1. Approaches to health Facility Data Collection and Mapping Bolaji Fapohunda, PhD. Dai Hozumi, MD, MPH JSI, Inc 29 March 2006

2. 2 Acknowledgement Dai Hozumi for the presentation given the 2005 Mini MAQ University, in collaboration with Bolaji Fapohunda. That work is the source document for many of the Slides in this presentation

3. 3 Objectives of this session Discuss the role of health facility mapping in strengthening health service delivery Disseminate key approaches to HF mapping, including advantages and disadvantages of specific approaches

4. 4 Presentation outline Role of health facility mapping/assessment: –What is it, what it does and what does not do Differences between health facility mapping and population based surveys Key approaches to health facility mapping: –Service Availability Mapping (SAM) –Service Provision Assessment (SPA) –Health Facility Census (HFC) –VCT and PMTCT mapping Conclusion

5. 5 Definition Facility: Any site where clients receive formal sector health services –May includes temporary sites/outreach service sites –Includes stand-alone VCT; maternity homes; hospices –Includes private doctor offices (limited availability of information thus far) Source: Fronczak, Nancy. 2006

6. 6 Why collect data on HF Huge investments in the formal health sector: –Construction and infrastructure development –Procurement of equipment and supplies –Procurement of medicines –Training –Pilot projects to strengthen service delivery and systems (for specific services) Source: Fronczak, Nancy. 2006

7. 7 What are the key questions answered by HF data? Quantity and availability of services –Where are the service delivery points? –What services available? –In what quantity/frequency? –How many health workers are working? Quality of services –Is there a standard of care guidelines? Are they being used? –Are health workers adhering to the guidelines? Support mechanism –Condition of building –Availability and condition of equipment –Availability of supplies –Management systems and practice

8. 8 Health facility versus population household based surveys

9. Safest feasible infant feeding Wellness Infant is HIV positive Improved child health Growth monitoring CTMZ Micronutrients Water/ sanitation ART adherence counseling Mother seeks care & counseling for signs and symptoms Mother recognizes signs and symptoms Mother provides safest/feasible IYCF, Vit A & Zinc suppl. Mother continues to give safest/feasible IYCF, Vit A & Zinc supplementation Provider gives appr. HIV/AIDS care & Rx. Referral Level care Provider gives appropriate HIV/AIDS care & Rx based on need &/or clinical staging Mother accepts referral Facility-based treatment/care community- based treatment/care INSIDE THE HOME OUTSIDE THE HOME Pathway to Child Survival: Pediatric HIV/AIDS (adapted from Waldman & Bartlett, 2000)

10. 10 Key questions answered by Population-based surveys What proportion of the population is using services? What is the characteristics of individuals/ households who are using services vis-a-vis those who are not? What are the key facilitating and constraining factors to service utilization? What are the socioeconomic differences in morbidity and mortality levels? How are health outcomes impacted by access to services?

11. 11 Advantages of HF data Contribute to health system strengthening Important component of the national HIS Increase the domains of data for investigation, making triangulation possible HF data can help determine whether population based surveys are necessary, saving costs (e.g. the IMCI-MCE Survey).

12. 12 Characteristics of system strength affected by HF mapping Provisions of basic services Well integrated & complementary services: public/private, static/outreach, different levels: (pry, secondary, referral) Efficient use of facility resources, including personnel, infrastructure, equipment, supplies and time Existence of coordinating mechanisms among key levels and programs: outreach departments, community workers etc Ownership by, & support for, national/community counterparts RHIS/monitoring & evaluation systems

13. Profiles of key approaches

14. 14 Key approaches Service Availability Mapping(WHO) Service Provision Assessment (ORC Macro/USAID) Health Facility Census (JICA) Facility Audit of Service Quality (UNC/USAID) VCT and PMTCT Mapping

15. 15 Service Availability Mapping PurposeSupports decision making by providing planners with skills and tools required to map and monitor services and resource availability on a regular basis Key areas of information Location of health service delivery points Availability and location of health services (MCH, HIV/AIDS, TB & Malaria) Availability and location of health workers What it doesSAM is a district owned service monitoring system Rapid and relatively inexpensive Use of PDA and HealthMapper Two phased approach: district SAM and facility SAM What it does not do Does not measure quality of services or resources. Does not necessary provide detail information.

16. 16 Service Provision Assessment PurposeTo provide information on quality of health services, as measured through resources, systems, and some observed practices Key areas of information Availability of infrastructure and resources for a given service Facility level support systems and maintenance of infrastructure and resources Information on staff qualifications, training, supervision Adherence to standards (observations and exit-interview) FP, child health, maternal health, STI, TB, HIV/AIDS What it doesProvides picture of the services and service quality Validates reported information. Allows comparison between implementing organizations, facility types, and regions Sample survey of facilities What it does not Does not provide representative information at the district level except specially requested and planned for

17. 17 Health Facility Census Purpose To provide information for policy, planning, and management of health system development with particular focus on physical assets Key information Availability and conditions of physical assets Location of health service delivery points Availability and type of health services Headcounts of health workers What it does Provide information on conditions and distribution of physical assets Covers all health facilities Cost estimates for future capital investment requirement What it does not do Does not collect information on service quality, patient satisfaction, and details of human resources

18. 18 Estimated cost of capital investment requirement for Malawi 2004 - 2009

19. 19 Facility Audit of Service Quality Purpose Facilitates the mapping of availability and quality of all government and private facilities Key areas of information Range of services offered, staffing and staff qualifications, Facility infrastructure – electricity, water, telephone, lighting, vehicles, privacy/capacity, emergency transportation, laboratory Readiness to provide quality care Digital maps of facilities and services available What it does Low tech application, minimal or no technical assistance needed for fieldwork; can be implemented by local staff Quick and low cost; feasible to repeat at intervals useful for monitoring applications (1-2 years) Measures standardized “short list” of service R/CH quality Produces integrated service profile covering all health facilities operating in district (government and private sector) What it does not do Trade off for rapid and low cost is the loss of some detail and in-depth information that would be available.

20. 20 VCT/PMTCT Mapping Purpose To provide information on availability and locations of VCT/PMTCT services Key areas of information Availability and distribution of VCT/PMTCT services Conditions of facilities where services are offered Availability of health workers and their qualifications What it does VCT/PMTCT mapping is implemented by various organizations Provides information on specific services being offered Information used to come up with directory of services What it does not do Often covers only delivery points that are currently offering services Does not collect information on potential service delivery points

21. 21 Displaying HF data May display data using simple basic maps or advanced maps

22. 22 Basic versus advanced mapping: dot map or shaded polygon map; displays simple patterns and geographic dispersions. Choropleth, or shaded polygon maps can also be a valuable way to display geographic data. Software requirements for basic mapping: EpiMap, SIGEpi (produced by PAHO), Healthmapper (WHO) as well as ArcGIS. Source: Spencer, John. 2006

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25. 25 Advanced Mapping: key is that data is explored in greater depth to produce fuller understanding of the geographic patterns. Require more sophisticated program such as ArcGIS, and additional training. Basic mapping may be transitioned to more advanced mapping if relevant information is available and there is adequate planning at the start of the Project Source: Spencer, John. 2006

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27. 27 Thank You

28. 28 Contact Bolaji Fapohunda: bfapohunda@jsi.combfapohunda@jsi.com Dai Hozumi: dhozumi@jsi.com