DHS COMPARATIVE

REPORTS 41

LEVELS AND TRENDS IN NEWBORN 

CARE SERVICE AVAILABILITY AND 

READINESS IN BANGLADESH, HAITI, 

MALAWI, SENEGAL, AND TANZANIA

August 2016

This publication was produced for review by the United States Agency for International Development (USAID). The report was prepared by

Rebecca Winter, Jennifer Yourkavitch, Lindsay Mallick, and Wenjuan Wang.

DHS Comparative Reports No. 41 

Levels and Trends in Newborn Care 

Service Availability and Readiness in 

Bangladesh, Haiti, Malawi, Senegal, and Tanzania 

Rebecca Winter 

Jennifer Yourkavitch 

Lindsay Mallick

Wenjuan Wang 

ICF International 

Rockville, Maryland, USA 

August 2016

Corresponding author: Rebecca Winter, The DHS Program, ICF International, 530 Gaither Road, Suite 

500, Rockville, Maryland 20850, USA; telephone: +1 301-572-0541; email: Rebecca.Winter@icfi.com. 
Acknowledgments: The authors would like to thank Barbara Rawlins, Deborah Sitrin, Tom Pullum, 

Shireen Assaf, and Cameron Taylor for their helpful consultation, and Allisyn Moran and Michelle Winner 

for their thoughtful review. 

Editor: Bryant Robey 

Document Production: Natalie La Roche 

This study was carried out with support provided by the United States Agency for International 

Development (USAID) through The DHS Program (#AID-OAA-C-13-00095). The views expressed are 

those of the authors and do not necessarily reflect the views of USAID or the United States Government. 

The DHS Program assists countries worldwide in the collection and use of data to monitor and evaluate 

population, health, and nutrition programs. For additional information about The DHS Program, contact 

The DHS Program, ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; telephone: 

301-407-6500; fax: 301-407-6501; email: reports@dhsprogram.com; Internet: www.dhsprogram.com. 

Recommended citation: 

Winter, Rebecca, Jennifer Yourkavitch, Lindsay Mallick, and Wenjuan Wang. 2016. Levels and Trends in 

Newborn Care Service Availability and Readiness in Bangladesh, Haiti, Malawi, Senegal, and Tanzania.

DHS Comparative Reports No. 41. Rockville, Maryland, USA: ICF International. 
iii 

Contents 

TABLES ....................................................................................................................................................................... v 

FIGURES ....................................................................................................................................................................vi 

PREFACE ...................................................................................................................................................................ix 

ABSTRACT ................................................................................................................................................................xi 

EXECUTIVE SUMMARY ..................................................................................................................................... xiii 

1. INTRODUCTION ......................................................................................................................................... 1 

1.1. Rationale for the Study ..................................................................................................................... 1 

1.2. Background ....................................................................................................................................... 1 

1.2.1. Country Context.................................................................................................................. 2 

1.2.2. Key Newborn Interventions and Measurement of Quality ................................................. 3 

2. DATA AND METHODS ............................................................................................................................... 5 

2.1. Data ................................................................................................................................................... 5 

2.2. Measurement of Newborn Care Quality ........................................................................................... 6 

2.2.1. Indicators ............................................................................................................................ 6 

2.2.2. Composite Scores ............................................................................................................. 12 

2.2.3. Facility Characteristics ..................................................................................................... 12 

2.3. Analysis .......................................................................................................................................... 12 

3. RESULTS ..................................................................................................................................................... 15 

3.1. Profile of Facilities with Normal Delivery Services ....................................................................... 15 

3.2. Current Levels of Newborn Care Service Availability and Readiness............................................ 17 

3.2.1. National Coverage ............................................................................................................ 17 

3.2.2. Service Availability and Readiness Scores by Facility Characteristics ............................ 26 

3.2.3. Availability of Medicines and Commodities versus Their Observed Use ........................ 34 

3.3. Trends in Newborn Care Service Availability and Readiness in Tanzania ..................................... 35 

3.3.1. Trends in Newborn Care Service Availability .................................................................. 35 

3.3.2. Trends in Newborn Care Service Readiness ..................................................................... 37 

3.4. Linking the SPA and DHS at the Regional Level: Bivariate Association between 

Newborn Care Service Availability, Service Readiness, and Neonatal Mortality .......................... 45 

4. DISCUSSION .............................................................................................................................................. 49 

REFERENCES .......................................................................................................................................................... 53 

APPENDIX ................................................................................................................................................................ 57 
iii 
v 

Tables 

Table 1. Interventions during labor, delivery, and the immediate postnatal period ............................................ 3 

Table 2. Description of SPA surveys included in the study ................................................................................ 6 

Table 3. Summary of metrics used to assess quality of newborn care at health facilities: Service availability 

and service readiness ............................................................................................................................ 7 

Table 4. Correspondence between timing of DHS and SPA surveys, most recent SPA and closest-timed 

DHS .................................................................................................................................................... 13 

Table A1. Percent distribution of facilities that offer normal delivery services by facility characteristics, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal .................................................................................. 57 

Table A2a. Service availability Domain A: BEmOC signal functions, Bangladesh 2014 SPA ............................ 58 

Table A2b. Service availability Domain B: Newborn signal functions, Bangladesh 2014 SPA ........................... 59 

Table A2c. Service availability Domain C: Routine perinatal care, Bangladesh 2014 SPA ................................. 59 

Table A2d. Service readiness Domain A: General requirements, Bangladesh 2014 SPA ..................................... 60 

Table A2e. Service readiness Domain B: Equipment, Bangladesh 2014 SPA ...................................................... 61 

Table A2f. Service readiness Domain C: Medicine and commodities, Bangladesh 2014 SPA ............................ 62 

Table A2g. Service readiness Domain D: Guidelines and staffing, Bangladesh 2014 SPA .................................. 63 

Table A3a. Service availability Domain A: BEmOC signal functions, Haiti 2013 SPA ...................................... 64 

Table A3b. Service availability Domain B: Newborn signal functions, Haiti 2013 SPA ...................................... 65 

Table A3c. Service availability Domain C: Routine perinatal care, Haiti 2013 SPA............................................ 66 

Table A3d. Service readiness Domain A: General requirements, Haiti 2013 SPA ............................................... 67

Table A3e. Service readiness Domain B: Equipment, Haiti 2013 SPA ................................................................ 68 

