Post on 26-Dec-2015
Dissemination of Service Availability and Readiness Assessment (SARA)
study
A methodology for measuring health systems strengtheningConducted by IHI for MOH&SW in 2012
28th Jan 2014, Julius Nyerere International Convention Centre,DSM
Outline• What is SARA? Why measure SARA? What does SARA add?
• Design and methodology
• SARA findings• General service availability and readiness• Specific service availability and readiness
• Maternal, newborn• Communicable diseases• Non-communicable diseases• Surgical, blood transfusion services
• Summary of key points
What is SARA?• It measures general service availability (access to health
services) • Health infrastructure (density of facilities and inpatient beds)• Core health personnel, inpatient/outpatient service utilization
• It measures general service readiness (capacity of health facilities to provide general health services) • Presence of basic amenities, equipment, standard precautions for
infections, diagnostic capacity and essential medicines
• It measures specific service availability and readiness• Proportion of facilities providing specific key interventions and
their capacity to provide them.
Why measure health services availability and readiness?
• More demand for accountability and to demonstrate results
• Need to track how health systems respond to increased inputs and improved outputs
• Need for strong country monitoring system of health facilities (public & private) and their readiness to deliver services :
• Need for core indicators of service availability and readiness
and appropriate sustainable measurement strategies to generate required data over time
Why measure SARA in Tanzania?
• Commitment of the Government of Tanzania to equitable delivery of quality health services.
• Existence of a wide network of health facilities pre-dating Alma Ata declaration on Primary Health care
• Help address major challenges such as HRH, information systems and equipment and drugs for combating major diseases
• Global Fund Round 9 Health System Strengthening Proposal
What does SARA add?
• Independent data quality assessment of service delivery
• Establishes a baseline for monitoring progress in scale up of service delivery
• Strengthens the analysis for annual health sector and mid-term review
6
METHODOLOGYSERVICE AVAILABILITY AND READINESS ASSESSMENT, TANZANIA 2012
Service Availability and Readiness: Survey Tool
• Global core set of indicators and measurement methods to detect change and monitor progress in HSS
• Measurement tool for Service Availability and Readiness to address critical data gaps in service availability and readiness– Availability : Physical presence of services– Readiness : Capacity to deliver services
• Builds on experiences of SAM, SPA working with USAID and partners to scale up SARA in countries
SARA Questionnaire
• Standard questionnaire built on prior facility survey instruments • Primary level • Additional questions for hospitals and large
facilities
• Uses commonly accepted guidelines & recommendations• Sick child: IMCI• Family Planning: USAID; UNFPA; WHO• Maternal Health: Safe Motherhood Initiatives• STIs and TB: WHO/others• HIV/AIDS: variety of initiatives
• Adapted to country needs• Technical meeting with MOH • Pretested and adjusted
Main domains assessed
• Service availability• Facility density, health worker density, service utilization
• General service readiness• Basic amenities, equipment & supplies, diagnostics,
essential medicines & commodities
• Specific service readiness areas:• Family planning, antenatal care• Obstetric care• Neonatal care and child health (curative, immunization)• HIV, PMTCT, TB, Malaria• Chronic Diseases
Where was SARA data collected?
Sentinel Panel of Districts (District Observatory)
How was SARA data collected?
• Conducted a 5 day training including field practice
• Data collection was done in three phases in May, June and December 2012
• Facility Based Information System coordinators in collaboration with CHMT members
• Data was collected on paper forms and entered electronically into a central database developed in google forms
• Respondents: facility in-charge, plus most knowledgeable person present day of survey for particular service.
Sample and sample weights
• A total of 1,297 health facilities in 27 districts were visited
• This a national representative sample of district selected by National Bureau of Statistics
• Two-stage, population-weighted probability sample
• Sampling weights at first stage were calculated as a reciprocal of the probability of a district to be included in SPD sample.
