The 2006 Tanzania Service Provision Assessment (TSPA 2006) is a facility-based survey designed to extract information about 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.
Unlike previous facility-based surveys which concentrated on maternal and child health (MCH), the TSPA 2006 covers both MCH and HIV/AIDS 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 the public sector, the private sector, parastatals, and faith-based organisations (FBOs) in all twenty-six regions of the country.
The TSPA 2006 provides national- and zonal-level representative information for hospitals, health centres, dispensaries, and stand-alone facilities offering HIV/AIDS-related services. Findings can supplement household-based health information from the Tanzania Demographic and Health Survey (TDHS) conducted in 2004-05, which provides information on health and the utilisation of services by the overall population.
The TSPA 2006 was implemented by the National Bureau of Statistics (NBS) in collaboration with the Ministry of Health and Social Welfare (MoHSW – Mainland and Zanzibar) and the Office of the Chief Government Statistician, Zanzibar. The survey received technical support from Macro International Inc. under the Measure DHS Project. Financial support for the survey was received from the Poverty Eradication Division (Ministry of Planning, Economy and Empowerment) under the pooled fund arrangement. The United States Agency for International Development (USAID) funded the technical support from Macro International Inc.
The objectives of the 2006 TSPA were to:
• Describe how well prepared facilities are to provide good 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 on-going supervisory systems;
• Describe the processes used in providing child, maternal, and reproductive health services and the extent to which accepted standards for good quality service provision are followed;
• Provide information for periodically monitoring progress in improving the delivery of reproductive, child health, and HIV/AIDS services at Tanzanian health facilities;
• Provide input into the evolution of a system of accreditation of health facilities in Tanzania; and • Provide baseline information on the capacity of health facilities to provide basic and advanced level 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 service facilities
The TSPA 2006 focussed on basic health services, particularly those important for women and children. Four high-priority health services, all interrelated to some extent, were assessed: child health, family planning, maternal health, and specific infectious diseases (STIs, HIV/AIDS, TB, and malaria).
In each of these four areas, the survey assessed whether components considered essential for good quality health services were present and functioning. The components assessed are those commonly promoted in different programmes supported by the government and development partners. The TSPA 2006 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 child health component of the survey was designed to assess the availability of preventive services (immunisation and growth monitoring) and outpatient care for sick children, with a focus on the process followed in providing services to sick children. Service provision was compared to the standards set in the guidelines for Integrated Management of Childhood Illness (IMCI).
The family planning component focussed on the process followed in counselling and providing contraceptive methods to family planning clients.
The maternal health component assessed counselling and screening during antenatal care (ANC) visits, the labour and delivery service environment, and postnatal care.
The infectious disease component assessed the availability of services for diagnosing and treating STIs, as well as HIV/AIDS, TB, and malaria diagnostic and treatment programmes.
Producers and sponsors
National Bureau of Statistics
Macro international Inc.
US Agency for International Development
Macro international Inc.
Data were collected from a representative sample of facilities, a sample of health service providers at each facility, and a sample of sick children, family planning, ANC, and STI clients.
Sample of Facilities
The sample used for the TSPA 2006 was obtained from a list of 5,663 health facilities in Tanzania. The list included hospitals, health centres, dispensaries, and stand-alone facilities, with different managing authorities, including government, private for-profit, parastatal, and faith-based organisations. A sample size of 612 facilities was selected for the survey, based on logistic considerations as well as the minimum sample size required for the desired analysis (margin of error of 10 percent). The sample allows for national and zonal estimates for key indicators for Mainland Tanzania and Zanzibar. All national referral hospitals, regional general hospitals, and district/district-designated hospitals were purposely included in the sample. The rest of the facilities (health centres, dispensaries, stand-alone facilities, and other private hospitals) were sampled in such a way as to provide national and zonal-level representation. Thus, the TSPA final sample covered approximately 10 percent of all facilities in the Mainland and approximately 36 percent in Zanzibar. This sample size is not large enough to present findings at the regional level.
Sample of Health Service Providers
A health service provider is defined as one who provides consultation services, counselling, health education, or laboratory services to clients. For example, health workers were not eligible for observation or interview if they only take measurements or complete registers and never provide any type of professional client services. The sample of health service providers was selected from providers who were present in the facility on the day of the survey and who provided services that were assessed by the TSPA. The idea was to interview an average of eight providers in a facility. In facilities with fewer than eight health providers, all of the providers present on the day of the visit were interviewed. In facilities with more than eight providers, an average of eight providers was interviewed, including all providers whose work was observed. If interviewers observed fewer than eight providers, then they also interviewed a random selection of the remaining health providers to obtain an average of eight provider interviews.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
The TSPA 2006 survey instruments were based on generic questionnaires developed by the MEASURE DHS+ project and were adapted for Tanzanian health services after consulting with technical specialists from the MoHSW, NGOs, and other key stakeholders knowledgeable about the health services and service programme priorities covered by the TSPA. All questionnaires were drafted in English. The client exit interview questionnaires were translated into the Kiswahili language.
The survey instruments were pre-tested from January 12, 2006 to February 3, 2006. A total of 20 interviewers (19 nurses and 1 clinical officer) underwent a two-week intensive training session in Tanga. The interviewers then conducted data collection in nine facilities located in Tanga town and Muheza and Pangani districts. The observations and experiences gathered from the pre-test were used to improve the instruments for the main survey.
A training manual was developed and distributed to all recruited data collectors to support standardized data collection.
Four main types of data collection tools were used:
1. 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, HIV/AIDS, laboratory, and pharmacy sections. The HIV/AIDS section 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 practises related to collecting and reporting HIV/AIDS-related records and statistics for services provided to clients through the health facility.
2. The Observation Protocol was tailored to the service being provided. For sick child, antenatal care, 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 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.
3. 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/her recall of instructions received about treatment or preventive behaviour. The interviewer also elicited the client’s perception of the service delivery environment.
4. 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.
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 first 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 processing:The design of the tabulation plan and the preparation of the programs for producing statistical tables were carried out from August through September 2006. Data analysis, including clarification of unclear information, was carried out from October 2006 through February 2007. During data analysis, the analysis plan was revised on the basis of feedback from the TSPA Task Force to ensure that the analysis was appropriate for the Tanzanian health system.
Data entry: Nine data operators entered the data under the supervision of one NBS staff. CSPro software developed by Macro International Inc. was used for data entry. All questionnaires were entered twice (100% verification) to ensure that the data had been accurately keyed in. Data entry took place from May through September 2006. All “other” responses were reviewed by NBS staff with assistance from MoHSW staff and recoded into categories relevant for data analysis.