DDI-ET-SARA-2018-vFINAL World Health Organization 2021-11-15 NADA Final version (report) Service Availability and Readiness Assessment (SARA) Ethiopia 2018 ET-EPHI-SARA-2018-vFINAL Ethiopian Public Health Institute (EPHI) Ministry of Health

Federal Ministry of Health

Ethiopian Public Health Institute

 World Health Organization NADA World Bank Ethiopian Public Health Institute (EPHI) Service availability and readiness assessment [HFA/SARA] v0.1: Final report Ethiopian Public Health Institute in collaboration with the Federal Ministry of Health implemented the 2018 Service Availability and Readiness Assessment (SARA) for Ethiopia. SARA was conducted to assist the health sector in assessing and monitoring service readiness and capacity at region and health facility levels on a regular basis. The objective of the survey was to generate reliable and regular information on service delivery including service availability, such as the availability of diagnostic, essential medicines, and infrastructure resources, and on the readiness of health facilities to provide basic health-care interventions relating to maternal health, child health services, HIV/AIDS, tuberculosis, malaria and non-communicable diseases. The survey covered 764 health facilities in 11 regions across the country. The Ethiopia SARA 2018 report provides information on a set of tracer indicators of service availability and readiness in the following categories: 1. General service readiness • Basic amenities • Basic equipment • Standard precautions for infection prevention • Diagnostic capacity • Essential tracer medicines 2. Service specific availability and readiness • Family planning • Antenatal • Basic Emergency and Essential Obstetric and Newborn care • Comprehensive obstetric care Services • Child immunization service • Child preventive and curative care service • 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 of HIV (PMTCT) • Sexually-transmitted infection • Neglected Tropical Disease (NTD) • Public Health Emergency Management (PHEM) Services • Surgery and blood transfusion • Emergency • Intensive Care Unit service Ethiopia Nationally representative, as well as representative at regional level. Health facilities The assessment covered 764 health facilities in 11 regions 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). A nationally representative sample stratified by health facility type and managing authority. Sample size calculation took into account Ethiopian's skewed health facility distribution. A total of 764 health facilities were selected for the sample. Of these, 303 were hospitals, 164 were health centres, 165 were clinics and 132 were health posts. 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 The core questionnaires are developed in English and are provided as external resources. The questionnaire was adapted to the country context and translated into Amharigna. A survey team of 89 people, mostly health providers (nurses, nurse midwives, and clinicians) were trained in the application of survey instruments and computer programmes. A pre-test for the survey took place before the start of the survey. Interviews were conducted in English and Amharigna using computer assisted personal interviewing–CAPI. The information entered in the PC-tablets by each interviewer was sent regularly to Ethiopian Public Health Institute (EPHI) central server by the team supervisor. These data files were concatenated, reviewed and checked for any errors and inconsistencies. Data cleaning included the checking of range, structure and a selected set of checks for internal consistency. All errors detected during machine editing were corrected. All data entry and editing programs were written using CSPro. 100%