• No weights in the second stage since all facilities were included in the district
Quality Control
• Field supervision (by a joint team from MOHSW&IHI)
• Spot checks (based on information received during data entry)
• Validation through sample of facilities to be re-surveyed by supervisors
• Regular conference calls using IHI closed user group for rapid problem solving and information sharing
14
RESULTS
General Service Availability
Health InfrastructureHeath workforce
Number of health facilities by type
Characteristic Hospitals HealthCenters Dispensary MCH
Clinics Percent Total
Managing authority
Government/Public 23 93 800 7 71% 923
Mission/Faith based 17 14 100 1 10% 132NGO/Not-for-profit - - 9 - 1% 9Private-for-profit 12 30 191 - 18% 233OwnershipGovernment/Public 23 93 800 7 71% 923Private 29 44 300 1 29% 374ResidenceRural 19 73 749 3 65% 844Urban 33 64 351 5 35% 453 Percent by level 4% 11% 85% 1% Total 52 137 1,100 8 1,297
Distribution of facilities by level and residence
Dispensary Health Centre MCH Clinic Hospital Total0
10
20
30
40
50
60
70
80
90
100
77
60
46 47
73
24
40
54 54
27
Rural Urban
Percent of facilities by residence
Source: SARA Tanzania 2012
Health workforce density
Dispensary
Health Centre
MCH Clinic
Hospital
Public/Govt.
Private
Rural
Urban
Total
0 1 2 3 4 5 6 7 8
2.7
1.3
0.7
2.3
4.8
2.3
2.2
4.9
7.1
Skilled health personnel per 10,000 population
Source: SARA Tanzania 2012
General Service Readiness
• Basic amenities• Basic equipment• Standard precautions• Laboratory diagnostics• Medicines
is a composite score summarizing information from five domains of health service delivery
It refers to the capacity of health facilities to provide general health services
Basic amenities
Computer with internet/email
Private consultation room
Improved sanitation facilities
Power(grid/generator)
Communication equipment
Improved water source
Emergency Transportation
0 10 20 30 40 50 60 70 80 90 100
12
15
19
21
40
45
47
Percent of basic amenities
Source: SARA Tanzania 2012
Basic equipment
Light source
Child/infant scale
Thermometer
Adult scale
Blood pressure apparatus
Stethoscope
0 10 20 30 40 50 60 70 80 90 100
30
75
81
82
85
87
Percent with basic equipment
Source: SARA Tanzania 2012
Standard precautions for infection prevention
Safe final disposal of infectious wastes
Sterilization equipment
Eye protection
Safe final disposal of sharp waste
Masks
Gowns
Guidelines for standard precautions
Appropriate storage of infectious waste
Soap and water or alcohol-based hand rub
Latex gloves
Appropriate storage of sharp waste
Disinfectant
Disposable or auto-disable syringes
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
11%
23%
24%
30%
33%
34%
38%
46%
50%
64%
67%
77%
87%
Diagnostic capacity
ALT and creatinine
Tuberculosis microscopy
General microscopy
Urine dipstick – glucose
Haemoglobin test
Urine pregnancy test
Dried Blood Spot collection
Syphilis rapid test
HIV diagnostic capacity
Malaria diagnostic capacity
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
4%
6%
14%
18%
19%
22%
32%
44%
70%
74%
Diagnostic capacity by facility level
Haemoglobin
Blood glucose
Malaria diagnostic capacity
Urine dipstick- protein
Urine dipstick- glucose
HIV diagnostic capacity
DBS collection
TB microscopy
Syphilis rapid test
General microscopy
Urine test for pregnancy
ALT and creatinine
0 10 20 30 40 50 60 70 80 90 100
HospitalHealth CentreDispensary
Percent of diagnostic capacity
Essential medicines
Simvastatin (high cholesterol)
Amitryptyline (depression)
Captropril (hypertension)
Atenolol (hypertension)
Omeprazole (gastroesophogal reflux)
Gilbenclamide (diabetes)
Salbutamol inhaler (asthma)
Diazepam (muscle relaxant)
Diclofenac (pain medication)
Amoxicillin (respiratory antibiotic for adults)
Cetriaxone injection (2nd line antibiotic)
Cotrimoxazole suspension (oral antibiotic for children)
Ciprofloxacin (2nd line antibiotic)
Paracetamol suspension (fever in children)
0% 20% 40% 60% 80% 100% 120%
3%
12%
13%
15%
18%
19%
20%
46%
55%
57%
62%
77%
80%
100%
Percent of essential tracer medicines
Source: SARA Tanzania 2012
General Service Readiness (GSR) Index
General ser-vice readiness
index
Basic amenities
Basic equipment
Standard precautions
Diagnostics Medicines0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
42%
27%
73%
45%
25%
41%
Source: SARA Tanzania 2012
Mean availability of components of service provision and GSR index
General Services Readiness: Comparison with other countries
General service readiness index
Basic amenities
Basic equipment Standard precautions
Diagnostics Medicines0
10
20
30
40
50
60
70
80
90
42
27
73
45
3541
48
57
75
60
11
35
64 65
85
77
42
49
Tanzania2012
Sierra Leone2011
Zambia2010
Key Message: General Service Availability and Readiness
• Basic equipment availability scored the highest• Fewer facilities had basic amenities such as power, computers
with email/internet, private consultation room and sanitation facilities
• Diagnostic capacity was surprisingly low even in health centers and hospitals
• Medicines score was also low. 30%-40% was out of stock of 4 basic medicine
• General service readiness index was 42%.
