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Health Facility Survey 2015

Nepal, 2015
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Reference ID
NPL_2015_SPA_v01_M
Producer(s)
Ministry of Health (MoH), Health Development Partners (HDPs)
Metadata
DDI/XML JSON
Study website
Created on
Jun 26, 2017
Last modified
Jul 06, 2017
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  • Study Description
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  • Identification
  • Scope
  • Coverage
  • Producers and sponsors
  • Sampling
  • Survey instrument
  • Data collection
  • Data processing
  • Access policy
  • Data Access
  • Disclaimer and copyrights
  • Contacts
  • Identification

    Survey ID number

    NPL_2015_SPA_v01_M

    Title

    Health Facility Survey 2015

    Country
    Name Country code
    Nepal NPL
    Study type

    Demographic and Health Survey, Special [hh/dhs-sp]

    Series Information

    The Service Provision Assessment (SPA) survey is a health facility assessment that provides a comprehensive overview of a country’s health service delivery. SPA surveys fill an urgent need for monitoring health system strengthening in developing countries. They collect information on the overall availability of different facility-based health services in a country and their readiness to provide those services.

    The 2015 Nepal Health Facility Survey (2015 NHFS) is the first comprehensive assessment of health facilities in Nepal that harmonizes various health facility among the Ministry of Health and health development partners. It 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.

    Abstract

    The 2015 Nepal Health Facility Survey (NHFS) is an assessment of health care facilities in the formal sector of Nepal. It 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 main objectives of the 2015 NHFS were to:

    • Assess the availability of basic and essential services in Nepal health facilities, including maternal and newborn care and child health, family planning, and reproductive health services, as well as services for NCDs and certain infectious diseases (HIV/AIDS, STIs, malaria, and TB).
    • Assess the preparedness of health facilities in Nepal to provide quality services.
    • Provide a comprehensive body of information on the performance of different types of health facilities that provide these essential services.
    • Identify gaps in the support services, 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.
    • Identify differences in service readiness among ecological regions, facility types, and managing authorities and in the 14 earthquake-affected districts.
    • Provide a baseline assessment for tracking future progress.

    The 2015 NHFS provides representative results for Nepal, for different facility types (public hospitals, primary health care centers [PHCCs], health posts [HPs], urban health centers [UHCs], standalone HIV testing and counseling sites [HTCs], and private hospitals), for different managing authorities (government and private), for each of the three geo-ecological regions in the country, the survey was also designed for representative results for each of the 13 development-ecological zones and for the area affected by the 2015 earthquake (14 districts). Stratification was achieved by separating the health facilities by facility type within each of the 13 development-ecological zones. Private hospitals were further stratified by number of inpatient beds (more than 100 or less than 100).

    Kind of Data

    Sample survey data [ssd]

    Unit of Analysis

    Health institutions, hospitals, and health centers

    Scope

    Notes

    The 2015 Nepal Health Facility Survey covered the following topics:

    FACILITY INVENTORY

    • Facility identification
    • Information and service availability
      o Service availability
      o Impatient services
    • Filter questions
      o Processing of instruments
      o Storage of medicines
    • Service readiness
    • Service specific readiness

    HEALTH PROVIDER/WORKER

    • Identification
    • Education and experience
    • General training, communicable, non-communicable diseases
    • Child health services
    • Family planning services
    • Maternal health services
    • Sexually transmitted infections, TB, HIV/AIDS
    • Diagnostic services
    • Working conditions in facility

    OBSERVATION OF ANC CONSULTATION

    • Facility identification, provider information, and information about observation
    • Observation of Antenatal-Care consultation

    ANC CLIENT EXIT INTERVIEW

    • Facility identification and information about interview
    • Information about the visit, Antenatal Care
    • Client satisfaction
    • Client personal characteristics

    OBSERVATION OF FAMILY PLANNING CONSULTATION

    • Facility identification, provider information and 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

    FAMILY PLANNING (FP) CLIENT EXIT INTERVIEW

    • Facility identification and information about interview
    • Information about the visit, family planning
    • Client satisfaction
    • Client personal characteristics

