DDI-MOZ-SARA-2018-vFINAL World Health Organization 2021-11-14 NADA Final version (2019) Mozambique SARA 2018 Inventário Nacional Mozambique Service Availability and Readiness Assessment (SARA) 2018 National Inventory MOZ-MOH-SARA-2018-vFINAL Ministry of Health National Institute of Health (INS) World Health Organization NADA Service Availability and Readiness Assessments [hfa/sara] Final report (2019) National Institute of Health (NIH) in partnership with the Directorate of Planning and Cooperation (DPC) under the Ministry of Health of Mozambique implemented Service Availability and Readiness Assessment (SARA) plus with technical support from the World Health Organization (WHO) in 2018. The SARA plus 2018 aimed to generate information on the availability and readiness of health resources and health services, aligned with information needs for planning and reform of the health system. The census covered 1,643 public health facilities, of which 1,575 were primary level facilities, 54 were secondary level facilities, and 7 were tertiary and quarternary level facilities at the time of the survey. Data collection started in April 2018 and was completed in August 2018. 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 • Family planning (contraception) • Prenatal care • Prevention of vertical transmission • Obstetric and neonatal care, including cesarean section when applicable • Voluntary interruption of pregnancy • Gender-based violence • Extensive vaccination program • Preventive and curative care for children • Adolescent health • HIV/AIDS counselling and testing for adults • HIV/AIDS counselling and testing for adolescents • HIV/AIDS care, treatment and psycho-social support • Sexually Transmitted Infections • Tuberculosis • Malaria • Non-communicable diseases • Surgery, including surgical services for obstetric fistula • Blood transfusion Mozambique Nationally representative, as well as at provincial level Health facilities The survey covered 1,643 public health facilities, of which 1,575 were primary level facilities, 54 were secondary level facilities, and 7 were tertiary and quarternary level facilities 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). A sampling frame of existing health facilities in the country provided by the Ministry of Health was used. Face-to-face [f2f] The standard data collection instruments of this inventory were adapted to the national context and national health care standards, in order to guarantee the collection of all information of current programmatic interest. The adaptation of the questionnaire to the Mozambique context aimed to collect more information on inventory of public and private health units and private health units, gender perspective, more comprehensive service indicators for women's and children's health as well as other key health service indicators. Two recording instruments were used, based on the standard SARA instrument (WHO 2015). SARA standard instrument, which served to capture information related to the availability and readiness of services, human resources, equipment, drugs, and medical articles and another designed to capture information related to public and private infrastructure. The SARA core questionnaires overview is as follows: 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 Data collection was done using the CSPro software application embedded in tablets. Alternatively, the teams had paper questionnaires that were used in case of an operational problem with the electronic data collection platform. Thirty-seven health technicians (14 from INS, 7 from the DPC-DIS, and 16 from the WHO) were trained to assist in the coordination and technical supervision of the survey. Eighty nine (89) health professionals were mobilized from all provinces of the country, making 26 field teams. At the end of each day, the teams performed data consistency checks and data synchronization to a server. The geographic positioning system (GPS) coordinates were recorded twice. Furthermore, the central technical team carried out data validation by repeating the surveys in 10% of the health facilities, chosen randomly from among the facilities surveyed in the 2-week period.