Maternal, Newborn, Child and Adolescent Health
• Family Planning• Antenatal• Delivery• Routine immunization• Preventive and
Curative• Adolescent Health
Source: SARA Tanzania 2012
Availability of Family Planning services
Percent of family planning services
Male sterilization
Female sterilization
Female condoms
IUCD
Implant
Cycle beads for standard days method
Combined injectable contraceptives
Emergency contraceptive pills
Progestin-only contraceptives
Progestin-only injectable contraceptives
Male condoms
Combined oral contraceptives
Offers at least two modern methods of FP
Offers FP services
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
6%
8%
9%
18%
23%
26%
37%
44%
54%
54%
68%
69%
70%
83%
Readiness to provide FP services
Source: SARA Tanzania 2012
At least one trained staff family planning
Guidelines available family planning
Blood pressure apparatus
Combined oral contraceptive pills
Injectable contraceptives
Condoms
Readiness score
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
45%
57%
89%
79%
75%
88%
72%
Readiness score Medicines and commoditiesEquipement Staff and training
Availability of ANC services
Source: SARA Tanzania 2012
Monitoring for hypertensive disorder of pregnancy
Iron supplementation
IPT
Folic acid supplementation
Tetanus toxoid vaccination
Offers antenatal care services
0% 20% 40% 60% 80% 100%
61%
70%
72%
72%
72%
85%
Readiness to provide ANC services
Source: SARA Tanzania 2012
Guidelines available antenatal care
At least one trained staff antenatal care
Blood pressure apparatus
Urine dipstick- protein test
Haemoglobin test
Folic acid tablets
Tetanus toxoid vaccine
Iron tablets
Readiness score
0% 20% 40% 60% 80% 100%
60%
49%
88%
17%
8%
92%
91%
90%
58%
Readiness score Medicines and commodities DiagnosticsEquipement Staff and training
Availability of emergency obstetric and new born care
BEmOC (7 signal functions)
Parenteral administration of anti-convulsants
Neonatal resuscitation
Manual removal of retained products
Parenteral administration of oxytocic drugs
Manual removal of placenta
Parenteral administration of antibiotics
Assisted vaginal delivery
Offers delivery services
0% 20% 40% 60% 80% 100%
25%
40%
51%
56%
61%
61%
67%
67%
64%
Source: SARA Tanzania 2012
Readiness to provide BEmOC services
At least one trained staff BEmOCGuidelines available BEmOC
Delivery packGloves
PartographEmergency transport
Suction apparatusExamination light
Neonatal bag and maskVacuum aspirator and D&C kit
Manual vacuum extractorDiazepam injectable
Skin disinfectantAntibiotic eye ointment for newbornIntravenous solution with infusion kit
Injectable uterotonicInjectable antibiotic
Magnesium sulphateReadiness score
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
20%20%
85%75%
69%52%
35%29%
21%14%
12%91%
85%84%
79%75%
67%35%
53%
Readiness score Medicine & CommoditiesEquipment Staff and training
Source: SARA Tanzania 2012BEmOC Basic Emergency Obstetric Care
Availability of child Immunization services
Routine measles immunization
Routine DPT-Hib+HepB immunization
Routine polio immunization
Routine BCG immunization
Offers child immunization services
0% 20% 40% 60% 80% 100%
73%
73%
73%
73%
73%
Source: SARA Tanzania 2012
Readiness to provide immunization services
Source: SARA Tanzania 2012
At least one trained staff EPI
Guidelines available EPI
Cold box with ice packs
Sharps container
Single use syringes
Refrigerator
Measles vaccine
DPT-Hib+HepB vaccine
Polio vaccine
BCG vaccine
Readiness score
0% 20% 40% 60% 80% 100%
74%
66%
79%
79%
79%
78%
81%
80%
80%
77%
77%
Readiness score Medicines and commoditiesEquipement Staff and training
Availability of preventive and curative services
ORS and zinc s
upplementation
to ch
ildren w
ith diarrh
ea
Child gro
wth
monitorin
g
Iron su
pplementation
Diagnosis/
treat m
alnutrition
Vitamin A
supplementation
Offers preventative and
curative ca
re for U
-5s
0%
20%
40%
60%
80%
100%
75%80% 82% 83% 83% 82%
Source: SARA Tanzania 2012
Readiness to provide curative and preventive services
Guidelines available IMCIAt least one trained staff IMCI
Guidelines available growth monitoringAt least one trained staff growth monitoring
StethoscopeThermometer
Child scaleGrowth chart
Length/height measuring equipmentMalaria diagnostic capacity
