DDI_IND_2002_QSDSH_v01_M Antonina Redko 2011-09-22 NADA v01 (September 2011) Quantitative Service Delivery Survey in Health 2002 QSDSH 2002 IND_2002_QSDSH_v01_M World Bank Global Development Network NADA UK Department for International Development Global Development Network Hooman Dabidian Cindy Audiguier Quantitative Service Delivery Survey (QSDS) Quantitative Service Delivery Surveys (QSDS) are multi-purpose surveys that assess quality and performance in resource usage at the frontline facility level, such as schools, health clinics and hospitals. QSDS collect information on characteristics and activities of service providers and on various agents in the system, on a sample basis, in order to examine the quality, efficiency and equity of service delivery on the frontline. QSDS are often combined with Public Expenditure Tracking Surveys (PETS) in order to obtain a more complete picture of the efficiency and equity of a public allocation system, activities at the provider level, as well as various agents involved in the process of service delivery. While most of PETS and QSDS have been conducted in the health and education sectors, a few have also covered other sectors, such as justice, Early Childhood Programs, water, agriculture, and rural roads. In the past decade, about 40 PETS and QSDS have been implemented in about 30 countries. While a large majority of these surveys have been conducted in Africa, which currently accounts for 66 percent of the total number of studies, PETS/QSDS have been implemented in all six regions of the World Bank (East Asia and Pacific, Europe and Central Asia, Latin America and Caribbean, Middle East and North Africa, South Asia and Sub-Saharan Africa). Health For this study, enumerators made unannounced visits to primary health care facilities in India and recorded whether they found medical personnel there. Investigators made three unannounced visits to over 1,350 public clinics from October 2002 to April 2003. Since these had an average of eight or nine health workers in each facility, researchers had approximately 32,500 observations on health worker presence. The survey also gathered data on reasons of health workers absence, characteristics of employees, facilities and communities. In India, the survey was designed to be representative in each of 20 states, which together account for 98 percent of India's population. A Quantitative Service Delivery Survey that assessed employee attendance in India primary education sector was carried out at the same time with this research. Moreover, similar studies were conducted in education and health sectors in Bangladesh, Uganda, Ethiopia, Kenya, Indonesia, Peru and Ecuador. India National Sample survey data [ssd] The description of the sampling procedure below is taken from "Initial Project Description: Survey of Education and Health Providers." This document is available in external resources. "For the health sector, we plan to sample using a facility-based rather than population-based approach. Where it is available, we will acquire a list of all the Primary Health Centers (PHCs) within each district. (With the schools, this may not be possible, because there may be no central lists of private schools). Facilities will then be chosen randomly for visits, after stratification by rural/urban location. Lists would ideally be obtained from both central government and district authorities. To reduce travel and transportation costs, it may sometimes be necessary to cluster villages/towns or facilities. Under the facility-based selection approach, for example, five areas may be randomly chosen within each district, and two schools in that area will be selected, rather than choosing a random sample of ten areas. During data analysis, we will adjust standard errors to account for clustered sampling. At the facility level, we will also obtain a roster of teachers in the school or health care workers assigned to the clinic. If the facility is large (for example, if there are more than 25 teachers in a school), we will interview a random sample of the teachers to keep the size of the survey manageable. This survey is focused on basic education and health care. Given time and personnel constraints, it will therefore focus only on primary schools and primary health care clinics, and not secondary schools or hospitals. In each jurisdiction (nation or Indian state), we will survey 10 districts, with at least two visits each to a representative sample of at least 10 health facilities and 10 or more primary schools within each; if the average village has 1.5 schools, the sample will actually be 15 schools per district. This means detailed and representative provider- and facility-level results from perhaps 150 schools and some 100 health centers for each jurisdiction. In addition, there will be a third visit to some smaller sub-sample of the schools and to all of the health centers, as a check and to provide additional data on long-term absence. With these repeated visits, we expect to carry out some 300 school visits and 300 health center visits in each jurisdiction, which should provide several thousand observations of presence/absence for individual providers and all of the necessary facility-level correlates." Face-to-face [f2f] A worker was counted as absent if, at the time of a random visit during facility hours, he or she was not in the health center. The enumerators for the survey took several measures to ensure that the rate of absence would not be overestimated. The list of employees used for checking attendance was created at the facility itself, based on staff lists and schedule information provided by the facility director or other principal respondent. Enumerators then checked the attendance only of those who were ordinarily supposed to be on duty at the time of the visit. Researchers omitted from the absence calculations all employees who were reported by the director as being on another shift, whether or not this could be verified. Only full-time employees were included in the analysis, to minimize the risk that shift workers would be counted as absent when they were not supposed to be on duty. Use of the survey data must be acknowledged using a citation which would include: - the identification of the Primary Investigator (including country name) - the full title of the survey and its acronym (when available), and the year(s) of implementation - the survey reference number. Public use file 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.