DDI-UGA-SARA-DQR-2018-vFINAL World Health Organization 2022-04-04 NADA Final version (2019) Service Availability and Readiness Assessment (SARA) & Data Quality Review (DQR) 2018 for Uganda UGA-MOH-SARA-DQR-2018-vFINAL Ministry of Health World Health Organization NADA Service Availability and Readiness Assessment [hfa/sara] vFINAL: Survey report The Uganda Ministry of Health implemented a Service Availability and Readiness Assessment (SARA) and Data Quality Review (DQR) in January 2018. The aim of the SARA 2018 was to generate reliable information on health services availability and readiness to support efforts to improve service delivery in the country. The focus of the SARA 2018 was on the assessment of availability and ability of health care facilities to provide essential services including family planning, child health services, basic and comprehensive obstetric care, HIV/AIDS, tuberculosis, malaria and noncommunicable diseases. The SARA 2018 covered 215 facilities across the country. This report covers the following categories of indicators: 1. General service availability • Health infrastructure density • Health workforce density • Service utilization 2. General service readiness • Basic amenities • Basic equipment • Standard precautions for infection prevention • Diagnostic capacity • Essential medicines 3. Service specific availability and readiness • Family planning • Antenatal care • Basic obstetric care • Comprehensive obstetric care • Child immunization • Preventive and curative services for children under five years of age • Adolescent health • Maternal, newborn, child, and adolescent health (MNCAH) • Malaria • Tuberculosis • HIV and antiretroviral therapy (ART) • Prevention of mother-to-child transmission of HIV (PMTCT) • Sexually-transmitted infections • Non-communicable diseases • Surgical services • Blood transfusion • Advanced diagnostic • High level diagnostic equipment Uganda Nationally representative as well as at regional and district levels Health facilities A sample of 215 health facilities across the country was used for the survey Sample survey data [ssd] The SARA survey is designed to generate a set of core indicators on key inputs and outputs of the health system, which can be used to measure progress in health system strengthening over time. The SARA focuses on three main areas: service availability, general service readiness and service-specific readiness. A basic approach to SARA is to collect data that are comparable both across countries and within countries (i.e. across regions and/or districts) using a standard core questionnaire developed by WHO in collaboration with the United States Agency for International Development (USAID). Usually, a country adopts the standard core questionnaire with adaptations to certain elements such as types of facilities, managing authority of facilities, national guidelines for services, staffing categories and national policies for medicines (e.g. for tuberculosis, HIV/AIDS). The SARA survey requires visits to health facilities with data collection based on key informant interviews and observation of key items. The survey can either be carried out as a sample or a census; the choice between these methodologies will depend on a number of elements including the country's resources, the objectives of the survey and the availability of a master facility list (MFL). The SARA questionnaire was administered together with a data verification tool. Data verification is a measure of internal consistency of data. It is one of the methods recommended by the World Health Organization for assessing quality of routine health facility data. It verifies whether information contained in the source documents has been transmitted correctly to the next level of reporting. Data verification allows for the identification of systemic errors in reporting data as well as the extent or degree of the errors. Data verification can be done for any indicator and for any reporting level of interest. The process involves a physical count of values for an indicator in the source document for a specified reporting period and then comparing it to the value for the same indicator that has been reported to the next reporting level for the same period. Reasons for any discrepancy between the values in the source document and reported values were then explored to facilitate efforts to improve accuracy of reporting. Health facilities were sampled through a multi-stage stratified random sampling method designed to give a representative national sample Face-to-face [f2f] The SARA core questionnaires overview: Section 1: Cover page Section 2: Staffing Section 3: Inpatient and observation beds Section 4: Infrastructure Section 5: Available services Section 6: Diagnostics Section 7: Medicines and commodities Section 8: Interviewers observations Sections of the questionnaire were adapted to capture some specific contexts in Uganda. Data collectors for this survey were qualified clinicians, nurses, midwives and biostatisticians working in the national health system. A three day training was conducted for the data collectors and supervisors. Prior to the survey, a pre-test of the adapted questionnaires was conducted. Data was entered into the Census and Survey Processing System (CSPro) and thereafter cleaned.