Table A3f. Service readiness Domain C: Medicine and commodities, Haiti 2013 SPA ...................................... 69 

Table A3g. Service readiness Domain D: Guidelines and staffing, Haiti 2013 SPA ............................................ 70 

Table A4a. Service availability Domain A: BEmOC signal functions, Tanzania 2014-15 SPA ........................... 71 

Table A4b. Service availability Domain B: Newborn signal functions, Tanzania 2014-15 SPA .......................... 72 

Table A4c. Service availability Domain C: Routine perinatal care, Tanzania 2014-15 SPA ................................ 73 

Table A4d. Service readiness Domain A: General requirements, Tanzania 2014-15 SPA ................................... 74 

Table A4e. Service readiness Dimension B: Equipment, Tanzania 2014-15 SPA ................................................ 75 

Table A4f. Service readiness Domain C: Medicines and commodities, Tanzania 2014-15 SPA ......................... 76 

Table A4g. Service readiness Domain D: Guidelines and staffing, Tanzania 2014-15 SPA ................................ 77 

Table A5a. Service availability Domain A: BEmOC signal functions, Malawi 2013-14 SPA ............................. 78 

Table A5b. Service availability Domain B: Newborn signal functions, Malawi 2013-14 SPA ............................ 79 

Table A5c. Service availability Domain D: Routine perinatal care, Malawi 2013-14 SPA .................................. 79 

Table A5d. Service readiness Domain A: General requirements, Malawi 2013-14 SPA ...................................... 80 

Table A5e. Service readiness Domain B: Equipment, Malawi 2013-14 SPA ....................................................... 81 

Table A5f. Service readiness Domain C: Medicine and commodities, Malawi 2013-14 SPA ............................. 82 

Table A5g. Service readiness Domain D: Guidelines and staffing, Malawi 2013-14 SPA ................................... 83 

Table A6a. Service availability Domain A: BEmOC signal functions, Senegal 2014 SPA .................................. 84 

Table A6b. Service availability Domain B: Newborn signal functions, Senegal 2014 SPA ................................. 85 

Table A6c. Service availability Domain C: Routine perinatal care, Senegal 2014 SPA ....................................... 86 

Table A6d. Service readiness Domain A: General requirements, Senegal 2014 SPA........................................... 87 

Table A6e. Service readiness Domain B: Equipment, Senegal 2014 SPA ............................................................ 88 

Table A6f. Service readiness Domain C: Medicine and commodities, Senegal 2014 SPA .................................. 89 

Table A6g. Service readiness Domain D: Guidelines and staffing, Senegal 2014 SPA ........................................ 90 

Table A7a. Trend in service availability Domain A: BEmOC signal functions, Tanzania 2006 and 

2014-15 SPA ...................................................................................................................................... 91 

Table A7b. Trend in service readiness Domain A: General requirements, Tanzania 2006 and 2014-15 SPA ...... 92 

Table A7c. Trend in service readiness Domain B: Equipment among facilities that offer normal delivery 

services, Tanzania 2006 and 2014-15 SPA ........................................................................................ 93 
vi 

Table A7d. Trend in service readiness Domain C: Medicines and commodities among facilities that offer 

normal delivery services, Tanzania 2006 and 2014-15 SPA .............................................................. 95 

Table A7e. Trend in service readiness Domain D: Guidelines and staffing among facilities that offer normal 

delivery services, Tanzania 2006 and 2014-15 SPA .......................................................................... 96 

Figures 

Figure 1. Decline in the neonatal mortality rate alongside decline in the under-five mortality rate, 

1985-2015, Bangladesh, Haiti, Tanzania, Malawi, Senegal ................................................................. 2

Figure 2. Percent distribution of facilities with normal delivery services by type of facility, Bangladesh, 

Haiti, Tanzania, Malawi, Senegal ....................................................................................................... 15

Figure 3. Percent distribution of facilities with normal delivery services by urban-rural location, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal .................................................................................. 16

Figure 4. Percent distribution of facilities with normal delivery services by managing authority, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal .................................................................................. 16

Figure 5. National coverage of newborn care service availability Domain A: BEmOC signal functions, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal .................................................................................. 17

Figure 6. National coverage of newborn care service availability Domain B: Newborn signal functions, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal .................................................................................. 18

Figure 7. National coverage of newborn care service availability Domain C: Routine practices, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal .................................................................................. 19

Figure 8. National coverage of newborn care service readiness Domain A: General requirements, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal .................................................................................. 20

Figure 9. National coverage of newborn care service readiness Domain B: Equipment, Bangladesh, Haiti, 

Tanzania, Malawi, Senegal ................................................................................................................. 21

Figure 10. National coverage of newborn care service readiness Domain C: Medicines and commodities, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal .................................................................................. 22

Figure 11. National coverage of newborn care service readiness Domain D: Guidelines and staffing, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal .................................................................................. 23

Figure 12. National service availability and service readiness summary scores, Bangladesh, Haiti, Tanzania, 

Malawi, Senegal ................................................................................................................................. 25

Figure 13. Service availability Domain A: BEmOC signal functions summary score by facility 

characteristics, Bangladesh, Haiti, Tanzania, Malawi, Senegal .......................................................... 26

Figure 14. Service availability Domain B: Newborn signal functions summary score by facility 

characteristics, Bangladesh, Haiti, Tanzania, Malawi, Senegal .......................................................... 27

Figure 15. Service availability Domain C: Routine perinatal care summary score by facility characteristics, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal .................................................................................. 28

Figure 16. Service readiness Domain A: General requirements summary score by facility characteristics, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal .................................................................................. 29

Figure 17. Service readiness Domain B: Equipment summary score by facility characteristics, Bangladesh, 

Haiti, Tanzania, Malawi, Senegal ....................................................................................................... 30

Figure 18. Service readiness Domain C: Medicines and commodities summary score by facility 

characteristics, Bangladesh, Haiti, Tanzania, Malawi, Senegal .......................................................... 31

Figure 19. Service readiness Domain D: Guidelines and staffing summary score by facility characteristics, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal .................................................................................. 32

Figure 20. Service availability (panels on left) and service readiness (panels on right) summary scores by 

facility characteristics, Bangladesh, Haiti, Tanzania, Malawi, Senegal ............................................. 33

