Service Provision Assessment Survey 2007

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.