HaemoglobinTest parasite in stool
Paracetamol syrup/suspensionMe-/albendazole cap/tab
Vitamin A capsulesORS packet
Amoxicillin syrup/suspensionCo-trimoxazole syrup/suspension
Zinc tabletsReadiness score
0% 20% 40% 60% 80% 100%
52%
42%
35%
33%
87%
81%
76%
75%
36%
42%
19%
12%
100%
92%
89%
87%
79%
77%
54%
65%
Readiness score Medicines and commodities DiagnosticsEquipement Staff and training
Source: SARA Tanzania 2012
Availability of adolescent health services by ownership and residence
Pubiic/Government
Private Rural Urban0%
10%
20%
30%
40%
50%
60%
70%
80%75%
49%
73%
57%
75% of public facilities offered adolescent health services
Source: SARA Tanzania 2012
Readiness to provide adolescent heath services
Staff providing HIV testing and counselling services trained in prevention, care, and management for adolescents
Staff providing family planning services trained in adolescent sexual and reproductive health
At least one trained staff provision of adolescent health services
Guidelines available service provision to adolescents
Condoms
Facility offers family planning services to adolescents
Facility offers HIV testing and counselling services to adolescents
Readiness score
0% 20% 40% 60% 80% 100%
39%
30%
20%
0%
88%
74%
54%
44%
Readiness score Adolescent health servicesMedicines and commodities Staff and training
No facility had guidelines for adolescent health services
Source: SARA Tanzania 2012
Key Messages: Maternal, Newborn, Child and Adolescent Health
• Availability of maternal, newborn, child and adolescent health was generally good.
• Although ANC services were available in 85% of the facilities, readiness was found to be 58%
• More than three quarters of the facilities had the capacity to deliver immunization services
• Adolescent services were mostly present in public facilities and in rural compared to urban facilities though no facility had guidelines
• Availability and readiness for preventive and curative services for under fives was 82% and 65% respectively
Communicable Diseases
Source: SARA Tanzania 2012
Malaria Tuberculosis HIV counseling and testing HIV care and support ARV prescription and client management PMTCT Sexually Transmitted Infections
Availability of malaria services
Malaria diagnosis verification
IPT
Malaria treatment
Malaria diagnosis
Offers diagnosis or treatment of
malaria
0% 20% 40% 60% 80% 100%
66%
72%
86%
86%
93%
Source: SARA Tanzania 2012
93% of health facilities offer malaria diagnosis and treatment services
Readiness to provide malaria services
Guidelines available diagnosis and treatment of malaria
At least one trained staff diagnosis and treatment of malaria
Guidelines available IPT
At least one trained staff IPT
Malaria diagnostic capacity
Paracetamol cap/tab
IPT drug
First-line antimalarial in-stock
ITN
Readiness score
0% 20% 40% 60% 80% 100%
60%
59%
45%
37%
75%
82%
78%
77%
61%
64%
Readiness score Medicines and commoditiesDiagnostics Staff and training
Source: SARA Tanzania 2012
Availability of TB services
TB treatment strategy
TB treatment
TB diagnostic method
TB diagnosis
Offers TB services
0% 20% 40% 60% 80% 100%
14%
21%
23%
24%
38%
Source: SARA Tanzania 2012
Less than 40% of facilities offered TB services
Readiness to provide TB services
Guidelines available management of HIV & TB co-infection
Guidelines available diagnosis and treatment of tuberculosis
At least one trained staff diagnosis and treatment of tuberculosis
At least one trained staff management of HIV & TB co-infection
At least one trained staff TB infection control
At least one trained staff MDR-TB
Guidelines available MDR-TB treatment
Guidelines available TB infection control
HIV diagnostic capacity
System for diagnosis of HIV among TB clients
TB microscopy
All first line TB medications
Readiness score
0% 20% 40% 60% 80% 100%
70%
30%
28%
28%
27%
23%
13%
10%
83%
33%
10%
60%
27%
Readiness score Medicines and commoditiesDiagnostics Staff and training
Source: SARA Tanzania 2012
Availability of HIV counseling and testing services
Public/Government
Private Rural Urban Overall0%
10%
20%
30%
40%
50%
60%
70%
80% 75%
49%
73%
57%
69%
Counseling and testing services were more likely to be offered in public facilities
Source: SARA Tanzania 2012