Figure 21. Gap between the availability of medicines and commodities and their observed use during 

delivery, Malawi 2013-14 SPA .......................................................................................................... 34
vii 

Figure 22. National trend in components of service availability Domain A: BEmOC signal functions 

among facilities that offer normal delivery services, Tanzania 2006 and 2014-15 SPA .................... 35

Figure 23. Trend in service availability Domain B: BEmOC signal functions summary score among 

facilities that offer normal delivery services, by facility characteristics, Tanzania 2006 and 

2014-15 SPA ...................................................................................................................................... 36

Figure 24. National trend in components of newborn care service readiness Domain A: General 

requirements, and trend in the summary score, among facilities that offer normal delivery 

services, Tanzania 2006 and 2014-15 SPA ........................................................................................ 37

Figure 25. Trend in newborn care service readiness Domain A: General requirements summary score 

among facilities that offer normal delivery services, by facility characteristics, Tanzania 2006 

and 2014-15 SPA ................................................................................................................................ 38

Figure 26. National trend in components of newborn care service readiness Domain B: Equipment, and 

trend in the summary score, among facilities that offer normal delivery services, Tanzania 2006 

and 2014-15 SPA ................................................................................................................................ 39

Figure 27. Trend in service readiness Domain B: Equipment summary score among facilities that offer 

normal delivery services, by facility characteristics, Tanzania 2006 and 2014-15 SPA .................... 40

Figure 28. National trend in components of service readiness Domain C: Medicines and commodities, 

and trend in the summary score, Tanzania 2006 and 2014-15 SPA ................................................... 41

Figure 29. Trend in service readiness Domain C: Medicines and commodities summary score among 

facilities that offer normal delivery services, by facility characteristics, Tanzania 2006 and 

2014-15 SPA ...................................................................................................................................... 42

Figure 30. National trend in components of service readiness Domain C: Guidelines and staffing, and 

trend in the summary score, among facilities that offer normal delivery services, Tanzania 2006 

and 2014-15 SPA ................................................................................................................................ 43

Figure 31. Trend in service readiness Domain C: Guidelines and staffing summary score among facilities 

that offer normal delivery services, by facility characteristics, Tanzania 2006 and 2014-15 SPA ..... 44

Figure 32. Association between neonatal mortality and newborn care service availability (left panel) 

and neonatal mortality and service readiness (right panel) for the regions of Bangladesh, Haiti, 

and Senegal ......................................................................................................................................... 45

Figure 33. Association between newborn care service availability and neonatal mortality for the regions of 

Bangladesh, Haiti, and Senegal .......................................................................................................... 46

Figure 34. Association between newborn care service readiness and neonatal mortality for the regions of 

Bangladesh, Haiti, and Senegal .......................................................................................................... 47

ix 

Preface 

The Demographic and Health Surveys (DHS) Program is one of the principal sources of international data 

on fertility, family planning, maternal and child health, nutrition, mortality, environmental health, 

HIV/AIDS, malaria, and provision of health services. 

One of the objectives of The DHS Program is to provide policymakers and program managers in low- and 

middle-income countries with easily accessible data on levels and trends for a wide range of health and 

demographic indicators. DHS Comparative Reports provide such information, usually for a large number 

of countries, in each report. These reports are largely descriptive, without multivariate methods, but where 

possible they include confidence intervals, statistical tests, or both. 

The topics in the DHS Comparative Reports series are selected by The DHS Program in consultation with 

the U.S. Agency for International Development. 

It is hoped that the DHS Comparative Reports will be useful to researchers, policymakers, and survey 

specialists, particularly those engaged in work in low- and middle-income countries. 

Sunita Kishor 

Director, The DHS Program

xi 

Abstract 

This study examines levels and trends in two dimensions of newborn care quality—service availability and 

service readiness—in Bangladesh, Haiti, Malawi, Senegal, and Tanzania, the five USAID maternal and 

child health (MCH) priority countries with Service Provision Assessment (SPA) surveys conducted since 

2011. In each country, key services, commodities, and medicines needed for comprehensive delivery and 

newborn care were missing from a large proportion of facilities that offer normal delivery services. Of the 

three domains of service availability examined, scores for routine care availability are consistently highest, 

and scores for newborn signal function availability are lowest. Of the four domains of service readiness 

examined, scores for general requirements and equipment are consistently highest, while scores for 

guidelines and staffing are lowest. Both service availability and service readiness tend to be highest in 

hospitals and in urban areas, pointing to substantial equity gaps in the quality of newborn care. In Tanzania, 

where two SPA surveys were conducted recently, in 2006 and 2014-15, all measurable domains of newborn 

care service availability and readiness showed significant improvement between surveys, and urban-rural 

and public-private quality gaps narrowed. In conclusion, we found some encouraging evidence of newborn 

care service availability and readiness among the countries studied, but we also identified a great deal of 

room for improvement. The findings indicate the need for broad initiatives that improve staff competence, 

address systemic barriers to service provision, and promote equity in newborn care quality. 

KEY WORDS: newborn care, quality of care, service provision assessment, USAID maternal and child 

health (MCH) priority countries

xiii 

Executive Summary 

This study examines levels and trends in two dimensions of newborn care quality—service availability and 

service readiness—in Bangladesh, Haiti, Malawi, Senegal, and Tanzania, the five USAID maternal and 

child health (MCH) priority countries with Service Provision Assessment (SPA) surveys conducted since 

2011. First, we present current levels of newborn care quality among facilities with normal delivery services 

in the five countries. Next, we show trends in newborn care quality in Tanzania, the one country with two 

recent SPA surveys available with adequate spacing between them (of roughly five years). Finally, we 

examine the bivariate association between newborn care quality scores and the neonatal mortality rate in 

the geographic regions of three study countries with closely timed Demographic and Health Surveys (DHS) 

and SPA surveys. 

To assess newborn care quality, the study examines three domains of service availability: basic emergency 

obstetric care (BEmOC) signal functions, newborn signal functions, and routine perinatal practices; and 

four domains of service readiness: general facility requirements, equipment, medicines and commodities, 

and guidelines and staffing. In accord with the WHO SARA approach, we computed composite indicators 

to assess overall newborn care service availability and readiness in the facilities. Indicators within each 

domain of service availability and service readiness were given equal weight to produce a domain score, 

and each domain was in turn weighted equally to produce a summary score for service availability and for 

service readiness. 

