Service Provision Assessment Survey 2014-2015
Tanzania, 2014 - 2015
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TZA_2014_SPA_v01_M
Service Provision Assessment Survey 2014-2015
| Name | Country code |
|---|---|
| Tanzania | TZA |
Service Provision Assessments [hh/spa]
Tanzania Service Provision Assessment Survey (2014-15 TSPA) is the second facility-based survey to be conducted in Tanzania as it follows the first TSPA which was conducted in 2006. The surveys covered both Tanzania Mainland and Zanzibar.
The 2014-15 TSPA was designed to provide national-level representative results by facility type, that is, hospitals, health centres, clinics, and dispensaries. National-level representative results were also expected by management authorities, that is, public, private, faith based, and parastatals. The survey was also designed to provide representative results for each of the 25 regions in Tanzania Mainland and the 5 regions in Tanzania Zanzibar, for a total number of 30 survey regions.
The 2014-15 Tanzania Service Provision Assessment (2014-15 TSPA) is an assessment of all formalsector health facilities in Tanzania. The survey was designed to provide information on the availability of basic and essential health care services and the readiness of health facilities to provide quality services to clients. The 2014-15 TSPA collected information from all facilities managed by the government, private sector, parastatal, and faith-based organisations to provide a comprehensive picture of the strengths and weaknesses of the service delivery environment for each assessed service.
The 2014-15 TSPA provides national and regional-level information for all hospitals, health centres, clinics and dispensaries that offer child health, maternal, and newborn care, family planning, and services for sexually transmitted infections (STI), non-communicable diseases (NCDs) (diabetes, cardiovascular diseases and chronic respiratory diseases), and HIV/AIDS-related conditions. For each of these services, the 2014-15 TSPA assessed whether components considered essential for quality service delivery were present and functioning. The components assessed are those commonly considered important to various programmes supported by the government and development partners. The 2014-15 TSPA also assessed whether more sophisticated components were present, such as higher-level diagnostic and treatment modalities or support systems for health services that are usually introduced after basic-level services have been put in place.
The main objectives of the 2014-15 TSPA were to:
• Assess the availability of basic and essential health services, including maternal and newborn care and child health, family planning, reproductive health services, non-communicable diseases (NCDs), as well as services for certain infectious diseases (HIV/AIDS, STIs, malaria, and TB), in Tanzanian health facilities;
• Assess the preparedness of health facilities in Tanzania to provide quality services;
• Provide comprehensive information on the performance of different types of health facilities that provide these essential services;
• Identify gaps in the support system, resources and processes used to provide health services that may limit the ability of facilities to provide quality services;
• Describe the processes followed in the provision of essential health care services and the extent to which accepted standards for quality service provision are met;
• Compare findings among regions, facility types, and managing authorities.
Sample survey data [ssd]
Health institutions, hospitals, and health centers
Scope
The 2014-2015 Tanzania Service Provision Assessment Survey covered the following topics:
FACILITY
• Facility identification
• General information and service availability
• General service readiness
HEALTH WORKER
• Identification
• Education, experience and HVB vaccination
• General training/ malaria/ non-communicable diseases
• Child health services
• Family planning services
• Material health services
• Sexually transmitted infections - TB - HIV/AIDS
• Diagnostic services
• Working conditions in facility
OBSERVATION and EXIT
- Observation of ANC Consultation
• Facility identification
• Provider information
• Information about observation
• Observation of antenatal-care consultation - ANC Client Exit Interview
• Facility identification
• Information about visit - antenatal care
• Client satisfaction
• Client personal characteristics - Observation of Family Planning Consultation
• Facility identification
• Provider information
• Information about observation
• Observation of family planning consultation
• Clinical observation
• Pelvic examination
• IUCD insertion and/or removal
• Injectable contraceptives
• Implant insertion and/or removal
• Client's family planning status - FP Client Exit Interview
• Facility identification
• Information about visit - family palnning
• Client satisfaction
• Client personal characteristics
• Observation of sick child consultation
• Provider interaction with caretaker and child
• Diagnosis
• Treatment - Sick Child Caretaker Exit Interview
• Facility identification
• Information about visit - caretaker of sick child
o Client age
o Signs and symptoms of current illness
o Information provided to caretaker
o Treatment and caretaker comfort level
o Referral
• Client satisfaction
• Client personal characteristics
Coverage
National coverage, the survey was also designed to provide representative results for each of the 25 regions in Tanzania Mainland and the 5 regions in Tanzania Zanzibar, for a total number of 30 survey regions.
