Facility censuses and surveys Shanthi Noriega Minichiello, WHO Josibert Rubona, MoH,Tanzania Meeting on Health System Metrics Glion 28-29 September, 2006.

Facility censuses and surveys

Shanthi Noriega Minichiello, WHO

Josibert Rubona, MoH,Tanzania

Meeting on Health System Metrics

Glion 28-29 September, 2006

Health system metrics, Glion | 28 - 29 September 20062 |

OverviewOverview

Facility based information sources

Why facility censuses and surveys?

Towards developing a "dashboard"

Proposed indicators (examples)

Country example: facility census in Tanzania


Information sourcesInformation sources

Facility reporting systems

District key informant censuses

Facility surveys

Facility censuses


Facility based reporting systemsFacility based reporting systems

Component of country HIS, routinely collected at the facility level and reported to regions; includes information on infrastructure, services and care offered, and treatments administered.

Figure 4Hospital beds per 10,000 population in countries

by WHO region, 2000-04 (each dot represents one country)

0

20

40

60

80

100

120

140

0 1 2 3 4 5 6AMRO EMRO EURO SEARO WPRO

Data from World Health Statistics, 2006


District key informant censusesDistrict key informant censuses

Census of all districts. Key informant interviews of DMOs and their teams. Includes information on available facilities and HR, coverage of well-defined interventions.

Example: District Service Availability Mapping (SAM) census


Facility surveysFacility surveys

Periodic survey of a representative sample of public and private health care facilities within a country

Example: Service Provision Assessments (SPAs)

– Carried out in 10 countries (more than once in 2)

– Over 400 facilities included in samples

– Carry out inventories, interviews of health workers, observation of provider-patient interaction, and exit interviews

Figure 3: Observed elements/discussions for ANC consultation

42

12

19

26

9

50

10

9

17

3

55

9

8

0 10 20 30 40 50 60

Delivery plans

Exclusive breast feeding

Family planning

Risk sign: vaginal bld

Use visual aids

Item

Percentage of observed clients

At least 8m pregnant

Follow-up

1st visit


Facility censusesFacility censuses

Periodic census of all public and private health care facilities within a country.

Example: Facility Service Availability Mapping (SAM) census

– Completed in 4 countries; on-going in 7; planned in 3

– Focus on determining service status, availability of specific services

65

74

70

53

63

76

91

71

0 20 40 60 80 100

Ilemela

Nyamagana

Geita

Kwimba

Magu

Misungwi

Sengerema

Ukerewe

Nurses/midwives per 10,000 population

Presence: nurses/midwives*(Region: 70%)

Public 72%Private non-profit 71%Private for profit 69%

*Hospitals excluded


Why use facility based censuses and surveys?

Why use facility based censuses and surveys?

Incomplete and inaccurate information on health resources, including infrastructure, workforce, and service delivery in many low and middle income countries

Results in limited utility for planning, monitoring and performance assessment

Facility based censuses and surveys can augment facility reporting

Results in a more comprehensive picture of the health system in the areas of service status and the availability of services.


What can these offer to the "Dashboard"?What can these offer to the "Dashboard"?

A core set of indicators for assessing the status of service delivery and availability

– TWG on health facility surveys proposed preliminary indicators and indices on infrastructure, infection control, lab capacity, basic equipment, and drugs and commodities. Aim to:

• Contribute to health system metrics in the area of availability and health service status

• Allow comparability between countries across different surveys and censuses


Infrastructure Electricity, safe water supply, at least one kind of communication equipment (telephone - landline or cell, short wave radio)

Infection control Sterilization equipment, sharps container, disinfectant, gloves, soap, safe water supply

Lab capacity Hemoglobin, blood count, urine dip stick (glucose/protein), RPR/VDRL test(able to be done in facility today)

Basic equipment Adult scale, Under-5 scale (salter), thermometer, stethoscope, BP cuff, refrigerator (not including hospitals)

