DDI-BFA-MOH-SARA-2016-vFINAL World Health Organization 2022-03-29 NADA Final version (report) Enquete Nationale sur la Disponibilite et la Capacite Operationnelle et la Qualite des Soins des Services de Sante (SARA III) Edition 2016, Burkina Faso National Survey on the Availability and Operational Capacity and Quality of Care of Health Services (SARA III) 2016 Edition, Burkina Faso BFA-MOH-SARA-2016-vFINAL Ministry of Health General Directorate of Health Information and Health Statistics World Health Organization NADA Service Availability and Readiness Assessments [hfa/sara] Final report (SARA and QoC) The Directorate General of Health Information and Statistics (DGISS) and Ministry of Health with technical support from the World Health Organization (WHO) implemented the 2016 Service Availability and Readiness Assessment (SARA) and a quality of care (QoC) for malaria, tuberculosis and HIV infection survey in 2016. The objective of the 2016 SARA was to generate reliable and regular information on service delivery including service availability, such as the availability of key human and infrastructure resources, and on the readiness of health facilities to provide basic health-care interventions relating to family planning, child health services, basic and comprehensive obstetric care, HIV/AIDS and tuberculosis. The 2016 SARA survey also assessed the operational capacity of health facilities in the fight against Ebola, management of malnutrition and rehabilitation activities. On the other hand, the purpose of the QoC study was to obtain information on the quality of services targeting priority diseases such as malaria, tuberculosis and HIV infection; and to propose corrective measures to improve the quality of care in public health facilities. The 2016 SARA survey covered 700 health facilities, where as the QoC study covered 122 health facilities, in all regions across the country. This report presents findings of both the 2016 SARA and QoC. The QoC results are presented through the three modules on malaria, tuberculosis and HIV/AIDS, with two components: prevention of mother to child transmission (PMTCT) and antiretroviral treatment. Burkina Faso The SARA survey covered health facilities in all the regions namely Boucle du Mouhoun, Cascades, Centre, Centre East, Centre-North, Centre-Ouest, Centre-Sud East, Hauts-Bassins, Nord Plateau, Central, Sahel and Sud-Ouest. The QoC study covered 122 health facilities across all regions in Burkina Faso. Health facilities The SARA survey and QoC study covered health facilities in all regions in Burkina Faso 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). For QoC, a record review is conducted by abstracting information documented in various records where individual patient/client care information is recorded to answer a series of questions about the patient/client care process for a specific service area or condition. Record review requires that service providers know what aspects of patient/client care are expected to be recorded and that the records be available for selecting a sample. The record abstractors must be familiar with medical terminology. This method is not dependent on whether patients/clients with a specific condition arrive on the day of record review. For record reviews it is important that there be some source for identifying records with the condition of interest for drawing a sample. This is usually a service register. Data collection for the survey took place from October 17 to November 6, 2016 The SARA sample size was determined according to a number of criteria namely: number of health facilities, number of strata, number of regions, level of precision of the indicators (or desired margin of error), level of confidence (or significance level) and the budget. For this survey, the sample size included all facilities in level 1 and level 2 strata to ensure that public and private hospitals were over-represented in the sample. Face to face A facility inventory questionnaire to obtain information on how the facilities are prepared to provide each of the priority services was used. The facility inventory questionnaire collects information on the availability of specific items (including their location and functional status), components of support systems (e.g., logistics, maintenance, and management), and facility infrastructure, including the service delivery environment. 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 For QoC, a WHO questionnaire already used in low-resource countries, notably Liberia, was adapted to the Burkina Faso context. The tool is composed of different modules based on Global Fund's priority diseases, namely malaria, tuberculosis and HIV/AIDS.A completion guide was developed and used for this purpose. For the SARA survey, a total of 110 interviewers were used for a 21-day collection period. The collectors were organized into teams and reported to 16 team leaders. They ensured the quality of the information collected by their respective teams by verifying, archiving and forwarding the completed forms to the controllers, who were responsible for validating the information collected before entering it. For the QoC, data collectors received a 4 day training. A pilot survey was conducted prior to the QoC study. The health facilities that were piloted had the same characteristics as those of the study's sample. Data entry and processing for the SARA survey was done using a data entry mask designed by WHO on CSPro (Census and Survey Processing System). Once the data were cleaned, they were exported to the SARA Excel analysis tool (SARA_chartbook v2.2) for analysis. Analysis of new modules integrated in the 2016 SARA survey (Nutrition, Ebola Virus Disease and Rehabilitation) was done using SPSS V21 and Excel 2013. For the QoC study, statistical analyses were performed using SPSS and estimates were made with 95% confidence.