Service Provision Assessment Survey 2007
Uganda, 2007
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Reference ID
UGA_2007_SPA_v01_M
Producer(s)
Ministry of Health (MOH), Bureau of Statistics (UBOS)
Created on
Dec 20, 2012
Last modified
Mar 29, 2019
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Identification
Survey ID Number
UGA_2007_SPA_v01_M
Title
Service Provision Assessment Survey 2007
Country
| Name | Country code |
|---|---|
| Uganda | UGA |
Study type
Demographic and Health Survey [hh/dhs]
Abstract
The 2007 Uganda Service Provision Assessment (USPA) is a facility-based survey designed to provide information on the general performance of facilities that offer maternal, child, and reproductive health services as well as services for specific infectious diseases, including sexually transmitted infections (STIs), HIV/AIDS, tuberculosis (TB), and malaria.
Information to provide a comprehensive picture of the strengths and weaknesses of the service delivery environment for each assessed service was collected from a representative sample of facilities managed by both the public (government) and private sectors (non-governmental [NGO], private-for-profit organisations, and faith-based organisations) in all 80 districts of the country.
The 2007 USPA provides national- and regional-level representative information for hospitals and health centres (HC-IIs, HC-IIIs, and HC-IVs) offering maternal and child health (MCH) and HIV/AIDS-related services. Findings can supplement household-based health information from the Uganda Demographic and Health Survey conducted in 2005-06, which provides information on health and the utilisation of services by the overall population.
The objectives of the 2007 USPA were to—
• Describe how well-prepared facilities are to provide quality reproductive and child health services and services for some infectious diseases (HIV/AIDS, STIs, malaria, and TB).
• Provide a comprehensive body of information on the performance of the full range of public and private health care facilities that provide reproductive, child health, and HIV/AIDS services.
• Help identify strengths and weaknesses in the delivery of reproductive, child health, and HIV/AIDS services at health care facilities, producing information that can be used to better target service delivery improvement interventions and to improve ongoing supervisory systems.
• Describe the processes used in providing child, maternal, and reproductive health services and the extent to which accepted standards for quality service provision are followed.
• Provide information for periodically monitoring progress in improving the delivery of reproductive, child health, and HIV/AIDS services at Ugandan health facilities.
• Provide input into the evolution of a system of accreditation of health facilities in Uganda.
• Provide baseline information on the capacity of health facilities to provide basic and advanced HIV/AIDS care and support services, and on the recordkeeping systems in place for monitoring HIV/AIDS preventive, diagnostic, care, and support services.
Information to provide a comprehensive picture of the strengths and weaknesses of the service delivery environment for each assessed service was collected from a representative sample of facilities managed by both the public (government) and private sectors (non-governmental [NGO], private-for-profit organisations, and faith-based organisations) in all 80 districts of the country.
The 2007 USPA provides national- and regional-level representative information for hospitals and health centres (HC-IIs, HC-IIIs, and HC-IVs) offering maternal and child health (MCH) and HIV/AIDS-related services. Findings can supplement household-based health information from the Uganda Demographic and Health Survey conducted in 2005-06, which provides information on health and the utilisation of services by the overall population.
The objectives of the 2007 USPA were to—
• Describe how well-prepared facilities are to provide quality reproductive and child health services and services for some infectious diseases (HIV/AIDS, STIs, malaria, and TB).
• Provide a comprehensive body of information on the performance of the full range of public and private health care facilities that provide reproductive, child health, and HIV/AIDS services.
• Help identify strengths and weaknesses in the delivery of reproductive, child health, and HIV/AIDS services at health care facilities, producing information that can be used to better target service delivery improvement interventions and to improve ongoing supervisory systems.
• Describe the processes used in providing child, maternal, and reproductive health services and the extent to which accepted standards for quality service provision are followed.
• Provide information for periodically monitoring progress in improving the delivery of reproductive, child health, and HIV/AIDS services at Ugandan health facilities.
• Provide input into the evolution of a system of accreditation of health facilities in Uganda.
