International Health Facility Assessment Network (IHFAN)
Introducing the Service Availability and Readiness Assessment (SARA) Methodology

Introducing the Service Availability and Readiness Assessment (SARA) Methodology

Thursday, Jul/12/2012

Development of SARA

SARA builds on previous and current approaches designed to assess health facility service delivery including the Service Availability Mapping (SAM) developed by the WHO, and the Service Provision Assessment (SPA) developed by ICF International under the USAID-funded MEASURE DHS project. The SARA methodology takes into account best practices and lessons learned from the many countries that have implemented health facility assessments of service availability and readiness. It also draws heavily on the work of the International Health Facility Assessment network (IHFAN) and experiences from program and service specific facility assessment work. As such, the SARA will take the place of the previous WHO SAM tool.

How can the questionnaires be used?

The core SARA questionnaires must be adapted within countries so that the data collected result in the ability to meet the objective of the indicator.

For example, an indicator may be defined to identify if a facility has the ability to treat childhood pneumonia. The actual antibiotic that is used may differ by country.

Conducting a SARA

The SARA may be conducted using only the core SARA questionnaires or it may be incorporated into other surveys. For example, the MEASURE DHS SPA inventory questionnaire incorporates the entire core SARA questions, and collects further data on health workers and quality of care using additional questionnaires, in addition to the service readiness indicators. A streamlined version of the SPA (inventory-only questionnaire) which includes the core SARA questionnaire and additional facility-level information can be also conducted as a stand-alone assessment. If the SARA indicators are incorporated into other surveys, however, it is advocated that the data collection and calculations for the SARA indicators follow the agreed methodology for the SARA so that these can be reported as a subset of the survey in question.

What type of information does the SARA collect?

The SARA collects information at the facility level on basic infrastructure, client amenities, equipment, infection control elements, medicines, and diagnostics that support a basic package of preventive and curative services.

The SARA also collects information on readiness to provide specific MCH, reproductive health, HIV, chronic disease, malaria, and tuberculosis services, if a facility reports providing the service. This involves assessing availability of qualified staff and guidelines, equipment, medicines and commodities identified as necessary to provide the service at a basic level (e.g., managing clients who are uncomplicated or who experience what are considered common complications) with an acceptable level of quality.

Finally, the SARA collects information on the type of health facility (using the country classification such as health center; polyclinic, etc.), the managing authority (e.g., faith-based, private-for-profit, etc.), and GPS coordinates.

How are the facilities assessed by the SARA selected?

Public and private, non-profit facilities and increasingly some level of representativeness of private-for-profit facilities are assessed.

It is advocated that the facilities assessed for the SARA be nationally representative.

Data Presentation, Dissemination and Use:

At present, the SPA and the WHO SARA each have a different reporting format for facility survey results. There has not yet been discussion on presenting SARA data in any uniform manner and this is an area where user input might benefit the process.

With regards to using the data for comparison purposes, there is a proposal for a scoring mechanism where results for each service are aggregated to reflect a single score. The objective is to provide a simple measure for indicating improvement (or lack of improvement) or stronger/weaker when comparing across time or geography. This is described in the WHO SARA website.

An agreement on a uniform way to present information (e.g., to map all facilities; to present results by specific managing authority) has not been addressed, however, there is scope for advocates of uniform methods for data presentation to advocate for maps that show where the sample (or census) facilities are, but that are not linked with survey results. There is also scope to propose other data presentation formats that users would like to see.

Here is the link to the WHO SARA site:

http://www.who.int/healthinfo/systems/sara_introduction/en/index.html

Here is a link to the SPA site:

http://www.measuredhs.com/What-We-Do/Survey-Types/SPA.cfm

If you would still like to reference SAM, the link has changed to:

http://www.who.int/healthinfo/systems/samintro/en/index.html

For more information please contact IHFAN at nkanagat@jsi.com