Drugs and commodities

11 tracer drugs and commodities in stock

Potential core indicators:monitoring the status of basic service provision


Potential core indicators: monitoring availability of services

HIV/AIDS treatment and care

Guidelines, trained staff (in last 2 years), ARVs, HIV testing, blood count

PMTCT Guidelines, trained staff, antenatal care, counseling and HIV testing, AZT / NVP in stock

TB control TB/HIV guidelines, TB smear microscopy, register TB suspects, direct observed therapy/treatment, drugs in stock, HIV testing access

NCD control Guidelines (diabetes, mental health), blood glucose test, BP cuff and stethoscope, adult scale, (training in last 2 years)

Examples of service areas:

Monitoring Health Service Provision:

Selected Results and Experiences of SAM in Tanzania


SAM Data collection & analysis, Tanzania 2006SAM Data collection & analysis, Tanzania 2006

Facility census of all public and private health care facilities in 22 districts (including all districts in Mwanza, Zanzibar and Dar es Salaam regions)

District key informant surveys carried out in all districts within the country

Used PDAs and GPS for data collection; HealthMapper for map production


Monitoring the status of basic service provision: Infrastructure

Monitoring the status of basic service provision: Infrastructure

TANZANIA

Infrastructure Mwanza ZanzibarDar es Salaam

Safe water supply 59.9 87.7 94.6

Telephone 16.3 18.2 24.7

Telephone mobile 61.4 74.6 94.1

Shortwave radio 8.2 2.6 5.5NOTE: Preliminary data

%of facilities with components


Monitoring the status of basic service provision: Equipment

Monitoring the status of basic service provision: Equipment

TANZANIA

Equipment Mwanza ZanzibarDar es Salaam

Stethoscope 86.5 90.4 98.5

Thermometer 67.4 90.0 99.0

Adult scale 76.5 90.9 95.4

Children's scale 83.4 66.0 65.0

Refrigerator 78.1 67.5 81.0NOTE: Preliminary data

%of facilities with components


Percentage of facilities with all components of indices

81.1

8.2

66.5

77.6

39

51.1

0

10

20

30

40

50

60

70

80

90

Drugs and commodities Infection control

Index

% o

f h

ealt

h c

are

faci

litie

s, b

y re

gio

n

Mwanza

Zanzibar

Dar es Salaam

Monitoring the status of basic service provision :drugs and commodities, infection control (indices)

NOTE: Preliminary data

Monitoring availability of specific services

HIV/AIDS care in Mwanza, SAM 2005


Training of health service providers in HIV/AIDS, by district, Mwanza Region, SAM 2005

31

33

6

3

46

3

2

12

0 20 40 60 80 100

Ilemela

Nyamagana

Geita

Kwimba

Magu

Misungwi

Sengerema

Ukerewe

Percent of health facilities

Facilities with at least 1 staff trained in HIV counselling (Region:16%)

31

29

8

9

6

11

2

12

0 20 40 60 80 100

Ilemela

Nyamagana

Geita

Kwimba

Magu

Misungwi

Sengerema

Ukerewe

Percent of facilities

Facilities with at least 1 staff trained in HIV counselling and testing (Region:13%)


Health facilities able to do on-site testing, by district, Mwanza Region, SAM 2005

HIV antibody testing (Region: 12%)

29

34

6

10

6

8

6

8

0 20 40 60 80 100

Ilemela

Nyamagana

Geita

Kwimba

Magu

Misungwi

Sengerema

Ukerewe


23

37

2

10

3

3

4

8

0 20 40 60 80 100

Ilemela

Nyamagana

Geita

Kwimba

Magu

Misungwi

Sengerema

Ukerewe


Blood counts done on site (Region: 10%)


Facilities providing HIV counselling and testingFacilities providing HIV counselling and testing

THANK YOU

Facility censuses and surveys Shanthi Noriega Minichiello, WHO Josibert Rubona, MoH,Tanzania Meeting on Health System Metrics Glion 28-29 September, 2006.

Documents

health facility surveys

health system metrics

health service status

mental health

health resources

private health care

overview facility

facility level