• Provide baseline information on the capacity of health facilities to provide basic and advanced HIV/AIDS care and support services, and on the recordkeeping systems in place for monitoring HIV/AIDS preventive, diagnostic, care, and support services.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
- Health Facilities (both private and public/government)
Scope
Notes
FACILITY
- Facility Identification and Information about Interview
- Outpatient and Inpatient Services
- General Information (how the facility is organized, and what infrastructure and resources are available)
- Information about Services
- Vaccine Logistical System
- Child Health Services
- Family Planning Services
- Availability of Contraceptive Supplies
- Antenatal and Postpartum Care
- Delivery and Newborn Care
- Services for Reproductive Tract and Sexually Transmitted Infections
- HIV/AIDS Outpatient Care
- Inpatient Care
- Health Management Information System
- Laboratory and Other Diagnostics
- Medicines and Supplies
- Tuberculosis Diagnosis and Treatment
- Counseling and Testing
- Antiretroviral Therapy
- Prevention of Mother-to-Child Transmission Services
HEALTH WORKER
- Education and Experience
- General Training and Services Provided in Current Position in The Facility
- Child Health Services
- Family Planning
- Maternal Health
- HIV/AIDS Services
- Laboratory Services
- HIV/AIDS and Working with Clients Who Have HIV/AIDS
OBSERVATION OF ANTENATAL-CARE CONSULTATION
- Facility Identification
- Provider Information
- Information about Observation
- Observation of Antenatal-Care Consultation
EXIT INTERVIEW FOR ANTENATAL-CARE CLIENT
- Information about Visit
- Information about Client's Satisfaction
- Personal Characteristics of Client
OBSERVATION OF FAMILY PLANNING CONSULTATION
- Information about Observation
- Observation of Family Planning Consultation
- Clinical Observation
- Pelvic Examination
- IUD Insertion and/or Removal
- Injectable Contraceptive
- Implant Insertion or Removal
- Client's Family Planning Status
EXIT INTERVIEW FOR FAMILY PLANNING CLIENT
- Information about Interview
- Information about Visit
- Information about Client's Satisfaction
- Personal Characteristics of Client
OBSERVATION OF SICK-CHILD CONSULTATION
- Provider Information
- Observation of Sick-Child Consultation
- Provider's Interaction with Caretaker and Child
- Diagnosis and Classification and Treatment
EXIT INTERVIEW FOR CARETAKER OF SICK CHILD
- Information about Interview
- Information about Visit
- Information about Client's Satisfaction
- Personal Characteristics of Client
OBSERVATION OF STI CONSULTATION
- Provider Information
- Information about Observation
- Observation of STI Client Consultation
EXIT INTERVIEW FOR STI CLIENT
- Information about Interview
- Information about Visit
- Information about Client's Satisfaction
- Personal Characteristics of Client
OBERVATION OF INJECTIONS
- Information about Observation
- Observation of Injections
- Facility Identification and Information about Interview
- Outpatient and Inpatient Services
- General Information (how the facility is organized, and what infrastructure and resources are available)
- Information about Services
- Vaccine Logistical System
- Child Health Services
- Family Planning Services
- Availability of Contraceptive Supplies
- Antenatal and Postpartum Care
- Delivery and Newborn Care
- Services for Reproductive Tract and Sexually Transmitted Infections
- HIV/AIDS Outpatient Care
- Inpatient Care
- Health Management Information System
- Laboratory and Other Diagnostics
- Medicines and Supplies
- Tuberculosis Diagnosis and Treatment
- Counseling and Testing
- Antiretroviral Therapy
- Prevention of Mother-to-Child Transmission Services
HEALTH WORKER
- Education and Experience
- General Training and Services Provided in Current Position in The Facility
- Child Health Services
- Family Planning
- Maternal Health
- HIV/AIDS Services
- Laboratory Services
- HIV/AIDS and Working with Clients Who Have HIV/AIDS
OBSERVATION OF ANTENATAL-CARE CONSULTATION
- Facility Identification
- Provider Information
- Information about Observation
- Observation of Antenatal-Care Consultation
EXIT INTERVIEW FOR ANTENATAL-CARE CLIENT
- Information about Visit
- Information about Client's Satisfaction
- Personal Characteristics of Client