In all five countries, key services and supplies needed for comprehensive delivery and newborn care were 

missing from a large proportion of facilities that offer normal delivery services. Summary scores for 

newborn care service availability range from 40 in Tanzania to about 60 in Malawi and Senegal. In all 

countries, of the three domains of service availability, scores for routine care availability are highest and 

scores for newborn signal function availability are lowest. Summary scores for newborn care service 

readiness range from 42 in Tanzania to 62 in Malawi. The coverage patterns for the four domains of service 

readiness are consistent across the countries, with guidelines and staffing scoring the lowest, followed by 

scores for medicines and commodities. Scores for general requirements and equipment are consistently 

similar to each other, and are higher. 

The patterns in service availability and service readiness scores by facility characteristics are strikingly 

similar. Both service availability and readiness scores tend to be highest in hospitals and in urban areas. 

There is less difference in scores between public and private facilities, except for Bangladesh and Tanzania, 

where private facilities score notably higher for service availability and service readiness. Differentials 

across facility characteristics tend to be widest in Bangladesh, and are remarkably narrow in Senegal. 

In Tanzania, where two SPA surveys have been conducted recently, in 2006 and 2014-15, we examined 

trends in a subset of indicators that were available in both surveys. All five measurable domains of newborn 

care service availability and service readiness showed significant improvement between surveys. The 

greatest improvements were made in average BEmOC availability, with notable increases in assisted 

vaginal delivery (a 66 percentage point increase) and removal of retained products (a 23 percentage point 

increase). Coverage of uninterrupted electricity availability and improved water onsite also increased 

substantially, with the largest gains at health centers and dispensaries/clinics, and at public rather than 

private facilities, indicating a narrowing of the equity gap in newborn care in Tanzania. 

In our bivariate analysis of the association between neonatal mortality rates and newborn care service 

availability and service readiness scores in Bangladesh, Haiti, and Senegal, we found regional neonatal 

mortality rates to be marginally significantly (p<0.10) associated with service availability scores, and not 

with service readiness scores. The associations between neonatal mortality rates and service availability 
xiv 

scores are in the expected direction, with lower scores tending to be correlated with higher regional neonatal 

mortality rates, and are marginally significant for two of the three domains of service availability: BEmOC 

availability and routine perinatal care availability. 

In conclusion, we found some encouraging evidence related to newborn care service availability and 

readiness among the countries studied, and also identified a great deal of room for improvement. Of the 

seven domains of service availability and service readiness studied, routine care consistently scores highest, 

while newborn signal functions and guidelines and staffing tend to score lowest. The results point to 

persistent inequities in access to high-quality newborn care between urban and rural areas and between 

hospitals and the more ubiquitous health centers and dispensaries/clinics. Together, the findings indicate 

the need for broad initiatives that improve staff competence, address systemic barriers to service provision, 

and promote equity in newborn care quality. The trend analysis for Tanzania provides a hopeful sign, but 

more studies are needed to understand the extent to which newborn care service availability and readiness 

is improving in other countries. 
1 

1. Introduction 

1.1. Rationale for the Study 

Recent gains in child survival have been concentrated in the post-neonatal period, with slower gains made 

in survival during the first month of life (UNICEF et al. 2015). While there is general agreement regarding 

the importance of essential delivery and newborn1

 care services, recent studies using household survey data 

have found no evidence that scale-up of facility deliveries or skilled birth attendance has been associated 

with reductions in neonatal mortality (Singh et al. 2012; Winter et al. 2014). These findings point to the 

need to supplement demand-side information on women’s use of delivery and newborn services with 

supply-side information on the quality and content of those services. The current study examines two 

dimensions of newborn care quality—service availability and service readiness—in five USAID maternal 

and child health (MCH) priority countries with Service Provision Assessment (SPA) surveys conducted 

since 2011. This report is the first comparative presentation of the quality of newborn care among five 

countries, and the first presentation of trends in the quality of newborn care in Tanzania, with measures 

derived from consecutive SPA surveys. 

Chapter 1 provides background information on the epidemiology of neonatal mortality, descriptions of key 

newborn care interventions, definitions of quality, and measurement issues. Chapter 2 describes the data 

and the methodology of the study and defines all variables. Chapter 3, with results, has three sections. 

Section 1 presents current levels of newborn care quality2

 among facilities with normal delivery services in 

the five study countries. This section also examines the gap between facility readiness to provide delivery 

care and observed service provision in Malawi, the one study country with data obtained from observations 

of normal deliveries. Section 2 shows trends in newborn care quality in Tanzania, the one country with two 

recent SPA surveys available with adequate spacing between them (of roughly five years). Section 3 

examines the bivariate association between newborn care quality scores and the neonatal mortality rate in 

the geographic regions of three study countries with closely timed Demographic and Health Surveys (DHS) 

and SPA surveys. Finally, chapter 4 provides interpretation of key findings, overall conclusions, and policy 

implications. 

1.2. Background 

Nearly half of under-five mortality occurs during the neonatal period, the first 28 days of life (WHO 2015a). 

The immediate postnatal period, the first 24 hours, holds the greatest risk for neonatal mortality, from birth 

asphyxia, trauma, pre-term birth-related breathing difficulty, and sepsis, and is the period when the need 

for high-quality newborn care is paramount; the early postnatal period (days 2 through 7) brings risks from 

sepsis, malaria and other infectious diseases; and the late postnatal period (days 8 through 42) is when these 

risks gradually diminish (Kanté et al. 2015; WHO 2010). While advocacy and policy efforts have advanced 

the agenda for newborn health, they have not been followed by adequate investment and large-scale 

implementation of evidence-based interventions (Darmstadt et al. 2014). Thus, while the neonatal mortality 

rate has decreased everywhere over the past 15 years, the proportion of under-five deaths that occur during 

the neonatal period has increased, in all regions except Western Pacific (WHO 2015b). 

