhaler Prednisolone cap/tabs Hydrocortisone injection Epinephrine injectable

M13 M59 M60 M61 M62

Cervical cancer screening

SERVICE AVAILABILITY % of facilities offering: Cervical cancer diagnosis S29

SERVICE READINESS IN26 % of facilities providing cervical cancer screening services with tracer items on the day of the assessment Staff and guidelines DO78 Guidelines for cervical cancer prevention and control Staff trained in cervical cancer prevention and control T60

Country adapt to which guidelines are required/accepted At least one staff providing the service trained in cervical cancer prevention and control in the last two years (can be a broader training including a section on cervical cancer).

Guidelines observed in service area.

T61

199

4. Indicators index Domain Equipment DO79 Diagnostics DO80

Tracer indicator Speculum Acetic acid

ID E44 D37

Definition

Data collection notes

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TABLE 4.4.4: TRACER INDICATORS FOR SURGERY AND BLOOD TRANSFUSION SERVICE AVAILABILITY AND READINESS Domain Basic surgery

Tracer indicator

Definition

Data collection notes

SERVICE AVAILABILITY % of facilities offering: Basic surgical services Incision and drainage of abscesses Wound debridement Acute burn management Suturing Closed repair of fracture Cricothyroidotomy Male circumcision Hydrocele reduction Chest tube insertion Closed repair of dislocated joint Biopsy of lymph node or mass or other Removal of foreign body (throat, eye, ear or nose) S25 S25_01 S25_02 S25_03 S25_04 S25_05 S25_06 S25_07 S25_08 S25_09 S25_10 S25_11 S25_12

SERVICE READINESS IN22 % of facilities providing basic surgical services with tracer items on the day of the assessment Staff and guidelines DO59 Guidelines for IMEESC T49

Country adapt to which guidelines are required/accepted At least one staff member providing the service trained in some aspect of IMEESC in the last two years

Guidelines observed in service area. Interview response from incharge of service area day of survey. Observed availability, reported functionality, and in service area.

Staff trained in IMEESC

T50

Equipment DO60

Needle holder Scalpel handle with blades Retractor Surgical scissors Nasogastric tubes (10-16 FG) Tourniquet Adult and paediatric resuscitators Suction apparatus (manual or electric sucker) Oxygen

E21 E22 E23 E24 E25 E26 E27 E28

Suction apparatus with catheter Oxygen cylinders OR

E45

201

4. Indicators index Domain

Tracer indicator

Definition concentrators OR central oxygen supply with functioning flowmeter for oxygen therapy (with humidification) AND oxygen delivery apparatus (key connecting tubes and mask/nasal prongs), available at any time during the 3 past months

Data collection notes

Medicines and commodities DO61

Skin disinfectant Sutures (any type) Ketamine (injectable) Lidocaine (1% or 2% injectable) Splints for extremities Material for cast

M26 M63 M64 M65 M148 M149

Observed in service area; in stock with at least one valid.

REFERENCES: Guide to Infrastructure and Supplies at Various Levels of Health Care Facilities: Emergency and Essential Surgical and Anaesthesia Procedure http://www.who.int/surgery/publications/GuideAnestheticInfrastFormatted06.pdf Surgical care at the district hospital http://www.who.int/surgery/publications/en/SCDH.pdf Blood transfusion

SERVICE AVAILABILITY % of facilities offering: Blood transfusion S27

SERVICE READINESS IN24 % of facilities providing blood transfusion services with tracer items on the day of the assessment Staff and guidelines DO66 Guidelines on the appropriate use of blood and safe blood transfusion Staff trained in the appropriate use of blood and safe blood transfusion T55

Country adapt to which guidelines are required/accepted At least one staff member providing the service trained in the appropriate use of blood and safe blood transfusion within the past 2 years Available and functional and with temperature being monitored (checked that temperature has been monitored at least once in the past 24 hours AND o maintained at 2 – 6 C) ABO blood group test, Rhesus blood group test, and centrifuge

Guidelines observed in service area. Interview response from incharge of service area day of survey.

T56

Equipment DO67

Blood storage refrigerator

E31

Observed availability, reported functionality, and in service area or adjacent area.

Diagnostics

Blood typing

D21

Able to conduct the test on-site (in the facility) and

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Tracer indicator Cross match testing

ID D22

Definition Cross match (should use methods that demonstrate ABO incompatibility and incompatibility due to other clinically significant antibodies and should include an indirect anti-globulin test or a test of equivalent sensitivity), centrifuge, 37°C incubator, and grouping sera No interruption of blood availability in last three months Blood obtained ONLY from national or regional blood bank, OR blood obtained from other sources but screened for HIV, Syphilis, Hepatitis B, and Hepatitis C.

Data collection notes functioning equipment and reagents needed to conduct the test are observed on-site on the day of the survey. This may be in a laboratory or in the service area where the test is conducted.