OBSERVATION OF FAMILY PLANNING CONSULTATION
- Information about Observation
- Observation of Family Planning Consultation
- Clinical Observation
- Pelvic Examination
- IUD Insertion and/or Removal
- Injectable Contraceptive
- Implant Insertion or Removal
- Client's Family Planning Status
EXIT INTERVIEW FOR FAMILY PLANNING CLIENT
- Information about Interview
- Information about Visit
- Information about Client's Satisfaction
- Personal Characteristics of Client
OBSERVATION OF SICK-CHILD CONSULTATION
- Provider Information
- Observation of Sick-Child Consultation
- Provider's Interaction with Caretaker and Child
- Diagnosis and Classification and Treatment
EXIT INTERVIEW FOR CARETAKER OF SICK CHILD
- Information about Interview
- Information about Visit
- Information about Client's Satisfaction
- Personal Characteristics of Client
OBSERVATION OF STI CONSULTATION
- Provider Information
- Information about Observation
- Observation of STI Client Consultation
EXIT INTERVIEW FOR STI CLIENT
- Information about Interview
- Information about Visit
- Information about Client's Satisfaction
- Personal Characteristics of Client
OBERVATION OF INJECTIONS
- Information about Observation
- Observation of Injections
Coverage
Geographic Coverage
National
Producers and sponsors
Primary investigators
| Name |
|---|
| Ministry of Health (MOH) |
| Bureau of Statistics (UBOS) |
Producers
| Name | Affiliation | Role |
|---|---|---|
| Macro International Inc. | MEASURE DHS | Technical assistance |
Funding Agency/Sponsor
| Name | Abbreviation | Role |
|---|---|---|
| United States Agency for International Development | USAID | Financial support |
Sampling
Sampling Procedure
Sampling
Data were collected from a representative sample of facilities in the country, a sample of health service providers at each sampled facility, and a sample of sick children, family planning, ANC, and STI clients.
Sample of Facilities
The sample used for the 2007 USPA was obtained from a list of 3,000 functioning health facilities in Uganda at the time of the survey. The list included hospitals and health centres (HC-IVs, HC-IIIs, and HC-IIs) with different managing authorities, including government, private-for-profit, parastatal, and faith-based organisations. For the purposes of the survey, specialised HIV/AIDS facilities or clinics, such as The AIDS Support Organisation (TASO), that may be providing purely HIV services (such as HIV counselling and testing, or antiretroviral therapy only) are categorised with HC-IIs. All facilities not managed by the government (private-for-profit, NGO, and faith-based facilities) were grouped together as private facilities.
A sample size of 500 facilities was selected initially for the survey, based on logistic considerations as well as the minimum sample size required for the desired analysis. The sample allows for national and regional estimates for key indicators. All hospitals throughout Uganda (national referral, regional, general, and other hospitals), and about half of all HC-IVs were purposely included in the sample. HC-IIIs and HC-IIs were sampled in such a way as to provide national and regional-level representation. Thus, the USPA final sample covered approximately 16 percent of all facilities in the country.
Note: Detailed sampling information is presented in the Uganda Service Provision Assessment Survey Report 2007.
Data were collected from a representative sample of facilities in the country, a sample of health service providers at each sampled facility, and a sample of sick children, family planning, ANC, and STI clients.
Sample of Facilities
The sample used for the 2007 USPA was obtained from a list of 3,000 functioning health facilities in Uganda at the time of the survey. The list included hospitals and health centres (HC-IVs, HC-IIIs, and HC-IIs) with different managing authorities, including government, private-for-profit, parastatal, and faith-based organisations. For the purposes of the survey, specialised HIV/AIDS facilities or clinics, such as The AIDS Support Organisation (TASO), that may be providing purely HIV services (such as HIV counselling and testing, or antiretroviral therapy only) are categorised with HC-IIs. All facilities not managed by the government (private-for-profit, NGO, and faith-based facilities) were grouped together as private facilities.