Causes of neonatal mortality include prematurity (35%), intrapartum-related complications including birth 

asphyxia (24%), neonatal sepsis (15%), congenital anomalies (11%), pneumonia (7%), neonatal tetanus 

(2%), and other causes (7%) (WHO 2015a). The health of mothers and infants is inextricably linked during 

 

1

 Throughout the report, the terms newborn and neonatal are used interchangeably to refer to the first 28 days of life. 2

 For simplicity, we use the word “quality,” though the report measures just two dimensions of quality: service 

availability and service readiness. 
2 

the neonatal period, and interventions to protect one can help both. Monitoring the quality and content of 

newborn care provides information needed to improve services to protect mothers’ and infants’ health. 

Mothers are advised to deliver their babies in health facilities in order to protect both their own and their 

infants’ health (Exavery et al. 2014; Tura, Fantahun, and Worku 2013). Evidence from a systematic review 

and meta-analysis suggests that facility delivery reduces the overall risk of neonatal mortality in low- and 

middle-income countries (Tura, Fantahun, and Worku 2013), but not all studies have found that to be the 

case (Lohela, Campbell, and Gabrysch 2012; Moyer, Dako-Gyeke, and Adanu 2013; Winter et al. 2014). 

The provision of newborn care in the immediate and early postnatal period depends particularly on “healthsystem infrastructure, capacity, and resources” (Dickson et al. 2014), and skilled health staff may be 

unavailable to provide immediate care to the newborn even where there was skilled attendance at birth. 

Thus, delivering in a facility that is ill-equipped to provide newborn care may not in fact protect the infant. 

It is critical to ensure an optimal standard of care for mothers and newborns in health facilities, but there is 

a gap in monitoring the quality of newborn care due to a lack of data (Rubayet et al. 2012). 

1.2.1. Country context 

Figure 1 shows the neonatal mortality rate (NMR) as a proportion of the under-five mortality rate over the 

past 30 years in the five countries studied. The NMR has been cut approximately in half in each country 

over the past 30 years, but in the past 10 years the decrease has slowed except in Senegal. While Bangladesh 

has seen the most dramatic decrease in NMR over the 30-year period compared with the other four countries 

(from 75 deaths per 1,000 live births in 1985 to 23 deaths per 1,000 live births in 2015), its NMR is still the 

highest proportion (more than half) of the under-five mortality rate. Visual inspection of the charts in Figure 

1 makes plain the case that the dramatic decreases in under-five mortality in these five countries have not 

occurred among newborns to the same extent as the rest of the under-five population. 

Note: The orange bar shows the neonatal mortality rate, the blue bar shows the mortality rate for children age 

1-59 months, and the total height represents the mortality rate for children under age 5. 

Source: Data were downloaded from www.childmortality.org 

75 52 36 23 0

50

100

150

200

250

300

1985 1995 2005 2015

Deaths per 1,000 live 

births

Bangladesh

Neonatal Months 1-59

50 34 30 25 0

50

100

150

200

250

300

1985 1995 2005 2015

Haiti

Neonatal Months 1-59

53 43 28 22 0

50

100

150

200

250

300

1985 1995 2005 2015

Deaths per 1,000 live 

births

Malawi

Neonatal Months 1-59

44 40 33 21 0

50

100

150

200

250

300

1985 1995 2005 2015

Senegal

Neonatal Months 1-59

43 36 26 19 0

50

100

150

200

250

300

1985 1995 2005 2015

Tanzania

Neonatal Months 1-59

Figure 1. Decline in the neonatal mortality rate alongside decline in the under-five mortality rate, 

1985-2015, Bangladesh, Haiti, Tanzania, Malawi, Senegal 
3 

Although few formal studies have been published about the status of newborn care and its association with 

neonatal survival in these five countries, evidence suggests that, in general, the quality of care in health 

facilities is lacking. A study using DHS data from Southern Tanzania found that delivery in health facilities 

was not associated with greater neonatal survival compared with delivery in the community in any of the 

three years assessed (Nathan and Mwanyangala 2012). In Malawi a major increase in facility births between 

2000 and 2010 did not improve access to essential services for the majority of mother-infant dyads with 

complications, leaving an estimated 22% unmet need for emergency obstetric care in 2010. In addition, 

75% of the facilities lacked three or more signal functions and had shortages of staff and supplies (Zimba 

et al. 2012). The quality of newborn care services in Malawi was consistently lower than that of other health 

services (Rozario et al. 2010). In Bangladesh, factors identified as favorable to newborn survival included 

local and global evidence from research, high-profile champions, considerable donor funding, and attention 

to community initiatives. Nevertheless, a notable gap remained in the quality of facility-based services 

(Rubayet et al. 2012). 

1.2.2. Key newborn interventions and measurement of quality 

1.2.2.1. Key newborn care interventions 

Interventions during labor and birth, including addressing obstetric complications, have the greatest impact 

on neonatal survival, followed by appropriate care for small or ill newborns (Bhutta et al. 2014). Available 

interventions during the antenatal, labor and delivery, and postnatal periods could reduce neonatal deaths 

due to being preterm by 58%, intrapartum complications by 79%, and infections by 84% (Table 1) (Bhutta 

et al. 2014). In addition, specific interventions that have an impact on neonatal mortality include: umbilical 

cord antiseptics; neonatal resuscitation; hypothermia for hypoxic ischaemic encephalopathy; surfactant 

therapy for respiratory distress syndrome; preventive surfactant therapy for preterm neonates; topical 

emollient therapy; hypothermia prevention for preterm infants; Kangaroo Mother Care in preterm infants; 

oral and injectable antibiotics for pneumonia; and antibiotics for sepsis (Bhutta et al. 2014). 

Table 1. Interventions during labor, delivery, and the immediate postnatal period (from Bhutta et 

al. 2014 conceptual model) 

Interventions during labor and delivery Interventions during the immediate postnatal period 

Skilled birth attendance1 Cord care and clamping 

Hygienic care at birth Prevention of hypothermia 

Emergency obstetric care Early and exclusive breastfeeding 

Management of term breech and post-term pregnancies Provision of Vitamin K 

Management of pre-term labor For small or ill neonates2: resuscitation; care for babies with 

encephalopathy; extra thermal care and other special care 

for small infants; managing infections; and preventing and 

managing supportive hyperbilirubinaemia 

Antibiotics for preterm premature rupture of membranes 

1 Closely corresponds to facility delivery in some countries (e.g., Malawi and Tanzania), but not in others (e.g., 

Bangladesh) (Winter et al. 2014). 

