DDI-LBY-SARA-2017-vFINAL World Health Organization 2021-12-07 NADA vFINAL (2017) Service Availability and Readiness Assessment (SARA) of Public Health Facilities in Libya 2017 LBY-MOH-SARA-2017-vFINAL Ministry of Health World Health Organization NADA World Health Organization European Union European Civil Protection and Humanitarian Aid Operations Service Availability and Readiness Assessment [hfa/sara] Final report (2017) The Ministry of Health (MoH) in collaboration with the World Health Organization - Regional Office for the Eastern Mediterranean implemented the 2017 Service Availability and Readiness Assessment (SARA) for Libya. The 2017 SARA was a systematic survey which aimed to provide reliable information on availability and readiness of health services delivery. The SARA 2017 survey covered 1656 public health facilities in Libya. Data collection for the hospital survey was conducted from August to December 2016, and the primary health care (PHC) level data collection started in September 2016 and ended in February 2017. Additional data on service utilization was provided by the Libyan MoH, while the population estimates for 2017 for Libya’s 22 districts were provided by the Libyan Bureau of Statistics. 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 prevention of infections • Diagnostic capacity • Essential medicines • Laboratory equipment capacity 3. Service specific availability and readiness • Antenatal care • Basic obstetric care • Child immunization • Preventive and curative care for children under fiive • Family planning • Tuberculosis • Adolescents health • Counselling and testing for HIV • Preventing mother-to-child transmission (PMTCT) of HIV • Sexually transmitted infections (STIs) • Leishmaniasis • Brucellosis • Diabetes • Cardiovascular diseases • Chronic respiratory diseases • Cervical and breast cancer • Mental health care • Emergency services • Diagnostic Libya Nationally representative, as well as representative at district, facility, central and sub central levels Health facilities The survey covered 97 hospitals, 1355 primary health care facilities, and 204 other facilities in 22 districts across Libya 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 Master Facility List (MFL) of all known public health facilities was prepared by the Libyan Health Information Centre (HIC), using data from both the SARA survey and the Health Management Information System (HMIS). All facilities were included in the survey regardless of status, even facilities which were known to be closed. The final list included 97 hospitals, 1355 primary care health facilities, and 204 other facilities. Face-to-face [f2f] The survey utilized the tools developed through SARA and modified to Libya context. The SARA questionnaire consisted of a set of questions measuring service availability and readiness that can be used to detect change and measure progress in health system strengthening over time. 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 The SARA- Hospital tool consists of seven modules: 1. Outpatient services 2. Overview, services, governance, management systems, human resources and capacity 3. Emergency services, procedures and surgical services 4. Delivery and inpatient services 5. Blood transfusion, diagnostics and pharmaceutical commodities 6. Infrastructure and support services 7. Facility information system and statistics The surveyors were all medical doctors employed by MoH. They were trained by staff from the Health Information Centre (HIC) and WHO Eastern Mediterranean Regional Office (EMRO). The Training of Trainers (TOT) trainings were conducted separately from the surveyors of hospitals (17-21 July 2016) and of PHC facilities (3-6 September, 2016) trainings. The TOT trainings were followed by a cascade of trainings conducted in Tripoli and Albeida. Twenty eight surveyors were trained for the hospital assessment, and 73 surveyors were trained for the public health care assessment. Data entry was done using electronic tablets at the field level. A specific program was developed to facilitate data entry using CSPro, with separate questionnaires for hospitals (the seven SARA-Hospital modules) and primary health care facilities (the single SARA core module). The software included data for quality checks like interview timings, GPS coordinates, contact details of interviewers and pictures of the facility.