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

Health system metrics, Glion | September |2 | Overview Facility based information sources Why facility censuses and surveys? Towards developing a "dashboard" Proposed indicators (examples) Country example: facility census in Tanzania

Health system metrics, Glion | September |3 | Information sources Facility reporting systems District key informant censuses Facility surveys Facility censuses

Health system metrics, Glion | September |4 | Facility 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.

Health system metrics, Glion | September |5 | District 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

Health system metrics, Glion | September |6 | Facility 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

Health system metrics, Glion | September |7 | Facility 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 Presence: nurses/midwives* (Region: 70%) Public72% Private non-profit71% Private for profit69% *Hospitals excluded

Health system metrics, Glion | September |8 | 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.

Health system metrics, Glion | September |9 | 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

Health system metrics, Glion | September | Electricity, safe water supply, at least one kind of communication equipment (telephone - landline or cell, short wave radio) Infrastructure Sterilization equipment, sharps container, disinfectant, gloves, soap, safe water supply Infection control Hemoglobin, blood count, urine dip stick (glucose/protein), RPR/VDRL test (able to be done in facility today) Lab capacity Adult scale, Under-5 scale (salter), thermometer, stethoscope, BP cuff, refrigerator (not including hospitals) Basic equipment 11 tracer drugs and commodities in stockDrugs and commodities Potential core indicators:monitoring the status of basic service provision

Health system metrics, Glion | September | Potential core indicators: monitoring availability of services Guidelines, trained staff (in last 2 years), ARVs, HIV testing, blood count HIV/AIDS treatment and care Guidelines, trained staff, antenatal care, counseling and HIV testing, AZT / NVP in stock PMTCT TB/HIV guidelines, TB smear microscopy, register TB suspects, direct observed therapy/treatment, drugs in stock, HIV testing access TB control Guidelines (diabetes, mental health), blood glucose test, BP cuff and stethoscope, adult scale, (training in last 2 years) NCD control Examples of service areas:

Monitoring Health Service Provision: Selected Results and Experiences of SAM in Tanzania

Health system metrics, Glion | September | SAM 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

Health system metrics, Glion | September | Monitoring the status of basic service provision: Infrastructure TANZANIA Dar es SalaamZanzibarMwanzaInfrastructure Safe water supply Telephone Telephone mobile Shortwave radio NOTE: Preliminary data % of facilities with components

Health system metrics, Glion | September | Monitoring the status of basic service provision: Equipment TANZANIA Dar es SalaamZanzibarMwanzaEquipment Stethoscope Thermometer Adult scale Children's scale Refrigerator NOTE: Preliminary data % of facilities with components

Health system metrics, Glion | September | 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

Health system metrics, Glion | September | Training of health service providers in HIV/AIDS, by district, Mwanza Region, SAM 2005 Facilities with at least 1 staff trained in HIV counselling (Region:16%) Facilities with at least 1 staff trained in HIV counselling and testing (Region:13%)

Health system metrics, Glion | September | Health facilities able to do on-site testing, by district, Mwanza Region, SAM 2005 HIV antibody testing (Region: 12%) Blood counts done on site (Region: 10%)

Health system metrics, Glion | September | Facilities providing HIV counselling and testing

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