2 Estimates suggest the greatest effect would come from interventions focusing on small or ill neonates. 

 
4 

1.2.2.2. Measurement of quality of newborn care 

There is no single, comprehensive definition for high-quality maternal and newborn care, but there is 

recognition of its multifaceted nature (Raven et al. 2012). WHO defines quality of maternal and newborn 

care with these characteristics: safe, effective, timely, efficient, equitable, and people-centered; WHO’s 

Quality of Care Framework emphasizes the importance of assuring quality in the provision of care as well 

as in the experience of care (Tuncalp et al. 2015). Addressing quality of care includes facilitating provider 

competencies and environments that can provide essential clinical interventions with dignity (Chou et al. 

2015). Important aspects of ensuring quality include: a rights-based approach, evidence-based care, 

consideration of the dependency within the mother-baby dyad, and consideration of pregnancy in general 

as a healthy state (Raven et al. 2012). 

With data from the SPA surveys, we cannot assess all aspects of the quality of newborn care. In this report 

we focus on two measurable dimensions of quality: service availability and service readiness. Service 

availability refers to the reported availability of essential newborn care services at the facility, while service 

readiness refers to the facility’s observed capacity to provide those services (WHO 2016b). These two 

dimensions are necessary—but not sufficient—components of providing high-quality newborn care. 

1.2.2.3. Measurement of service availability and readiness 

Despite agreement on the key packages and health interventions needed to protect and save newborn lives, 

there is little consensus on which key indicators are needed to assess facility-level readiness to provide 

newborn care (Gabrysch et al. 2012). The basic and comprehensive emergency obstetric care (EmOC) 

signal functions, shortlists of life-saving services first introduced in 1997 by the United Nations, are widely 

used to assess the functionality of health facility delivery care. But these functions focus primarily on 

provisions to treat the main causes of maternal mortality. With the exception of one recently added signal 

function on newborn resuscitation (introduced in 2009), the EmOC signal functions do not gauge facility 

readiness to provide essential newborn care (WHO et al. 2009). 

Work has been underway to develop metrics for facility provision of newborn care. The Newborn Indicators 

Technical Working Group (TWG)3

 developed an evidence-based list of newborn care service indicators 

that includes measures of service availability, equipment and supplies, documentation, staff training, 

supervision, and additional optional indicators (Newborn Indicators Technical Working Group 2012). 

Gabrysch and colleagues (2012) also proposed a new set of obstetric and newborn signal functions that 

includes four areas: general health facility requirements, routine care for all mothers and babies, basic 

emergency care for mothers and babies with complications, and comprehensive emergency care functions. 

Finally, the WHO Service Availability and Readiness Assessment (SARA) includes numerous indicators 

on newborn care. The current study combines indicators from these three sources—the TWG, Gabrysch 

and colleagues (2012), and the WHO SARA—to generate metrics to assess the quality of newborn care 

provided at health facilities during labor and delivery and the immediate postnatal period. 

 

3

 First convened by Save the Children’s Saving Newborn Lives program (SNL) in 2008, the Newborn Indicators 

Technical Working Group is a team of experts from evaluation and measurement, researchers, UN agencies, nongovernmental organizations and donors, who collaborate to assess survey-based indicators to monitor and evaluate 

newborn health. The group includes representatives from SNL, USAID, ICF, and UNICEF (Save the Children 

Federation). 
5 

2. Data and Methods 

2.1. Data 

The study uses data from Service Provision Assessment (SPA) surveys in 5 of the 24 USAID maternal and 

child health (MCH) priority countries—Bangladesh, Haiti, Malawi, Senegal, and Tanzania. These facilitybased surveys, developed by ICF International, provide information on the availability and readiness of 

health services, including antenatal care, delivery care, and newborn care services at formal-sector health 

facilities Specifically, the SPA surveys collect data on facility infrastructure (running water, electricity, 

privacy, etc.), the availability of resources (equipment, supplies, and medicines) and supportive processes 

and systems (client records, supervision, staff training, etc.). For certain types of services, the SPA surveys 

also collect information on the extent to which service providers adhere to standards of care, and the extent 

to which clients are satisfied with the care received. 

Study countries were selected according to two criteria. We focused the initial selection on the 24 USAID 

MCH priority countries. These 24 countries account for more than 70% of global maternal deaths and are 

the focus of USAID programmatic efforts to scale up high-impact interventions and strengthen health 

systems (USAID 2013). We then restricted the analysis to countries with a SPA survey conducted within 

the last five years (i.e. since 2011) with data available as of May 2016. Table 2 presents survey 

characteristics for the five countries (six surveys) included in the study. Tanzania is the only study country 

with two recent SPA surveys available with adequate spacing between them (of roughly five years), 

enabling an analysis of trends in facility-level provision of newborn care. Four of the six surveys included 

in the study are nationally representative sample surveys, while two (Haiti 2013 and Malawi 2013-14) are 

a census of all health facilities in the country. All six surveys are able to produce indicators that are 

representative at the national level by facility type, managing authority, and geographic region. 

Table 2 shows the total number of facilities included in each survey. The study was restricted to facilities 

that offer normal delivery services. It included 280 facilities with normal delivery services in the 

Bangladesh 2014 survey, 389 facilities in the Haiti 2013 survey, 528 facilities in the Malawi 2013-14 

survey, 279 facilities in the Senegal 2014 survey, 451 facilities in the Tanzania 2006 survey, and 905 

facilities in the Tanzania 2014-15 survey. Sample weights were applied throughout the study, so that 

indicator estimates are representative of each country’s actual mix of facilities, rather than the sample’s mix 

of facilities. 
6 

Table 2. Description of SPA surveys included in the study 

Country/year 

Number of 

facilities1 

Unweighted number of 

facilities with normal 

delivery services 

Weighted number of 

facilities with normal 

delivery services 

Sample or 

census 

Bangladesh 2014 1548 586 280 sample 

Haiti 2013 905 389 389 census 

Malawi 2013-14 977 528 528 census 

Senegal 20142 363 282 279 sample 

Tanzania 2006 611 433 451 sample 

Tanzania 2014-15 1188 951 905 sample 

1 For all SPA surveys, the facility weights are normalized to have an equal unweighted and weighted total number 

of facilities. 