Producers and sponsors
| Name | Affiliation |
|---|---|
| National Bureau of Statistics (NBS) | Government of Tanzania |
| Office of Chief Government Statistician, Zanzibar (OCGS) | Government of Tanzania |
| Name | Affiliation | Role |
|---|---|---|
| Ministry of Health and Social Welfare | Government of Tanzania | Collaborated in conducting the study |
| Ministry of Health, Zanzibar | Government of Tanzania | Collaborated in conducting the study |
| ICF International | The DHS Prgram | Provided technical assistance |
| Name | Role |
|---|---|
| Government of Tanzania | Funded the study |
| United States Agency for International Development | Funded the study |
Sampling
The 2014-15 TSPA was designed to be a sample survey of all formal-sector health facilities in Tanzania. A master list of health facilities that consisted of 7,102 verified (active) health facilities in Tanzania was obtained from the Ministry of Health and Social Welfare (MoHSW) on the Tanzania Mainland and the Ministry of Health (MOH) in Zanzibar. The list included hospitals, health centres, dispensaries, and clinics. These facilities were managed by the government, private-for-profit, parastatal, and faith-based entities.
A sample of 1,200 facilities was selected to participate in the survey. The sample was designed to provide nationally representative results by facility type and managing authority and regionally representative results for the 25 Tanzania Mainland regions and the 5 Zanzibar regions (a total of 30 survey regions).
1,200 health facilities sampled in the 2014-15 TSPA. Seven sampled facilities refused to be surveyed, 4 had closed down, and one facility could not be reached. The remaining 1,188 facilities were successfully interviewed, with a response rate of 99 percent. Among the surveyed facilities, 256 were hospitals, 379 were health centres, 493 were dispensaries, and 60 were clinics.
Survey instrument
Four questionnaires were used to collect the survey data:
• Facility Inventory questionnaire
• Health Provider Interview questionnaire
• Observation Protocols for antenatal care (ANC), family planning, services for sick children, and normal obstetric delivery and immediate newborn care
• Exit Interview questionnaires for ANC and family planning clients and for caretakers of sick children whose consultations were observed.
The Facility Inventory questionnaire was loaded onto tablet computers and administered as computerassisted personal interviews (CAPI). The other questionnaire types were administered as paper questionnaires but with data entry and data editing taking place immediately following data collection and while the team was still in the facility (computer-assisted field editing – CAFE).
Data collection
| Start | End |
|---|---|
| 2014-10 | 2015-03 |
| Name | Affiliation |
|---|---|
| National Bureau of Statistics | Government of Tanzania |
Main Training
As part of the preparations for the 2014-15 TSPA main training, the eight health providers and five staff (four from NBS and one from OCGS) who participated during the pre-test were given a training of trainers (TOT) for four days, September 10–13, 2014. The training, led by ICF International survey specialists, was intended to equip participants with the necessary skills for them to be in charge of the main training as facilitators.
Participants were introduced to tablet computers, and then transitioned to the use of the tablet computers for data collection (CAPI) and for data entry and editing (CAFE); this was done using completed paper questionnaires from the facilities visited during the pre-test and from field practice during the first two weeks of main training. For the duration of the third week, participants practiced all questionnaire types and CAPI and CAFE approaches in teams and in pairs.
The training involved about 90 nurses from all over the country who were trained to be interviewers. The number of nurses/interviewers was reduced to 67 after selecting those who performed best on a series of practical tests and examinations.