A sample size of 500 facilities was selected initially for the survey, based on logistic considerations as well as the minimum sample size required for the desired analysis. The sample allows for national and regional estimates for key indicators. All hospitals throughout Uganda (national referral, regional, general, and other hospitals), and about half of all HC-IVs were purposely included in the sample. HC-IIIs and HC-IIs were sampled in such a way as to provide national and regional-level representation. Thus, the USPA final sample covered approximately 16 percent of all facilities in the country.
Note: Detailed sampling information is presented in the Uganda Service Provision Assessment Survey Report 2007.
Data Collection
Dates of Data Collection
| Start | End |
|---|---|
| 2007-07 | 2007-10 |
Data Collection Mode
Face-to-face [f2f]
Data Collection Notes
Methods for Data Collection
Four main types of data collection tools were used: the Facility Audit Questionnaires, the Observation Protocol, Exit Interviews, and Health Worker/Provider Interviews.
Using the Facility Audit Questionnaires, interviewers collected information on the availability of resources, support systems, and facility infrastructure elements necessary to provide a level of service that generally meets accepted national and international standards. The support services assessed were those that are commonly acknowledged as essential management tools for maintaining health services. The Facility Audit Questionnaires include MCH (including family planning), HIV/AIDS, laboratory, and pharmacy sections. The HIV/AIDS sections assessed how clients with HIV/AIDS were handled, from counselling and testing through treatment, referral, and follow-up. Interviewers also collected information on health facility policies and practices related to collecting and reporting HIV/AIDS-related records and statistics for services provided to clients through the health facility.
The Observation Protocol was tailored to the service being provided. For sick child, ANC, family planning, and STI consultations, the observer assessed the extent to which service providers adhered to standards of care, based on generally accepted practices for good quality service delivery. The observations were recorded in a checklist and included both the process used in conducting specific procedures and examinations, and also the content of information (including history, symptoms, and advice) exchanged between the provider and the client. Clients receiving injections (therapeutic) were also observed to assess how providers carry out the procedure and infection control practices.
After clients were observed receiving a service, they were asked to participate in an Exit Interview as they left the facility. The Exit Interview included questions on the client’s understanding of the consultation or examination, as well as his or her recall of instructions received about treatment or preventive behaviour. The interviewer also elicited the client’s perception of the service delivery environment.
In the Health Worker/Provider Interview, service providers were interviewed regarding their qualifications (training, experience, and continued in-service training), the supervision they had received, and their perceptions of the service delivery environment.
Training and Supervision of Data Collectors
Data collectors were primarily recruited from among nurses, nurse midwives, counsellors, clinical officers, and demographers experienced in survey implementation and interviewing. A total of 68 interviewers/data collectors completed a three-week training (June 25 to July 13, 2007) for the main survey. Training included classroom lectures/discussion, practical demonstrations, roleplaying, and field practices. A consultant from Macro International Inc. and two medical doctors from the MOH conducted the training. At the end of the three-week training, 11 teams were formed, each consisting of a team leader and four interviewers. Each team was allocated a vehicle and a driver.
Data Collection
Data collection commenced on July 18, 2007 and ended October 10, 2007. One interviewer in each team was selected to be the team leader, and he or she had the added responsibility of checking all administered questionnaires before leaving each facility. Each team was given a list of facilities to visit, with the facilities’ name, type, and location. Information on the intended visits was passed on to the sampled facilities at least one day before the visit so that they could prepare to receive the interviewers.
Fieldwork supervision was coordinated at MOH headquarters; two MOH officers periodically visited the teams to review their work and monitor data quality.
Data collection took one day in small facilities and up to three days, on average, in larger facilities. Every effort was made for teams to visit facilities on days when services of interest would be offered. Whenever any of the services of interest was not being offered on the day of the visit, the teams returned on a day when the service would be offered to observe and interview the clients who came on that day. If, however, the service was offered on the day of the visit but no clients came, the teams did not revisit the facility.