2 The Senegal 2014 SPA is part of the Senegal Continuous Survey project, which is designed to have five annual 

rounds of both DHS and SPA data collection, with the last round in 2017. This study uses the most recent available 

year of data, 2014. This survey included a subsample of health huts (case de santé). However, the methodology 

used to select health huts was different and their probability of selection was dependent on that of the health posts 

with which they were affiliated. Health huts are excluded from the current study. 

SPA surveys include four standardized data collection instruments—the Facility Inventory Questionnaire, 

the Provider Interview Questionnaire, Observation Protocol, and Client Exit Interview—which provide 

general and service-specific information on the availability and quality of health services. This study relies 

primarily on the Facility Inventory Questionnaire, which collects information on health facilities’ 

infrastructure, supplies, medicines, staffing, training, and procedures, as well as on the availability of 

specific delivery and newborn services, through interviews with the person most knowledgeable about 

delivery services in the facility. The study also draws on the Provider Interview Questionnaire, which 

collects information on the experience, qualifications, and perceptions of the service delivery environment 

among health care workers who provide selected services. SPA surveys do not typically include 

observations of normal deliveries, or exit interviews with women after giving birth. However, the Malawi 

2013-14 SPA did include observation of normal deliveries, and this report examines those results. 

2.2. Measurement of Newborn Care Quality 

2.2.1. Indicators 

The analysis focuses on tracer indicators that report on two dimensions of newborn care quality: service 

availability and readiness. Newborn care quality indicators included in the study draw from three sources. 

The primary source is a list of Newborn Care Service Indicators selected by the Newborn Indicators 

Technical Working Group (TWG) (Newborn Indicators Technical Working Group 2012). These indicators 

are supplemented by additional indicators in the WHO Service Availability and Readiness Assessment 

(SARA) indicators of “basic obstetric and newborn care” (WHO 2015c), and by Gabrysch and colleagues’ 

(2012) proposed obstetric and newborn signal functions. The study examines most but not all suggested 

TWG indicators. Indicators related to prevention of mother-to-child transmission of HIV (PMTCT), for 

example, are not included for several reasons. First, since the burden of HIV varies substantially across the 

study countries, the indicator is less relevant in some country contexts than in others. Second, while PMTCT 

is important, HIV is not a common cause of newborn death; it becomes more relevant for the post-neonatal 

period (Naniche et al. 2009). Several other suggested indicators are not available in the SPA surveys. For 

example, referral services for lower-level facilities, suggested by Gabrysch and colleagues (2012), are 

crucial, but the standard SPA survey does not collect this information. It also does not include information 

on whether the following items are available: resuscitation table, towel for drying the baby, or up-to-date 

delivery register. 
7 

Following the WHO SARA approach, the selected indicators are organized into two dimensions of newborn 

care—service availability and service readiness. Specifically, the study assesses three domains of service 

availability: basic emergency obstetric care (BEmOC) signal functions, newborn signal functions, and 

routine perinatal practices; and four domains of service readiness: general facility requirements, equipment, 

medicines and commodities, and guidelines and staffing. Table 3 describes the seven domains, lists and 

defines the indicators, and notes their relevance to newborn survival. 

Table 3. Summary of metrics used to assess quality of newborn care at health facilities: Service 

availability and service readiness 

Indicator name Definition 

Recommended 

as indicator by: 

Importance of this 

component of care 

Service Availability 

Domain A: Basic emergency obstetric 

care (BEmOC) signal functions Parenteral administration of 

antibiotics 

Among facilities offering normal delivery 

services, percentage reporting that they 

performed this signal function for emergency 

obstetric care at least once during the three 

months before the assessment 

NITWG; Gabrysch et 

al 2012; WHO SARA 

Part of EmoNC, which 

reduces risk of intraprumrelated neonatal deaths 

(Bhutta et al. 2014). 

Parenteral administration of 

uterotonic drugs see above see above see above 

Parenteral administration of 

anticonvulsants for 

hypertensive disorders of 

pregnancy 

see above see above see above 

Manual removal of placenta see above see above see above 

Assisted vaginal delivery see above see above see above 

Removal of retained products see above see above see above 

Domain B: Newborn signal functions 

Neonatal resuscitation 

Among facilities offering normal delivery 

services, percentage reporting that they 

performed neonatal resuscitation at least 

once during the three months before the 

assessment 

NITWG; Gabrysch et 

al 2012; WHO SARA 

Reduces risk of intrapartumrelated death (Bhutta et al. 

2014) 

Corticosteroids in preterm labor 

Among facilities offering normal delivery 

services, percentage reporting that they 

performed this intervention at least once 

during the three months before the 

assessment 

NITWG; Gabrysch et 

al 2012; WHO SARA 

Reduces risk of neonatal 

death, NICU admission, and 

other unfavorable outcomes 

(Bhutta et al. 2014) 

KMC for premature/very small 

babies1 

Among facilities offering normal delivery 

services, percentage reporting that they 

provide KMC for low birth weight babies 

NITWG; Gabrysch et 

al 2012; WHO SARA 

Reduces risk of neonatal 

mortality, hypothermia, and 

other unfavorable 

outcomes; associated with 

increase weight gain 

(Bhutta et al. 2014). 

Domain C: Routine perinatal 

practices 

Partograph routinely used to 

monitor and manage labor2

Providers at the facility routinely use 

partograph to monitor and manage labor 

Gabrysch et al 2012; 

WHO SARA 

No evidence of effect 

(Bhutta et al. 2014). 

Routine early initiation of 

breastfeeding2 

Providers at the facility routinely initiate 

breastfeeding within the first hour 

Gabrysch et al 2012; 

WHO SARA 

Prevents diarrhea (Bhutta et 

al. 2014); sets stage for 

continued breastfeeding, 

which has immediate and 

long-term benefits (Victora 

et al.). 

Routine thermal care (drying 

and wrapping)2

Providers at the facility routinely dry and wrap 

newborns to keep them warm 

Gabrysch et al 2012; 

WHO SARA 

Wrapping newborn reduces 

risk of hypothermia (Bhutta 

et al. 2014). 

Continued 

 
8 

Table 3−Continued

Indicator name Definition

Recommended 

as indicator by:

Importance of this 

component of care

Service Readiness 

Domain A: General requirements 

Electricity 

Facility is connected to a central power grid and 

there has not been an interruption in power supply 

lasting for more than two hours at a time during 

normal working hours in the seven days before the 

assessment, or the facility had a functioning 

generator with fuel available on the day of the 

assessment, or else facility has a back-up solar 

power 

Gabrysch et al 2012 

Light and temperature control 

are required for optimal care. 