Medicines and commodities DO69

Blood supply sufficiency Blood supply safety

M66 M67

Reported availability.

REFERENCES: Universal access to safe blood transfusion http://www.who.int/bloodsafety/publications/UniversalAccesstoSafeBT.pdf Screening Donated Blood for Transfusion-Transmissible Infection http://whqlibdoc.who.int/publications/2009/9789241547888_eng.pdf

203

4. INDICATORS INDEX TABLE 4.4.5: TRACER ESSENTIAL MEDICINES BY CATEGORY Domain Tracer indicator ID Definition Data collection notes Infectious disease medicines % of facilities that have the following medicines in stock (observed valid) on the day of the assessment Me-/albendazole cap/tab Amoxicillin cap/tab Ceftriaxone injection Co-trimoxazole cap/tab Ciprofloxacin cap/tab Fluconazole cap/tab Metronidazole cap/tab M35 M2 M5 M43 M6 M135 M49

Observed in pharmacy or in area where they are routinely stored, at least one with valid expiration date.

Non-communicable disease medicines % of facilities that have the following medicines in stock (observed valid) on the day of the assessment Amlodipine tablet or alternative calcium channel blocker Aspirin cap/tab Beclometasone inhaler Beta blocker (e.g.bisoprolol, metoprolol, carvedilol, atenolol) Enalapril tablet or other ACE inhibitor e.g. lisinopril, ramipril, perindopril Epinephrine injectable Furosemide cap/tab Glibenclamide cap/tab Gliclazide tablet or glipizide tablet Glucose 50% injection Glyceryl trinitrate sublingual tablet Hydrochlorothiazide tablet or other thiazide diuretic tablet Hydrocortisone injection Ibuprofen tablet Insulin regular injection Isosorbide dinitrate tablet Metformin tablet Omeprazole tablet or alternative such as pantoprazole, rabeprazole Paracetamol cap/tab Prednisolone cap/tab Salbutamol inhaler Simvastatin tablet or other statin e.g. atorvastatin, pravastatin, fluvastatin M56

M57 M59 M55

Observed in pharmacy or in area where they are routinely stored, at least one with valid expiration date.

M53

M62 M114 M10 M115 M52 M116 M54

M61 M95 M51 M118 M50 M11

M38 M60 M13 M14

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Tracer indicator Spironolactone tablet

ID M147

Definition

Data collection notes

Reproductive health medicines % of facilities that have the following medicines in stock (observed valid) on the day of the assessment See “8. Priority medicines for mothers”

Child health medicines % of facilities that have the following medicines in stock (observed valid) on the day of the assessment See “9. Priority medicines for children”

Mental health and neurological medicines % of facilities that have the following medicines in stock (observed valid) on the day of the assessment Amitriptyline tablet Carbamazepine tablet Chlorpromazine injection Diazepam tablet Diazepam injection or diazepam rectal tubes Fluoxetine tablet Fluphenazine injection Haloperidol tablet Levodopa + carbidopa tablet Lorazepam injection Lithium tablet Phenobarbital tablet Phenytoin tablet Valproate sodium tablet M1 M119 M120 M121 M122 M94 M123 M124 M145 M144 M125 M126 M127 M128

Observed in pharmacy or in area where they are routinely stored, at least one with valid expiration date.

Levodopa+carbidopa combination tablet

Palliative care medicines % of facilities that have the following medicines in stock (observed valid) on the day of the assessment Dexamethasone injection Haloperidol injection Hyoscine butylbromide injection Ibuprofen Loperamide tab/cap Lorazepam tablet Metoclopramide injection Morphine granule, injectable or cap/tab Paracetamol Senna preparation (laxative) M129 M130 M131 M95 M146 M132 M133 M83 M38 M134

Observed in pharmacy or in area where they are routinely stored, at least one with valid expiration date.

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TABLE 4.4.6: TRACER INDICATORS GENERAL SERVICE READINESS: HOSPITAL LEVEL OPTIONAL INDICATORS

* THESE ARE IN ADDITION TO THE PRIMARY LEVEL INDICATORS* Domain Tracer indicator ID Definition Data collection notes 23. Comprehensive surgery

SERVICE AVAILABILITY % of facilities offering: Comprehensive surgical services Tracheostomy Tubal ligation Vasectomy Dilatation & Curettage Obstetric fistula repair Episiotomy Appendectomy Hernia repair (strangulated) Hernia repair (elective) Cystostomy Urethral stricture dilatation Laparotomy Congenital hernia repair Neonatal surgery Cleft palate Skin grafting and Contracture release Open reduction and fixation for fracture Amputation Cataract surgery Club foot repair Drainage of osteomyelitisseptic arthritis S28 S28_01 S28_02 S28_03 S28_04 S28_05 S28_06 S28_07 S28_08 S28_22 S28_09 S28_10 S28_11 S28_12 S28_13 S28_14 S28_23 S28_17 S28_18 S28_19 S28_20 S28_21

Hospital that provide surgical services

Casting or open club foot release

SERVICE READINESS IN25 % of facilities providing comprehensive surgical services with tracer items on the day of the assessment Staff and guidelines DO72 Materials for IMEESC (WHO Integrated Management for Essential and Emergency Care) Staff trained in IMEESC T49

Country adapt to which guidelines are required/accepted

Guidelines observed in service area.

