DDI-TZA-SARA-2012-vFINAL World Health Organization 2021-11-15 NADA DDI-TZ-SARA-2012-v02 Service Availability and Readiness Assessment (SARA) United Republic of Tanzania 2012 TZA-MOHSW-SARA-2012-vFINAL Ministry of Health and Social Welfare Ifakara Health Institute World Health Organization NADA Global Fund to fight AIDS, Tuberculosis, and Malaria Service Availability and Readiness Assessment [hfa/sara] vFINAL: Final report, revised from first draft The Ministry of Health and Social Welfare in collaboration with WHO implemented the 2012 Service Availability and Readiness Assessment (SARA) for Tanzania. The survey was conducted by Ifakara Health Institute (IHI) in three rounds from May to December 2012. 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 family planning, child health services, basic and comprehensive obstetric care, HIV/AIDS, tuberculosis, malaria and noncommunicable diseases. The survey was conducted in a nationally-representative sample of 27 districts, with a target sample of 1,908 health facilities and a final sample of 1,297 health facilities, representing more than 18% of all health facilities in the country. The sample comprised non-government as well as government health facilities and results were stratified by facility level, operating authority, ownership and urban/rural areas. This report provides an important insight into service availability and readiness – both for health care in general and for a range of specific services. Further, the report covers three categories of indicators: 1. Service availability • Health infrastructure • Health workforce 2. General service readiness • Basic amenities • Basic equipment • Standard precautions for infection prevention • Diagnostic capacity • Essential tracer medicines 3. Service specific availability and readiness • Family planning services • Delivery services (normal delivery and basic emergency obstetric care) • Routine child immunization • Preventive and curative services for children under five years of age • Adolescent health services • Malaria services • Tuberculosis diagnosis and treatment • 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 infections services • Diabetes services • Cardiovascular disease services • Chronic respiratory disease management • Basic surgical services • Advanced delivery • Blood transfusion services United Republic of Tanzania Nationally representative, as well as representative at district level Health facilities and district health offices The survey covered 1,297 health facilities in 27 districts. 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). Data was collected from May to December 2012 The sample for this survey comprised all districts in the Sentinel Panel of Districts (SPD). This is a panel of 23 districts, plus an additional four districts where demographic sentinel surveillance systems are in operation (Rufiji, Kilombero, Ulanga, Kigoma Urban). The SPD district sampling was conducted by the National Bureau of Statistics using a two-stage, population-weighted probability sample to assure a nationally representative sample of districts that also permitted stratification by zone and by urban/rural area. The targeted sample was 1908 health facilities which was reduced to 1297 health facilities. This was because of large number of facilities in some districts and highly dispersed (difficult to reach) facilities. 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 SARA survey in Tanzania focused on the following modules: 1. Services available 2. Staffing 3. Service utilisation 4. Infrastructure 5. Available services 6. Infection control precautions 7. Family planning 8. Antenatal 9. PMTCT 10. Obstetric & newborn 11. Child immunisation 12. Child preventative & curative care 13. Adolescent health 14. HIV counselling & testing 15. HIV treatment 16. HIV care & support 17. Sexually transmitted infections 18. Tuberculosis services 19. Malaria services 20. Non-communicable disease services 21. Surgical services 22. Blood transfusion 23. Diagnostics A three days training of data collectors was conducted. A district team comprising of two data collectors. Visited health facilities and administered data collection questionnaires to respective facility in-charges or the person responsible for respective specific services. Supervisors from the MOHSW and IHI went to all districts to provide supervision and reviewed data collection for completeness and quality. Sampling weights at first stage were calculated as a reciprocal of the probability of a district to be included in SAVVY sample. Since all health facilities in selected districts had equal chances of being included, no sampling weights were incorporated at second stage. Data cleaning was performed using SQL management studio. 68%