    OBSERVATION OF SICK CHILD CONSULTATION

    • Facility identification, provider information and information about observation
    • Observation of sick child consultation
    • Provider interaction with caretaker and child
    • Diagnosis
    • Treatment

    SICK CHILD CARETAKER EXIT INTERVIEW

    • Facility identification and information about interview
    • Information about the visit, caretaker of sick child
    • Client satisfaction
    • Client personal characteristics

    EXIT INTERVIEW QUESTIONNAIRE FOR POSTPARTUM WOMEN

    • Facility identification and information about interview
    • Background
    • Accessing care and decision making
    • Delivery care
    • Quality of care

    HEALTH FACILITY OPERATION AND MANAGEMENT COMMITTEE (HFOMC) MEMBER

    • General information and interviewer visits
    • Background
    • Composition, training and knowledge
    • Participation
    • Observation

    Coverage

    Geographic Coverage

    National coverage

    Producers and sponsors

    Primary investigators
    Name Affiliation
    Ministry of Health (MoH) Government of Nepal
    Health Development Partners (HDPs) Government of Nepal
    Producers
    Name Role
    ICF International Provided technical assistance through the worldwide DHS Program
    Funding Agency/Sponsor
    Name Role
    United States Agency for International Development Funded the study
    UK Department for International Development Funded the study
    World Health Organization Funded the study
    Government of Nepal Funded the study

    Sampling

    Sampling Procedure

    Sampling
    A master list of 4,719 formal-sector health facilities in Nepal was obtained from the MoH and used as the sampling frame for the survey. The majority of the facilities in the sampling frame were health posts (80 percent). For private hospitals, only those having 15 beds or more were included in the master list.

    Sample of Facilities
    A total of 1,000 facilities were selected for the survey. By design, the sample included all nonspecialized government hospitals, all private hospitals with 100 or more inpatient beds, and all PHCCs. The remainder of the sample consisted of sampled health posts, private hospitals with at least 15 beds but fewer than 100 beds, stand-alone HTC sites, and UHCs. Eight sampled facilities turned out to be duplicates, resulting in an effective sample size of 992 facilities.

    Survey instrument

    Questionnaires

    The 2015 NHFS used five main types of data collection tools/ questionnaires:

    • Facility Inventory Questionnaire.
    • Health Provider Questionnaire.
    • Observation protocols for antenatal care (ANC), family planning (FP), and services for sick children (SC).
    • Exit Interview Questionnaires for ANC and family planning clients and for caretakers of sick children whose consultations were observed. Also, postpartum clients were interviewed as they were discharged from facilities; these interviews took place only in facilities that offered delivery services. Unlike antenatal care, family planning, and curative care for sick children, the survey did not involve observations of delivery services.
    • Health Facility Operation and Management Committee (HFOMC)/Hospital Development Committee (HDC) Member Questionnaire for the chairperson or other committee members in public facilities (except the committee secretary). Members were interviewed based on their availability in the facility on the day of the survey.

    Data collection

    Dates of Data Collection
    Start End
    2015-04 2015-11
    Data Collectors
    Name Affiliation
    New ERA Private research firm
    Data Collection Notes

    Main Training
    The main interviewer training for the 2015 NHFS took place March 22 through April 17, 2015, in Godavari. New ERA staff conducted the training in Nepali, with DHS staff providing technical support. Eighty-nine interviewer candidates (68 women and 21 men) participated. Almost all of the female trainees were nursing graduates (bachelor of science in nursing or bachelor of nursing), while the male candidates were mainly public health graduates with experience as health assistants. The NHFS training included classroom lectures and discussions, practical demonstrations, mock interviews, role plays, and field practices. Video clips of mock interviews as well as actual family planning, ANC, and sick child consultations were prepared and used to train the trainees.

    The first two weeks of training were dedicated exclusively to training interviewers on the use of paper questionnaires and to a two-day field practice session. The third and fourth weeks of training, interviewer trainees were introduced to tablet computers and how to use them for data collection (CAPI) and for data entry and editing (CAFE).

