DDI-SIERRA-SARA-2017-vFINAL World Health Organization 2021-11-15 NADA Final version Service Availability and Readiness Assessment (SARA), Quality of Care Survey and Data Quality Review Sierra Leone 2017 SLE-MOHS-SARA-2017-vFINAL Ministry of Health and Sanitation World Health Organization NADA Global Fund to fight AIDS, Tuberculosis, and Malaria Service Availability and Readiness Assessment [hfa/sara] Final report (2017) The Ministry of Health and Sanitation (MOHS) implemented the 2017 Service Availability and Readiness Assessment (SARA) Plus which integrated a Data Quality Review (DQR) and Quality of Care (QoC) assessment of service delivery at health facilities. The SARA Plus aimed to (i) determine the physical availability or presence of quality health services, encompassing the health infrastructure, core health personnel and aspects of services utilization; and (ii) assess service readiness, in terms of general service readiness and service-specific readiness. The SARA Plus was conducted as a census of all health facilities in Sierra Leone. The DQR and the QoC assessment were conducted in a sample of 10% of the facilities (150 sites), proportionately selected to include facilities that offered antenatal care (ANC), delivery and newborn care, and HIV, malaria and TB care services. First, the 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 Second, findings from record reviews conducted for HIV testing, malaria services, ANC, delivery services and immediate postpartum care for the newborn at an average of 82 facilities and for TB services at 42 facilities are also presented in this report. Third, the report also presents findings from the Data Quality Review (DQR) which include the following set of indicators: • Maternal health – number of ANC first visits • Immunization – number of third dose pentavalent vaccinations • HIV/AIDS – number of clients counselled and tested for HIV • Tuberculosis - number of TB cases • Malaria – number of confirmed malaria cases Sierra Leone Nationally representative Health facilities The survey covered all health facilities across the country. 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 Data Quality Review (DQR) employs a standard set of indicators, data collection tools, analytical tools, and format for the presentation of results. Implementing countries adapt the forms and tools, as necessary, to meet their specific needs; however, the standard implementation calls for one indicator from each of five health programmes: maternal health, immunization, HIV/AIDS, TB, and malaria. A qualitative component, called the Systems Assessment, allows for the identification of weaknesses in the reporting system that contribute to data quality problems. Face-to-face [f2f] Six questionnaires were adapted to the country context: one SARA questionnaire included the overview of health facilities, general services availability, general readiness, and specific availability and readiness; four questionnaires for QoC covered HIV counselling and testing services, management of TB, malaria, pregnancy and childbirth; and there was one questionnaire for the DQR. 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 World Health Organization’s (WHO) SARA questionnaires, version 2017, were customized for Sierra Leone during a three-day workshop. Field enumerators were competitively selected and interviewed by the MOHS. Following a ten-day training workshop for the enumerators, a total of 62 were selected. Twenty-one pairs of enumerators were formed, each with responsibility for an average of 56 facilities. The questionnaires were pilot tested in the Western urban and rural districts. The questions were adjusted based on the experience obtained during the pilot test. Ten back checkers were selected and trained to conduct quality assurance. The back checker team re-collected data from 5% of randomly selected facilities.