Readiness to provide HIV counseling and testing
Source: SARA Tanzania 2012
Guidelines available HIV counselling and testing
At least one trained staff HIV counselling and testing
Room with visual and auditory privacy
HIV diagnostic capacity
Condoms
Readiness score
0%10%
20%30%
40%50%
60%70%
80%90%
100%
58%
44%
11%
84%
70%
53%
Readiness score Medicine & Commodities DiagnosticsEquipment Staff and training
Availability of HIV care and support services
Treatment for Kaposi's sarcoma
Provide/prescribe fortified protein supplementation
Nutritional rehabilitation services
Provide/prescribe micronutrient supplementation
Preventative treatment for opportunistic infections
Provide condoms
Offers HIV care and support services
0 10 20 30 40 50 60 70 80 90 100
8
11
11
15
23
25
25
26
29
33
33
39
38
Chart Title
Percent of facilities with HIV care and support services
Source: SARA Tanzania 2012
Readiness to provide HIV care and support services
Guidelines available clinical management HIV & AIDS
At least one trained staff clinical management HIV & AIDS
Guidelines available palliative care
System for diagnosis of TB among HIV+ clients
Condoms
Intravenous solution with infusion set
Co-trimoxazole
Palliative care pain management
All first line TB medications
IV treatment fungal infection
Readiness score
0% 20% 40% 60% 80% 100%
46%
44%
36%
35%
88%
69%
69%
63%
56%
24%
50%
Readiness score Medicines and commoditiesDiagnostics Staff and training
Source: SARA Tanzania 2012
ARV prescription and client management
Antiretroviral prescription
Provide treatment follow-up services for persons on ART
Offers ARV prescription or ARV treatment follow-up services
0% 20% 40% 60% 80% 100%
20%
20%
28%
Source: SARA Tanzania 2012
Readiness to provide ARV prescription and client management services
At least one trained staff ART prescription and management
Guidelines available antiretroviral therapy
Liver function test
Renal function test
CD4 or viral load
Complete blood count (CBC)
Three first line antiretrovirals
Readiness score
0% 20% 40% 60% 80% 100%
45%
42%
60%
50%
11%
10%
36%
21%
Readiness score Medicines and commoditiesDiagnostics Staff and training
One out of five facilities were ready to provide ARV prescription
Source: SARA Tanzania 2012
Availability of PMTCT services
ARV prophylaxis to newborns born to HIV+ pregnant women
ARV prophylaxis to HIV+ pregnant women
Infant and young child feeding counselling
Family planning counselling to HIV+ women
HIV counselling and testing to infants born to HIV+ pregnant women
Nutritional counselling for HIV+ women and their infants
HIV counselling and testing to HIV+ pregnant women
Offers services for the prevention of mother-to-child transmission of HIV
0% 20% 40% 60% 80% 100%
67%
68%
70%
70%
71%
71%
72%
78%
Source: SARA Tanzania 2012
Readiness to provide PMTCT services
Guidelines available PMTCT
At least one trained staff PMTCT
Guidelines infant and young child feeding
At least one trained staff infant and young child feeding
Room with visual and auditory privacy
HIV diagnostic capacity for adults
DBS for diagnosing newborn HIV
Nevirapine syrup
Maternal ARV prophylaxis
Zidovudine syrup
Readiness score
0% 20% 40% 60% 80% 100%
79%
71%
69%
64%
13%
79%
38%
50%
50%
32%
55%
Readiness score Medicines and commodities DiagnosticsEquipement Staff and training
Source: SARA Tanzania 2012
Availability of STIs services
Prescribe treatment for STIs
Diagnosis of STIs
Offers services for STIs
0% 20% 40% 60% 80% 100%
66%
68%
78%
Source: SARA Tanzania 2012
Readiness to provide STI services
Guidelines available diagnosis and treatment of STIs
At least one trained staff diagnosis and treatment of STIs
Syphilis rapid test
Metronidazole cap/tab
Condoms
Ciprofloxacin cap/tab
Ceftriaxone injectable
Readiness index
0% 20% 40% 60% 80% 100%
55%
36%
49%
100%
85%
79%
64%
67%
Readiness score Medicines and commoditiesDiagnostics Staff and training
Source: SARA Tanzania 2012
Two thirds of facilities were ready to provide STI service
Key Messages: Communicable Diseases
• Malaria, PMTCT, HIV counseling and testing services were available in more than 70% of facilities
• Diagnostic capacity for communicable diseases was high except for TB
