ACQUIRE Evaluation and Research Studies - Baseline Survey 2005
Health Facility Survey [fac/hfs]
Kind of Data
Sample survey data [ssd]
Unit of Analysis
Because the survey sample was restricted to the four districts, was purposive, and used quota sampling, the results from this data collection exercise may not be representative of all health facilities in all ACQUIRE-supported districts. In addition, data may be skewed: Dinajpur and Chandpur-the two "high-functioning" districts-together account for 70% of the assessed sites, and it is likely that those FWCs chosen for audit in the high-performing districts are also "higher" performing than average, since a major selection factor was their accessibility by road.
Producers and sponsors
The ACQUIRE Project
United States Agency for International Development
Districts were purposively selected. During the first phase of selection, to ensure homogeneity, districts were excluded if the capital city or divisional headquarters were located in the district. Districts were also excluded if they previously received any support from EngenderHealth. During the second phase of selection, districts were purposively selected from the remaining list of districts based on service performance level and intervention schedules.
- Service performance level was judged by service statistics from October 2000 to September
2001 for tubectomy, vasectomy, IUD, and Norplant implant clients
- The intervention schedules were:
- Group 1: scheduled to receive ACQUIRE interventions from April to June 2004
- Group 2: scheduled to receive ACQUIRE interventions from July 2004 to June 2005
Based on these criteria, four districts were purposively chosen. All 29 sub-districts (upazilas) were included within the four districts. Within the 29 upazilas, 121 facilities were purposively chosen and divided into two categories, comprehensive and non-comprehensive. (These categories are named for the tools that ACQUIRE implemented at the sites, not for the range of services provided there.) At the comprehensive sites, a full set of tools, including the facility audit, client-provider observation, client exit interview, and provider interview, was implemented. At the non-comprehensive sites, only the facility audit was used.
The comprehensive sites included all UHCs and MCWCs. Of the total FWCs within each upazila, 40% were chosen purposively based on logistical variables (e.g., road conditions to the site and availability of service providers at the site). Of this 40%, two were identified as comprehensive sites and the remaining were noncomprehensive sites.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
Interviewer Selection and Training
The survey employed six teams, with 3–4 persons per team. Each team included at least one general data collector, a physician, and a field supervisor. In total, there were 18 general data collectors, six physicians, and six supervisors, all of whom were selected based on educational qualifications, relevant experience, willingness to work in hardship areas, and sex. The team attended a one-week data collection training workshop in Dhaka. The training, led by ACQUIRE/Bangladesh, was conducted in Bangla. Each team leader was provided a training guide for each instrument. The questionnaires were translated into Bangla and back-translated into English for accuracy.
Pretesting and Fieldwork
The entire data collection team pilot tested all four instruments for four days following the training and then returned to Dhaka to discuss the results, solve problems, clarify terms and procedures, and make necessary adjustments to the tools. Data collection began immediately following the training in Dhaka in four districts from April 23 to July 7, 2004. Data collection was intermittent, as the teams had to return to Dhaka and then go back out again several times due to competing project priorities and political unrest.
Upon arriving at the facility, the field supervisor conducted the facility audit. During this time, the physician observed a client-provider session. Directly afterward, the interviewer conducted the client exit interview and the physician interviewed the service provider. To reduce nonresponse and reporting biases, interviews were conducted in the service-provision area when no other staff or clients were present. In an effort to maintain confidentiality during the interview, if the serviceprovision area was unavailable or other staff were in the service-provision area, the interviewer selected another area within the facility (or directly outside the facility) where no one could hear the interview being conducted.
At the comprehensive sites, each team used quota sampling to identify at least three clients to interview (new clients were preferred), and all providers were interviewed. At the UHCs and MCWCs, the service providers included one MO, two FWVs, and one senior FWV. At the FWCs, the providers included one FWV and one SACMO. During the time when the teams were interviewing and observing clients and providers, the field supervisor completed the facility audit and traveled to the nearest noncomprehensive site to conduct one facility audit. The teams stayed at the comprehensive sites for one day and returned to the sites when the required numbers of clients were unavailable during the first day.
Data Collection/ Interview Status
All data were collected using structured methods and closed-ended questionnaires. Facility audits were completed in each of the 121 facilities. Client-provider interactions (CPIs) were observed for 240 FP clients at 85 facilities. Exit interviews were obtained from 245 FP clients at 85 facilities. Interviews were obtained from 193 service providers at 86 facilities.
Each data collection team included at least one general data collector, a physician, and a field supervisor. Upon arrival at the facility, the field supervisor conducted the facility audit. During this time, the physician observed the client-provider session. Directly following, the interviewer conducted the client exit interview and the physician interviewed the service provider.
Informed consent was obtained from clients and service providers prior to interviews. Consent was carefully documented and stored. To reduce nonresponse and reporting biases, team members conducted interviews in the service-provision area when no other staff or clients were present. To maintain confidentiality during the interview, if the service-provision area was unavailable and other staff were in the service-provision area, the interviewer selected another area within the facility (or directly outside the facility) where no one could hear the interview being conducted.
Data Collection Tools
MEASURE Evaluation originally developed the data collection tools and methodology used in this survey for the AMKENI Project, a bilateral USAID project led by EngenderHealth in Kenya. The MEASURE pilot tested these tools for AMKENI in 2002. The tools are based on MEASURE Evaluation’s Services Provision Assessment and Quick Investigation of Quality Tools.
The four tools used in this survey include:
- Facility audit
- Client-provider observation
- Client exit interview
- Provider interview