DDI-ZIM-SARA-2015-vFINAL World Health Organization 2021-11-15 NADA Final report Service Availability and Readiness Assessment (SARA) Zimbabwe 2015 ZIM-MOHCC-SARA-2015-vFINAL Ministry of Health and Child Care World Health Organization NADA Global Fund United Nations Population Fund Service Availability and Readiness Assessment [HFA/SARA] Final report The Ministry of Health and Child Care (MoHCC) implemented the 2014 Service Availability and Readiness Assessment (SARA) 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, tuberculosis, malaria and noncommunicable diseases. The SARA assessment was a cross sectional survey of health facilities from a two tiered health system in Zimbabwe. Data was collected from 275 health facilities in all 10 provinces of Zimbabwe. These health facilities included rural health centres, rural hospitals, urban clinics, secondary referral facilities such as district and mission hospitals, and private hospitals and clinics. All the provinces and facilities were stratified by type of facility and administration. 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 and readiness • Maternal, neonatal and child health • Non-communicable diseases • Adolescent health • Malaria • Tuberculosis • HIV counselling and testing • HIV/AIDS care and support • Antiretroviral prescription and client management • Prevention of mother-to-child transmission (PMTCT) of HIV • Sexually-transmitted infections • Blood transfusion • Surgical services • Advanced diagnostic Zimbabwe Nationally representative, as well as representative at provincial and district levels. Health facilities and district health offices The survey covered 275 health facilities including all levels of care and administrative authority i.e. church affiliated (mission), government, council and private. 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 nationally representative sample of 275 health facilities was randomly selected from 1,487 health facilities in 10 provinces across the country. All the provinces and facilities were stratified by type of facility and administration. The sampling framework for each province was re-defined into three ownership domains and by facility type (public, mission and private). In each selected district, a proportionate sample of health facilities were identified and selected. Face-to-face [f2f] The SARA core instrument has three main areas of focus that included service availability, general service readiness and service specific readiness. The 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 Core functional capacities assessed in Zimbabwe were as follows: 1. Identification, location and managing authority of the health facility 2. General facility status e.g. availability of water supply, telecommunications, electricity, beds etc. 3. Basic medical equipment, such as X-ray, oxygen, washing machines 4. Availability of health work force e.g. cadre of human resources, staff training and guidelines 5. Drugs and commodities – availability of general medicines 6. Diagnostic facilities – availability of laboratory tests 7. Standard precaution – availability of injection, sterilization, disposal and hygiene practices 8. Specialized service, such as for maternal and newborn child health, family planning, child and adolescent health, communicable diseases and non-communicable diseases 9. Standard and specialized surgery services and blood transfusion A total of 27 enumerators comprising of trained medical personnel already working within the MoHCC and local council authorities were recruited for the survey. Each survey team was made up of a team lead and 2 enumerators.