DDI-NIG-SARA-2016-vFINAL World Health Organization 2021-11-14 NADA Final version National Health Facility Survey Nigeria 2016 NIG-MOH-SARA-2016-vFINAL Federal Ministry of Health World Bank NADA Service Availability and Readiness Assessment Mapping Survey [HFA/SARAM] v0.1: Final report The Federal Ministry of Health, Nigeria implemented a National Health Facility Survey (NHFS) in 2016. The NHFS 2016 builds on the service delivery indicator (SDI) surveys developed by the World Bank and on the Service Availability and Readiness (SARA) developed by the World Health Organization (WHO). The objectives of the 2016 NHFS and subsequent NHFS’s are to: 1) provide insights for managers so they can take specific actions to strengthen the health care system; 2) provide robust, independent, objective, and frequent data by which to track progress in improving the quality of health care in Nigeria; 3) make available information by which to benchmark the performance of States; and 4) provide the quality of care scores needed under Disbursement Linked Indicator (DLI) 2 of the Saving One Million Lives (SOML) Program for Results (PforR) which rewards States for improving the quality of care and health services provided at primary health care level. The NHFS survey covered 3325 health facilities in 36 states across the country. Data collection started in August, 2016 and was completed in December, 2016 This report presents findings on: i. Clinical competence of health workers ii. Provider knowledge of the IMCI protocol for diagnosis and treatment of the sick child iii. Provider knowledge of protocol for eMTCT during antenatal care iv. Availability of drugs and equipment v. Readiness of health facilities to deliver key saving one million lives interventions, sexually transmitted infections and Tuberculosis services vi. Management (financial, health care financing, integrated supportive supervision, health management information systems,etc) vii. Comparison of selected indicators between performance based financing (PBF) and control states. Nigeria Nationally representative, as well as state level Health facilities The survey covered 3325 health facilities in 36 states 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 stratified sampling strategy was used in the survey to select a total of 90 health facilities from each of the 36 States and the FCT bringing the total sample size to 3,300. Face-to-face [f2f] Components of the National Health Facility Survey questionnaire were as follows: 1. Facility Questionnaire - Module 1: Facility linkages with community and Management, staff and Finance - Module 2: Facility Infrastructure and Maintenance - Module 3: Community and Outpatient services - Module 4:Delivery, postnatal care and reproductive, health surgical services - Module 5:Blood transfusion, diagnostics and pharmacy - Module 6:Health Management Information System 2. Observation of sick children 3. Vignette (provider questionnaire) - Acute diarrhoea with dehydration - Pneumonia - Diabetes Mellitus - Pulmonary tuberculosis - Malaria + Anaemia - Post-Partum Haemorrhage - Neonatal Asphyxia - Care of Sick child based on IMCI & EMTCT standards 4. Exit interview - Child 5. Record review - ANC (women 32 wks+) - T.B (Patient on 1st line for 6mnths +) - ART (patient 5+ years on treatment for 6 months) - EMTCT (HIV positive women, 8 weeks post delivery of a live birth - Suspect Malaria for under 5 children (under 5 with clinically or laboratory r diagnosed malaria or presently on anti-malaria therapy) A total of 37 state team leaders (STLs) and 374 enumerators were recruited and trained in three clusters. Each State had an extra enumerator with the exception of Borno, Taraba, Yobe and Zamfara States which had two extra enumerators invited for training to address specific challenges. At the end of the training, 37 STLs and 330 enumerators were competitively selected for the survey. Each State had f 9 enumerators and 1 STL. A training on data collection was conducted for 25 days. Field data quality was assured through the conduct of back-checks. Back checks were conducted on approximately 10% of the sample size per State. An abridged version of the questionnaire was used for the back checks. Data was uploaded to the cloud using a separate SurveyCTO server created for each cluster specifically for the NHFS project. Once the data was uploaded, the datasets were subject to real time quality assurance before downloading and merged to form a dataset according the module. These were exported as flat tables in Stata for basic data quality checks before reshaping relevant sections. Government of Kenya, 2014: Kenya Service Availability and Readiness Assessment Mapping (SARAM). Ministry of Health, Nairobi Kenya