DDI-DRC-SARA-2014-vFINAL World Health Organization 2021-12-10 NADA Final version Indice de disponibilité et de capacité opérationnelle des services de santé (SARA) République démocratique du Congo 2014 Health Services Availability and Capacity Index (SARA) Democratic Republic of Congo 2014 DRC-MOPH-SARA-2014-vFINAL Ministry of Public Health World Health Organization NADA Global Fund to Fight Malaria, HIV/AIDS and Tuberculosis GAVI alliance Commission on Information and Accountability for Women's and Children's Health and Child Health Service Availability and Readiness Assessment Mapping Survey [HFA/SARAM] Final report The Ministry of Public Health of the Democratic Republic of Congo (DRC) and the Directorate of Primary Health Care Development implemented the Service Availability and Readiness Assessment (SARA) survey in 2014. The 2014 SARA aimed to generate reliable and regular information particularly on the availability of services, infrastructure, essential human resources, and the availability of equipment and medicines in health facilities, which allows them to offer basic health interventions in the area of family planning, pediatric health services, essential and comprehensive obstetric care, HIV/AIDS, tuberculosis, malaria, non-communicable diseases, surgical care, and blood transfusion. This report presents the main results of the survey conducted in a representative sample of 1,555 health facilities at national and provincial levels spread over all 11 provinces of the DRC. The following set of indicators are presented: 1. General service availability • Health infrastructure density • Health workforce density • Service utilization 2. General service readiness • Basic amenities and comfort elements • Basic equipment • Standard precautions for infection prevention • Diagnostic capacity • Essential medicines 3. Service specific availability and readiness • Maternal, newborn and child health (MNCH) • Family planning • Adolescent health • Immunization services • Preventive and curative care services for the child • Adolescent health services • Malaria • HIV/AIDS counselling and testing services • Tuberculosis • HIV/AIDS care and support services • PMTCT • Sexually transmitted infections • Diabetes • Cardiovascular diseases • Chronic respiratory diseases • Non-communicable diseases (NCDs) • Advanced and state of the art diagnosis • Basic surgical services • Blood transfusion Democratic Republic of Congo Nationally representative, as well at provincial level Health facilities The SARA survey covered all health facilities in 11 provinces 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 list of all health facilities in the country from National Health Information System (SNIS) was used as a sample frame. Stratified random sampling was used to select health facilities. The sample was stratified by type of facility and province. Five types of health facilities were selected for the sample: general referral hospitals, hospital centres, referral health centres, health centres and health posts. A predetermined sample size of 1,555 health facilities was constructed representing all provinces (an average of 150 health facilities per province). Face-to-face [f2f] The SARA core questionnaires overview is as follows: 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 questionnaire was adapted to DRC context. The following elements and specifics of the health system were taken into consideration during this adaptation: type of health facility, management bodies of the health facilities, national guidelines for services, staff categories and national drug policy (e.g., for HIV/AIDS). A training of field supervisors and enumerators was conducted. The field supervisors were selected from among experts from the Ministry of Health, partner agencies and civil society on the basis of a criterion.They had to be either a public health specialist, a medical doctor with experience as a chief of staff, or a statistician, demographer, sociologist or anthropologist. The questionnaire was piloted twice in health facilities in Kinshasa, first during training of supervisors and second, during a trial focusing on child immunization in the DRC. Following these two pilot experiences, the last adjustments and modifications were made to the questionnaire before data collection. Data was collected in two phases. The first phase which involved 8 provinces was from May to July 2014 involved eight province. The second phase took place between August and September 2014, and collected data from the remaining 3 provinces. Data validation was carried out in 10% of the sampled health facilities, randomly selected from each pool, to ensure the quality of data collection. Ministère de la Santé Publique (MSP), Enquête sur la Disponibilité et la capacité opérationnelle des services de santé en République Démocratique du Congo, DSSP/DSNIS, 2014,RDC