Each interviewer ensured that the respondent for each component of the facility audit was the most knowledgeable person for the particular service or system component being assessed. Informed consent was obtained from the facility in-charge, from all respondents for the facility audit questionnaires, and from observed and interviewed providers and clients. Where relevant, the data collector indicated whether a specific item being assessed was observed, reported available but not observed, not available, or whether it was uncertain if the item was available. Equipment, supplies, and resources for specific services were only recorded as available if they were in the relevant service delivery area or in an immediately adjacent room.
Quality control was ensured by periodic field visits and spot checks by MOH officers. Field check tables generated by the data entry programme were also used to check the quality of the collected data, and where necessary MOH staff communicated with team leaders and sorted out any emerging problems.
Four main types of data collection tools were used: the Facility Audit Questionnaires, the Observation Protocol, Exit Interviews, and Health Worker/Provider Interviews.
Using the Facility Audit Questionnaires, interviewers collected information on the availability of resources, support systems, and facility infrastructure elements necessary to provide a level of service that generally meets accepted national and international standards. The support services assessed were those that are commonly acknowledged as essential management tools for maintaining health services. The Facility Audit Questionnaires include MCH (including family planning), HIV/AIDS, laboratory, and pharmacy sections. The HIV/AIDS sections assessed how clients with HIV/AIDS were handled, from counselling and testing through treatment, referral, and follow-up. Interviewers also collected information on health facility policies and practices related to collecting and reporting HIV/AIDS-related records and statistics for services provided to clients through the health facility.
The Observation Protocol was tailored to the service being provided. For sick child, ANC, family planning, and STI consultations, the observer assessed the extent to which service providers adhered to standards of care, based on generally accepted practices for good quality service delivery. The observations were recorded in a checklist and included both the process used in conducting specific procedures and examinations, and also the content of information (including history, symptoms, and advice) exchanged between the provider and the client. Clients receiving injections (therapeutic) were also observed to assess how providers carry out the procedure and infection control practices.
After clients were observed receiving a service, they were asked to participate in an Exit Interview as they left the facility. The Exit Interview included questions on the client’s understanding of the consultation or examination, as well as his or her recall of instructions received about treatment or preventive behaviour. The interviewer also elicited the client’s perception of the service delivery environment.
In the Health Worker/Provider Interview, service providers were interviewed regarding their qualifications (training, experience, and continued in-service training), the supervision they had received, and their perceptions of the service delivery environment.
Training and Supervision of Data Collectors
Data collectors were primarily recruited from among nurses, nurse midwives, counsellors, clinical officers, and demographers experienced in survey implementation and interviewing. A total of 68 interviewers/data collectors completed a three-week training (June 25 to July 13, 2007) for the main survey. Training included classroom lectures/discussion, practical demonstrations, roleplaying, and field practices. A consultant from Macro International Inc. and two medical doctors from the MOH conducted the training. At the end of the three-week training, 11 teams were formed, each consisting of a team leader and four interviewers. Each team was allocated a vehicle and a driver.
Data Collection
Data collection commenced on July 18, 2007 and ended October 10, 2007. One interviewer in each team was selected to be the team leader, and he or she had the added responsibility of checking all administered questionnaires before leaving each facility. Each team was given a list of facilities to visit, with the facilities’ name, type, and location. Information on the intended visits was passed on to the sampled facilities at least one day before the visit so that they could prepare to receive the interviewers.
Fieldwork supervision was coordinated at MOH headquarters; two MOH officers periodically visited the teams to review their work and monitor data quality.
Data collection took one day in small facilities and up to three days, on average, in larger facilities. Every effort was made for teams to visit facilities on days when services of interest would be offered. Whenever any of the services of interest was not being offered on the day of the visit, the teams returned on a day when the service would be offered to observe and interview the clients who came on that day. If, however, the service was offered on the day of the visit but no clients came, the teams did not revisit the facility.
Each interviewer ensured that the respondent for each component of the facility audit was the most knowledgeable person for the particular service or system component being assessed. Informed consent was obtained from the facility in-charge, from all respondents for the facility audit questionnaires, and from observed and interviewed providers and clients. Where relevant, the data collector indicated whether a specific item being assessed was observed, reported available but not observed, not available, or whether it was uncertain if the item was available. Equipment, supplies, and resources for specific services were only recorded as available if they were in the relevant service delivery area or in an immediately adjacent room.
