Percent of facilities prepared to provide the essential services
This composite indicator combines several indicators for preparedness to provide a given service at a minimum standard. It measures the percentage of facilities with each of the following:
- All essential equipment present, functioning, and located in the service delivery area or in reasonable proximity for utilization;
- All essential medications and supplies present; and
- At least one set of staff members assigned to the facility who have either professional or inservice
training that qualifies them to provide the service following standard procedures.
Inventory of functional status of equipment, and location in relation to the service delivery area; inventory of medications and supplies; inventory of all assigned staff and their basic qualification; and information on qualification and continued training related to theservice provided, for staff providing the service on the day of the visit.
Evaluators will use core definitions for “essential items” (based on generally accepted standards for practice) to compare preparedness to provide the service across various countries. However, evaluators may also adjust the essential items to reflect individual country service standards.
This indicator can be measured using the SPA or SARA questionnaire.
Interviews with staff and with persons in charge of each service; facility inventory and physical verification of equipment and supplies
This indicator provides information on the preparedness of a facility to offer a specific service with a minimum standard of quality. It can be used to identify gaps between planned service standards and actual resources on-site, which are required to provide the service to the given standard. These gaps will most often reflect problems with the support systems, such as the commodities and logistics systems, staff allocation, or staff training.
One important aspect of this indicator is that it assesses the resource availability at the delivery site. Evaluators interpret as “not available” any essential items absent from the service delivery area (e.g., a blood pressure gauge sitting in another service delivery area, or supplies locked in a storage closet). This approach more realistically assesses a facility’s capability for meeting service standards.
Preparedness is an important measure, because a facility that fails to meet the indicator standard is incapable of providing the service to the established standard.
Evaluators may analyze facility service availability by type of facility, by geographic area, or by sector (e.g., government, private for profit, private non-profit).
The service provision assessment (SPA) provides an assessment at a single point in time. However, one can evaluate changes over time by repeating the SPA at a given facility or at a set of facilities at periodic intervals (e.g., 3-5 years). With a representative sample, the picture of preparedness should accurately reflect the overall situation at a given level of analysis (e.g., region or nation), although it may not provide an accurate picture of an individual facility.
Several caveats warrant mention. First, this indicator provides data on the extent to which a given facility or set of facilities is prepared to provide service to a given standard. It does not measure the actual delivery of the service (e.g., whether the service meets the standard of quality during a given client visit). Similarly, the SPA does not measure whether service providers followed the right process and made the right decisions regarding the course of action for specific clients.
Second, this indicator does not assess preparedness in relation to the potential demand for the services based on normal client load. If the client load is greater than the facility can handle, the overload can increase waiting times, cause staff to neglect tests or other processes for which equipment is in short supply, or cause the clinic to have inadequate supplies to meet client demand. Thus, service quality declines.
Third, preparedness provides only one measure of access; this indicator fails to capture other aspects of access, such as hours the service is provided, and geographic, cultural or financial constraints.