    Data Collection
    As a result of the earthquake that occurred on April 25, 2015, NHFS data were collected in two phases. Phase 1 took place April 20 through 25, 2015, with all 20 teams collecting data in the Sunsari, Jhapa, and Morang districts. Following the earthquake, fieldwork was halted for more than one month while the situation was assessed. After it was determined that it was feasible for the survey to continue, data collection resumed on June 4 and continued through November 5, 2015. As a result of staff turnover due to the earthquake, only 18 teams participated in the second data collection phase. The teams resumed work in the far western development region of Nepal, and data collection in the 14 districts most affected by the earthquake took place in October and November 2015.

    Data processing

    Data Editing

    All of the paper questionnaires used for recording information from the observation protocols and the exit interviews were sent to the NHFS central office in Kathmandu via courier services. Once the paper questionnaires arrived at the central office, they were sorted to ensure that they were in the correct order and none were missing. The office editor then edited the questionnaires to eliminate any mistakes that would prevent the computer from accepting information during data entry. When there was a problem with the questionnaires from a facility, the data collection team was consulted so that the problem could be rectified. Once data editing was completed, two data operators under the supervision of a data entry supervisor entered the paper questionnaires, allowing 100 percent verification. A data entry program developed by ICF International using CSPro software was employed during the entry of the questionnaires. Data entry began on April 20, 2015, when fieldwork commenced, and ended in November 2015, two weeks after the completion of fieldwork.

    Access policy

    Location of Data Collection

    The DHS Program

    Archive where study is originally stored

    The DHS Program
    http://dhsprogram.com/data/available-datasets.cfm
    Cost: None

    Data Access

    Access authority
    Name URL Email
    The DHS Program http://www.DHSprogram.com archive@dhsprogram.com
    Access conditions

    Request Dataset Access
    The following applies to DHS, MIS, AIS and SPA survey datasets (Surveys, GPS, and HIV).
    To request dataset access, you must first be a registered user of the website. You must then create a new research project request. The request must include a project title and a description of the analysis you propose to perform with the data.

    The requested data should only be used for the purpose of the research or study. To request the same or different data for another purpose, a new research project request should be submitted. The DHS Program will normally review all data requests within 24 hours (Monday - Friday) and provide notification if access has been granted or additional project information is needed before access can be granted.

    DATASET ACCESS APPROVAL PROCESS
    Access to DHS, MIS, AIS and SPA survey datasets (Surveys, HIV, and GPS) is requested and granted by country. This means that when approved, full access is granted to all unrestricted survey datasets for that country. Access to HIV and GIS datasets requires an online acknowledgment of the conditions of use.

    Required Information
    A dataset request must include contact information, a research project title, and a description of the analysis you propose to perform with the data.

    Restricted Datasets
    A few datasets are restricted and these are noted. Access to restricted datasets is requested online as with other datasets. An additional consent form is required for some datasets, and the form will be emailed to you upon authorization of your account. For other restricted surveys, permission must be granted by the appropriate implementing organizations, before The DHS Program can grant access. You will be emailed the information for contacting the implementing organizations. A few restricted surveys are authorized directly within The DHS Program, upon receipt of an email request.

    When The DHS Program receives authorization from the appropriate organizations, the user will be contacted, and the datasets made available by secure FTP.

    GPS/HIV Datasets/Other Biomarkers
    Because of the sensitive nature of GPS, HIV and other biomarkers datasets, permission to access these datasets requires that you accept a Terms of Use Statement. After selecting GPS/HIV/Other Biomarkers datasets, the user is presented with a consent form which should be signed electronically by entering the password for the user's account.

    Dataset Terms of Use
    Once downloaded, the datasets must not be passed on to other researchers without the written consent of The DHS Program. All reports and publications based on the requested data must be sent to The DHS Program Data Archive in a Portable Document Format (pdf) or a printed hard copy.

    Download Datasets
    Datasets are made available for download by survey. You will be presented with a list of surveys for which you have been granted dataset access. After selecting a survey, a list of all available datasets for that survey will be displayed, including all survey, GPS, and HIV data files. However, only data types for which you have been granted access will be accessible. To download, simply click on the files that you wish to download and a "File Download" prompt will guide you through the remaining steps.

    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

    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.

    Contacts

    Contacts
    Name Affiliation Email 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
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