Quality control was ensured by periodic field visits and spot checks by MOH officers. Field check tables generated by the data entry programme were also used to check the quality of the collected data, and where necessary MOH staff communicated with team leaders and sorted out any emerging problems.
Questionnaires
Questionnaires
Data Collection Instruments
The 2007 USPA survey instruments were based on generic questionnaires developed by the MEASURE DHS project and were adapted for Ugandan health services after consulting with technical specialists from the MOH, NGOs, and other key stakeholders knowledgeable about the health services and service programme priorities covered by the USPA. All questionnaires were drafted in English.
The survey instruments were pretested from April 16 to May 3, 2007. A total of 21 interviewers comprising nurses, nurse midwives, clinical officers, and social scientists underwent a two-week intensive training session in Jinja in the application of the questionnaires prior to pre-test data collection in eight facilities in Jinja, Iganga, and Mukono districts. The questionnaires were then finalised for main fieldwork and data collection.
The 2007 USPA survey instruments were based on generic questionnaires developed by the MEASURE DHS project and were adapted for Ugandan health services after consulting with technical specialists from the MOH, NGOs, and other key stakeholders knowledgeable about the health services and service programme priorities covered by the USPA. All questionnaires were drafted in English.
The survey instruments were pretested from April 16 to May 3, 2007. A total of 21 interviewers comprising nurses, nurse midwives, clinical officers, and social scientists underwent a two-week intensive training session in Jinja in the application of the questionnaires prior to pre-test data collection in eight facilities in Jinja, Iganga, and Mukono districts. The questionnaires were then finalised for main fieldwork and data collection.
Data Processing
Data Editing
Management of questionnaires in the field: After completing data collection in each facility, the interviewers reviewed the questionnaires before handing them over to the team leader, who reviewed them a second time. Staff from headquarters picked up the questionnaire when visiting the teams. Sometimes, team leaders posted the questionnaires to headquarters by courier services.
Data sorting and editing at headquarters: Once the questionnaires from each facility were received at headquarters, they were sorted to ensure that they were in the correct order and none were missing. They were then edited to eliminate any mistakes that would prevent the computer from accepting information during data entry. In cases where there was a problem with the questionnaires from a facility, the data collection team was consulted so that the problem could be rectified.
Data entry: Eight data operators entered the data under the supervision of one data entry manager and one UBOS staff. CSPro software developed by Macro International Inc. was used for data entry. All questionnaires were entered twice (100 percent verification) to ensure that the data had been accurately keyed in. Data entry took place from July through November 2007. All ‘other’ responses were reviewed by MOH staff and recoded into categories relevant for data analysis.
Data sorting and editing at headquarters: Once the questionnaires from each facility were received at headquarters, they were sorted to ensure that they were in the correct order and none were missing. They were then edited to eliminate any mistakes that would prevent the computer from accepting information during data entry. In cases where there was a problem with the questionnaires from a facility, the data collection team was consulted so that the problem could be rectified.
Data entry: Eight data operators entered the data under the supervision of one data entry manager and one UBOS staff. CSPro software developed by Macro International Inc. was used for data entry. All questionnaires were entered twice (100 percent verification) to ensure that the data had been accurately keyed in. Data entry took place from July through November 2007. All ‘other’ responses were reviewed by MOH staff and recoded into categories relevant for data analysis.
Other Processing
Data processing: The design of the tabulation plan and the preparation of the programmes for producing statistical tables were carried out from August through September 2007. Data analysis, including clarification of unclear information, was carried out from December 2007 through March 2008. During data analysis, the analysis plan was revised on the basis of feedback from the USPA management team to ensure that the analysis was appropriate for the Ugandan health system.
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Citation requirements
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
Disclaimer and copyrights
Disclaimer
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
Metadata production
DDI Document ID
DDI_UGA_2007_SPA_v01_M