Percent of facilities where service providers for specific services provide the services in adherence to expected expected standards
This composite indicator combines several indicators for adherence to standards for service delivery in practice. It measures the percentage of observations of a specific service within facilities where each of the following was observed:
- Relevant client examinations and diagnostics were carried out.
- Relevant information was elicited from the client, and shared with the client.
- Relevant provider practices (e.g., documentation, infection prevention practices) were carried out.
Observation of routine examinations that are conducted on all clients for the service in question (e.g., routine taking temperature and blood pressure) prior to meeting with the service provider, observation of the actions and interactions between the service provider and the client.
Evaluators will use core definitions for “essential components of service provision” (based on generally accepted standards for practice) to compare adherence to standards in practice across various countries. However, evaluators may also adjust the essential items to reflect individual country service standards
Interviews with staff and with persons in charge of each service and observation of routine practices outside the consultation area; observation of client-provider interaction during consultation.
This indicator provides information on the extent to which services are actually provided according to expected standards of practice. It can be used to identify gaps between planned service standards and actual examinations and information sharing that occurs. These gaps will most often reflect problems with service delivery related to lack of availability of items required to adhere to standards, provider training or the need for supervisory support of the standards providers are expected to adhere to when providing services.
Adherence to standards is an important measure, because it measures the extent to which a systematic process for client examinations and services is followed. This systematic process is most often defined using generally accepted elements that are needed to identify problems and to provide appropriate treatments and advice.
Evaluators may analyze provider adherence to standards in practice by type of provider, 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 services are provided in adherence to given standards. It does not provide information on why standards are not followed. Information on availability of resources, and client status at the time of the service (e.g., whether the visit is a first or a follow-up visit, whether abnormal conditions exist, the reason for the visit) is needed to interpret the information and to help attribute causality. This indicator does not measure whether service providers followed the right process and made the right decisions regarding the course of action for specific clients.