Facility censuses and surveys Shanthi Noriega Minichiello, WHO Josibert Rubona, MoH,Tanzania Meeting...
-
Upload
bryan-mckinnon -
Category
Documents
-
view
215 -
download
0
Transcript of Facility censuses and surveys Shanthi Noriega Minichiello, WHO Josibert Rubona, MoH,Tanzania Meeting...
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
Health system metrics, Glion | 28 - 29 September 20063 |
Information sourcesInformation sources
Facility reporting systems
District key informant censuses
Facility surveys
Facility censuses
Health system metrics, Glion | 28 - 29 September 20064 |
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
Health system metrics, Glion | 28 - 29 September 20065 |
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
Health system metrics, Glion | 28 - 29 September 20066 |
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
Health system metrics, Glion | 28 - 29 September 20067 |
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
Health system metrics, Glion | 28 - 29 September 20068 |
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.
Health system metrics, Glion | 28 - 29 September 20069 |
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
Health system metrics, Glion | 28 - 29 September 200610 |
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
Health system metrics, Glion | 28 - 29 September 200611 |
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
Health system metrics, Glion | 28 - 29 September 200613 |
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
Health system metrics, Glion | 28 - 29 September 200614 |
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
Health system metrics, Glion | 28 - 29 September 200615 |
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
Health system metrics, Glion | 28 - 29 September 200616 |
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
Health system metrics, Glion | 28 - 29 September 200618 |
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 system metrics, Glion | 28 - 29 September 200619 |
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
Percent of facilities
23
37
2
10
3
3
4
8
0 20 40 60 80 100
Ilemela
Nyamagana
Geita
Kwimba
Magu
Misungwi
Sengerema
Ukerewe
Percent of facilities
Blood counts done on site (Region: 10%)
Health system metrics, Glion | 28 - 29 September 200620 |
Facilities providing HIV counselling and testingFacilities providing HIV counselling and testing
THANK YOU