DDI-LKA-MOHNIM-SARA-2017-vFINAL World Health Organization 2021-11-15 NADA Final version (report) Service Availability and Readiness Assessment (SARA) Sri Lanka 2017 LKA-MOHNIM-SARA-2017-vFINAL Ministry of Health, Nutrition and Indigenous Medicine Department of Census and Statistics World Health Organization NADA Global Fund to fight AIDS, Tuberculosis, and Malaria Service Availability and Readiness Assessment [hfa/sara] vFINAL: Final report The Ministry of Health, Nutrition and Indigenous Medicine in collaboration with the Department of Census and Statistics implemented the 2017 Service Availability and Readiness Assessment (SARA) for Sri Lanka. The objective of the survey 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 maternal and child health services, basic and comprehensive obstetric care, HIV/AIDS, tuberculosis, malaria and non-communicable diseases. The SARA 2017 was conducted in a nationally representative sample of 755 facilities drawn from a population of 2543 health facilities in Sri Lanka. Data was collected between June and July 2017. This report covers the following categories of indicators: 1. General service availability and readiness • Basic amenities • Length of operation hours • Basic and emergency equipment • Standard precautions for infection control • Diagnostic capacity • Essential medicines • Surgical management services • Blood transfusion services 2. Service specific availability and readiness • Maternal and child health • HIV/AIDS • Tuberculosis diagnosis and treatment • Malaria services • Rabies • Dengue • Chronic non-communicable diseases • Sexually-transmitted infections • Diabetes services • Cardiovascular disease services • Chronic obstructive pulmonary disease (COPD) • Chronic kidney disease • Cancer • Mental health • Care for the elderly • Disability care Sri Lanka Nationally representative, as well as representative at sub-national level Health facilities The survey covered 755 health facilities including 41 tertiary care hospitals, 50 secondary care hospitals, 252 primary health care facilities, 344 public clinics and 68 privately owned hospitals. 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 sampling process adopted a two stage stratified random sampling technique with probability proportion to the size representing all facility types and districts. The first stratification was done based on facility type, and the second stratification was done taking into consideration the geographic variation within the country covering all 26 health districts. The strata according to facility type were: (i) primary health care facilities (primary medical care units and divisional hospitals); (ii) secondary health care institutions (Base Hospitals); (iii) tertiary health care institutions (District General Hospitals, Provincial General Hospitals, National Hospital of Sri Lanka and other Teaching Hospitals); (iv) public clinics (TB clinics, sexually transmitted disease (STD) clinics, Regional Malaria Offices (RMO), clinics at Medical Officer of Health (MOH), and Healthy Lifestyle Centres (HLC)); and (v) privately owned hospitals with in-patient services. 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. The WHO SARA tool was adapted to Sri Lanka's specific settings. The following modules were added to the questionnaire: dengue, rabies, breast cancer, oral cancer, chronic kidney disease, mental health, elderly care, disability care and gender based violence care.The modules on supervision and supply chain were excluded since they were beyond the scope of the survey. Modified SARA data collection tools were pretested among 10 health facilities in the Western province representing all types of health facilities considered in the survey. Appropriate revisions were done following the pretest. Data were collected by a team of enumerators led by a medical officer and 2 statistical officers from the Department of Census and Statistics with past experience in health surveys. The survey team was trained and provided with a manual for data collectors prior to data collection. Data collection was facilitated by the district coordinators appointed in every health district to liaise with health facilities and the data collection teams. Data were entered by a team of experienced data entry operators into a database developed using CSPro programme by the Department of Census and Statistics. Quality of data was assured through appropriate validity checks and data cleaning under supervision of the quality assurance team. Ministry of Health, Nutrition and Indigenous Medicine and Department of Census and Statistics, 2018. Service Availability and Readiness Assessment 2017 Sri Lanka.