Data Collection
Following the training of interviewers, 20 teams were formed (2 for Zanzibar and 18 for Tanzania Mainland). Each team consisted of a team leader, 3 interviewers and a driver. Each team was provided two tablet computers. One was dedicated to CAPI for the Facility Inventory, and the other was dedicated to CAFE for entering responses to the paper-based Health Provider Interview and Exit Interview questionnaires as well as observation protocols. Each team was given a list of facilities to visit, including name, type, and location. On average, data collection took one day for a small facility (dispensary clinics and some health centres) and two or three days for large facilities (mostly hospitals). Every effort was made to assure that teams visited facilities on days when ANC, family planning, or sick child services were offered, because the assessment involved observation of these consultations. 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 was offered to observe consultations and interview clients. If, however, the service was offered on the day of the visit but no clients came for this service, the team did not revisit the facility.
Interviewers ensured that respondents to the Facility Inventory questionnaire sections were the most knowledgeable persons for the particular service or system components being assessed.
Fieldwork supervision was coordinated by NBS. Four NBS staff and three MoHSW representatives were responsible for field supervision and made periodic visits to teams to review work and monitor data quality.
Data collection for the 2014-15 TSPA took place from October 20 – February 21. There was a revisit of some facilities that were not covered in Dar es Salaam from March 2-13.
Data processing
After completing data collection in each facility, the interviewers reviewed the paper questionnaires (Health Provider Interview, Exit Interview and Observation) and the Inventory data that had been collected directly onto the tablet computer before handing the questionnaires and electronic data over to the team leader, who reviewed them a second time. The paper questionnaires were then entered into the second tablet computer. Once data collection and all data entry were completed in a facility, the team leader conducted consistency and structural checks on the data to identify any errors or missing information. When a team was satisfied that data collection and entry were complete for the facility, the team sent the data to the NBS headquarters in Dar es Salaam via the Internet, using ICF International’s Internet File Steaming System (IFSS). Each team was given a modem device that enabled the tablet computer to send the completed data files to the central office. Questionnaires completed during the 2014-15 TSPA fieldwork were periodically gathered up by quality control teams and taken from the field to be processed at the NBS headquarters in Dar es Salaam. Processing consisted of data entry and the editing of computer-identified errors. The data were processed by a team of 5 data entry clerks, 1 questionnaire administrator, and 2 data entry supervisors. The questionnaire administrator was responsible for receiving the questionnaires from the field. A program developed by ICF International using CSPro software was employed for data entry. At the central office, the data from the paper questionnaires were entered twice (100 percent verification). The concurrent processing of the data was a distinct advantage for data quality because 2014-15 TSPA staff were able to advise the field teams of errors detected during data entry. Data entry started in October 2014, two weeks after the beginning of fieldwork, and ended in March 2015, two weeks after fieldwork ended. All responses with “other” category were reviewed by NBS with assistance from the MoHSW staff and were recorded in categories relevant for data analysis.
Access policy
The DHS Program
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Cost: None
Data Access
| Name | URL | |
|---|---|---|
| The DHS Program | http://www.DHSprogram.com | archive@dhsprogram.com |
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Contacts
| Name | Affiliation | URL | |
|---|---|---|---|
| Information about The DHS Program | The DHS Program | reports@DHSprogram.com | http://www.DHSprogram.com |
| General Inquiries | The DHS Program | info@dhsprogram.com | http://www.DHSprogram.com |
| Data and Data Related Resources | The DHS Program | archive@dhsprogram.com | http://www.DHSprogram.com |
Metadata production
DDI_TZA_2014_SPA_v01_M_WB
| Name | Affiliation | Role |
|---|---|---|
| Development Data Group | The World Bank | Documentation of the DDI |
2016-04-14
Metadata version
Version 01 (March 2016). Metadata is excerpted from "Tanzania Service Provision Assessment Survey 2014-2015" Report.