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

2. Health system metrics, Glion | 28 - 29 September 2006 2 |2 | Overview Facility based information sources Why facility censuses and surveys? Towards developing a "dashboard" Proposed indicators (examples) Country example: facility census in Tanzania

3. Health system metrics, Glion | 28 - 29 September 2006 3 |3 | Information sources Facility reporting systems District key informant censuses Facility surveys Facility censuses

4. Health system metrics, Glion | 28 - 29 September 2006 4 |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.

5. Health system metrics, Glion | 28 - 29 September 2006 5 |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

6. Health system metrics, Glion | 28 - 29 September 2006 6 |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

7. Health system metrics, Glion | 28 - 29 September 2006 7 |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

8. Health system metrics, Glion | 28 - 29 September 2006 8 |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.

9. Health system metrics, Glion | 28 - 29 September 2006 9 |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

10. Health system metrics, Glion | 28 - 29 September 2006 10 | 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

11. Health system metrics, Glion | 28 - 29 September 2006 11 | 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:

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

13. Health system metrics, Glion | 28 - 29 September 2006 13 | 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

14. Health system metrics, Glion | 28 - 29 September 2006 14 | Monitoring the status of basic service provision: Infrastructure TANZANIA Dar es SalaamZanzibarMwanzaInfrastructure 94.687.759.9Safe water supply 24.718.216.3Telephone 94.174.661.4Telephone mobile 5.52.68.2Shortwave radio NOTE: Preliminary data % of facilities with components

15. Health system metrics, Glion | 28 - 29 September 2006 15 | Monitoring the status of basic service provision: Equipment TANZANIA Dar es SalaamZanzibarMwanzaEquipment 98.590.486.5Stethoscope 99.090.067.4Thermometer 95.490.976.5Adult scale 65.066.083.4Children's scale 81.067.578.1Refrigerator NOTE: Preliminary data % of facilities with components

16. Health system metrics, Glion | 28 - 29 September 2006 16 | Monitoring the status of basic service provision: drugs and commodities, infection control (indices) NOTE: Preliminary data

17. Monitoring availability of specific services HIV/AIDS care in Mwanza, SAM 2005

18. Health system metrics, Glion | 28 - 29 September 2006 18 | 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%)

19. Health system metrics, Glion | 28 - 29 September 2006 19 | 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%)

20. Health system metrics, Glion | 28 - 29 September 2006 20 | Facilities providing HIV counselling and testing

21. THANK YOU