• Availability of staff trained to deliver communicable services was better for malaria and PMTCT services
• Medicines for malaria and TB were more available compared to those for HIV
Source: SARA Tanzania 2012
Non-Communicable Diseases
Source: SARA Tanzania 2012
Diabetes Cardiovascular Disease (CVD) Chronic Respirator Disease (CRD)
Availability of diagnosis and/or management of NCDs
Diabetes
Chronic respiratory disease
Cardiovascular disease
0% 20% 40% 60% 80% 100%
12%
17%
18% Percent of facilities providing diagnosis and /or management of NCDs
Source: SARA Tanzania 2012
Readiness to provide treatment or management of Diabetes, CVD and Chronic
Respiratory Disease
0%20%40%60%80%
100%
54% 51%
40%
Readiness score Staff and training EquipmentDiagnostics Medicine & Commodities
Source: SARA Tanzania 2012
n=291n=248
n=316
Key message for NCDs
• Overall, availability of treatment and /or diagnosis of NCDs was low
• 91% of facilities had equipment available for CVD (blood pressure apparatus, stethoscope and adults scale)
• Staff trained in the last two years and guidelines were less common. Approximately 3 out of 10 facilities
• Readiness scores for Diabetes and CVD were better off compared for CRD
Source: SARA Tanzania 2012
Basic surgical and blood transfusion services
Availability of basic surgical services
Cricothyroidotomy
Chest tube insertion
Hydrocele reduction
Closed treatment of fracture
Male circumcision
Acute burn management
Wound debridement
Suturing
Incision and drainage of abscesses
Offers basic surgical services
0% 20% 40% 60% 80% 100%
3%
4%
6%
7%
25%
40%
45%
50%
55%
28%
26% of facilities provided basic surgical services
Source: SARA Tanzania 2012
Readiness to provide basic surgical services
At least one trained staff IMEESC
Guidelines available IMEESC
Needle holder
Scalpel handle with blade
Surgical scissors
Tourniquet
Suction apparatus
Nasogastric tubes
Retractor
Adult and paediatric resuscitators
Skin disinfectant
Oxygen
Sutures
Lidocaine
Ketamine
Readiness score
0% 20% 40% 60% 80% 100%
11%
9%
38%
33%
33%
24%
24%
14%
13%
11%
87%
63%
43%
42%
16%
31%
Readiness score Medicines and commoditiesEquipment Staff and training
Approximately one third of facilities were ready to provide basic surgical services
Source: SARA Tanzania 2012IMEESC Integrated Management for Emergency & Essential Surgical Care
Availability of blood transfusion services
Dis-pen-sary
Health Centre
Hospital MCH Clinic Public Private Total0
10
20
30
40
50
60
70
80
90
100
3
16
77
51
612
8
Chart TitlePercent availability of blood transfusion services by level and ownership
Source: SARA Tanzania 2012
Readiness for provision of blood transfusion services
Guidelines available appropriate use of blood and safe blood trans-fusion
At least one trained staff appropriate use of blood and safe blood transfusion
Blood storage refrigerator
Blood typing
Blood supply sufficiency
Blood supply safety
Readiness score
0% 20% 40% 60% 80% 100%
34%
25%
24%
23%
52%
19%
25%
Readiness score Medicines and commodities DiagnosticsEquipement Staff and training
Source: SARA Tanzania 2012
Readiness for blood transfusion services
Key messages surgical and blood transfusion services
• One quarter of the facilities offered basic surgical services
• Readiness score for surgical services was 31%
• Blood transfusion was available in only 8% of facilities.
• Private facilities were twice more likely to have blood transfusion service compared to public
• Readiness score was 23 out of 100
Source: SARA Tanzania 2012
SARA take home messages• This is the first SARA in Tanzania and provides a good baseline for
future assessments
• General Service Readiness highlighted low scores in basic amenities and low diagnostic capacity to perform basic diagnostic tests
• Specific Service Availability was at two thirds or more for services such as malaria, child health, PMTCT and immunization but lower for TB and HIV care and support.
• Specific Service Readiness varied across with high scores for immunization and family planning scoring but lower for ARV prescription and client management and basic surgery
Acknowledgements
• Ministry of Health & Social Welfare• Global Fund• World Health Organization• HMIS focal persons in SPD districts• IHI members