T50

At least one staff member providing the service trained in some aspect of IMEESC in the last two years Trained health professional (clinical officer, general doctor, or surgeon) providing surgery present in the facility or available 24 hours a day

Interview response from in-charge of service area day of survey.

Staff trained in surgery

T57

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Domain

Tracer indicator Staff trained in anaesthesia

ID T58

Definition Trained health professional (nurse, clinical officer, general doctor, surgeon, or anaesthesiologist) providing anaesthesia present in the facility or available 24 hours a day Oxygen cylinders OR concentrators OR central oxygen supply AND (functioning flowmeter for oxygen therapy AND oxygen delivery apparatus (key connecting tubes and mask/nasal prongs) AND oxygen available at all times during the 3 past months •Anaesthesia machine to deliver aesthetic gases and oxygen •Tubings and connectors to connect to the endotracheal tube (neonatal, paediatric and adult) •Resuscitator bag and mask- adult and paediatric and neonatal (size 1 for term babies) •Intubation set adult and paediatric: (Oropharyangeal airway, endotracheal tubes, laryngoscope (neonatal, paediatric and adult), Magill’s forceps, stylet) Manual or electric

Data collection notes

Equipment DO73

Oxygen

E45

Observed availability, reported functionality, and in service area.

Anaesthesia equipment

E29

Spinal needle Suction apparatus

E32 E28

Medicines and commodities D074

Thiopental (powder) Suxamethonium bromide (powder) Atropine (injectable) Diazepam (injectable) Halothane (inhalation) Bupivacaine (injectable) Lidocaine 5% (heavy spinal solution) Epinephrine (injectable) Ephedrine (injectable)

M84 M85 M86 M25 M87 M88 M89 M62 M90

Observed in service area; in stock with at least one valid.

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4. INDICATORS INDEX

Domain

Tracer indicator

Definition

Data collection notes

24. Laboratory capacity DO75 (in addition to the primary lab tests)

SERVICE AVAILABILITY % of facilities offering: Serum electrolytes Full blood count with differential Blood typing (ABO and Rhesus) and cross match (by anti-globulin or equivalent) D24 D25 D21/ D22

Specific assay kit, centrifuge, biochemistry analyser Haematological counter, stains ABO blood group test, Rhesus blood group test, and centrifuge. Cross match (should use methods that demonstrate ABO incompatibility and incompatibility due to other clinically significant antibodies and should include an indirect anti-globulin test or a test of equivalent sensitivity), centrifuge, 37°C incubator, and grouping sera Specific assay kit, centrifuge, biochemistry analyzer Specific assay kit, centrifuge, biochemistry analyzer CD4 counter, specific assay kit ELISA washer, incubator, ELISA reader, specific assay kit Specific assay kit Specific assay kit Microscope, slides, gram stains Microscope, slides Microscope

Able to conduct the test on-site (in the facility) and functioning equipment and reagents needed to conduct the test are observed on-site on the day of the survey. This may be in a laboratory or in the service area where the test is conducted.

Liver function test (ALT or other) Renal function test (serum creatinine testing or other) CD4 count and percentage HIV antibody testing (ELISA) Syphilis serology Cryptococcal antigen Gram stain Urine microscopy testing CSF/body fluid counts REFERENCES:

D19 D18 D16 D23 D29 D30 D31 D32 D33

Consultation on technical and operation recommendations for clinical laboratory testing harmonization and standardization http://www.who.int/healthsystems/round9_9.pdf 25. High level diagnostic equipment DO76

SERVICE AVAILABILITY % of facilities offering: X-ray ECG Ultrasound CT scan E33 E34 E35 E36

Observed availability, reported functionality, anywhere in the facility.

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TOC – DO NOT PRINT 4. Indicators index ......................................................................................................... 161 4.1 Indicators ID numbers ................................................................................. 163 4.2 4.3 SARA general service availability indicators ....................................... 163 SARA general service readiness indicators ......................................... 167

TABLE 4.3.1: TRACER INDICATORS FOR GENERAL SERVICE READINESS ..................................................... 167 4.4 SARA service specific availability and readiness indicators ............... 172

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Основные сведения

Организация Всемирная организация здравоохранения (ВОЗ / WHO)

Тип документа Technical Documents

Дата принятия 31 декабря 2014 г.

Источник Всемирная организация здравоохранения