Some pieces of equipment 

(e.g., ultrasound machines and 

incubators) require electricity to 

function. SARA manual: 

electricity for lights and 

communication (at a minimum) 

during normal working hours. 

Improved water 

source 

Facility has an improved water source available. 

For most countries, this means that water is piped 

into the facility or onto facility grounds, or else 

water comes from a public tap or standpipe, a tube 

well or borehole, a protected dug well, protected 

spring, rain water, or bottled water and the outlet 

from this source is within 500 meters of the facility 

Gabrysch et al 2012 

(i.e. reliable water 

source) 

For hygiene, (e.g., 

handwashing (SARA)), surgery 

(Chawla et al. 2016), infection 

control, and drinking. 

Handwashing prevents 

neonatal tetanus and sepsis, 

among other infections (Bhutta 

et al. 2014) 

Improved sanitation 

Facility has a functioning flush or pour-flush toilet, 

a ventilated improved pit latrine, or composting 

toilet 

Gabrysch et al 2012 

(i.e. clean toilets) 

For human waste disposal. 

Poor sanitation causes 

unnecessary sickness and 

death from polluted water, food, 

and soil and can lead to 

diarrhea and other problems. 

(Hesperian Health Guides 

2014). Diarrhea is a leading 

cause of death for children 

under age 5 (WHO 2016a). 

Skilled birth 

attendance available 

24/7 

Provider of delivery care available on-site or on-call 

24 hours/day, with observed duty schedule 

NITWG; Gabrysch et 

al 2012 

Skilled birth attendance is 

fundamental to reducing 

maternal and neonatal mortality 

(Darmstadt et al. 2008), and 

babies can be born at any time, 

any day. 

Emergency transport 

Facility had a functioning ambulance or other 

vehicle for emergency transport that was stationed 

at the facility and had fuel available on the day of 

the assessment, or the facility has access to an 

ambulance or other vehicle for emergency 

transport that is stationed at another facility or that 

operates from another facility 

WHO SARA 

Delay in accessing care is a 

major risk factor for maternal 

and neonatal mortality. 

Distance to a facility and lack of 

transportation limit access to 

EmOC (Garenne et al. 1997; 

Lema nd; Menendez et al. 

2008). 

Continued 

 
9 

Table 3−Continued

Indicator name Definition

Recommended 

as indicator by:

Importance of this 

component of care

Service Readiness 

Domain B: Equipment 

Sterilization equipment 

Facility reports that some instruments are 

processed in the facility and the facility has a 

functioning electric dry heat sterilizer, a functioning 

electric autoclave, or a non-electric autoclave with 

a functioning heat source available somewhere in 

the facility 

WHO SARA Sterilization can prevent infection, a 

leading cause of neonatal death. 

Delivery bed At least one delivery bed available and observed 

the in delivery area WHO SARA 

Provides comfort to mother and a 

place for her to recover from 

delivery. 

Examination light Examination light (flashlight okay) available, 

observed, and functioning in the delivery area WHO SARA Providers must be able to see what they are doing. 

Delivery pack 

Delivery pack OR cord clamp, episiom scissors, 

scissors/blade to cut cord, suture material with 

needle, and needle holder all available in the 

delivery area 

WHO SARA 

Provision of clean birth kits and 

education on their use reduces risk 

of neonatal mortality, perinatal 

mortality, and infection, and 

promotes sterile cord cutting (Bhutta 

et al. 2014). 

Suction apparatus 

(mucus abstractor) 

Suction apparatus (mucus abstractor) available, 

observed, and functioning in the delivery area WHO SARA Clears infant airways to promote breathing. 

Manual vacuum 

extractor 

Manual vacuum extractor available, observed, and 

functioning in the delivery area WHO SARA 

Part of EmoNC, which reduces risk 

of intrapartum-related neonatal 

deaths (Bhutta et al. 2014). 

Vacuum aspirator or 

D&C kit 

Vacuum aspirator or D&C kit available, observed, 

and functioning in the delivery area WHO SARA 

Removes uterine contents after 

spontaneous or induced abortion, 

with a low rate of infection (ARHP 

2008). 

Partograph Partograph available, observed, and functioning in 

the delivery area WHO SARA No evidence of effect (Bhutta et al. 2014). 

Disposable latex 

gloves 

Disposable latex gloves observed in the delivery 

area WHO SARA Reduces risk of infection (Ng et al. 2004). 

Newborn bag and 

mask 

Newborn bag and mask (AMBU bag and mask) 

available, observed, and functioning in the delivery 

area 

NITWG; WHO 

SARA 

Used for oxygen administration; 

components of supportive care 

package for preterm infants (Bhutta 

et al. 2014) 

Infant scale Infant scale observed and functioning in the 

delivery area 

NITWG; WHO 

SARA 

Used to weigh infant; low birthweight 

triggers interventions. 

Blood pressure 

apparatus (digital or 

manual) 

Manual or digital blood pressure apparatus 

observed and functioning in the delivery area WHO SARA 

Used to monitor maternal blood 

pressure. High blood pressure 

indicates the need for intervention. It 

may also predict early postpartum 

pre-eclampsia (Cohen et al. 2015). 

Handwashing soap 

and running water or 

hand disinfectant 

Handwashing soap and running water or hand 

disinfectant available and observed in the delivery 

area 

NITWG; WHO 

SARA 

Handwashing prevents neonatal 

tetanus and sepsis, among other 

infections (Bhutta et al. 2014) 

Continued 

 
10 

Table 3−Continued

Indicator name Definition

Recommended 

as indicator by:

Importance of this 

component of care

Service Readiness 

Domain C: Medicines and commodities 

Injectable antibiotic3 Injectable antibiotics observed in the delivery 

area and at least one dose valid 

NITWG; Gabrysch et 

al 2012; WHO SARA 

Prevents and treats infection in 

the infant and/or mother. 

Hydrocortisone 

available at the facility 

Hydrocortisone observed at the facility and at 

least one dose valid 

NITWG; Gabrysch et 

al 2012 

Used to prevent infection from 

meconium aspiration. Reduced 

duration of hospital stay and 

oxygen therapy, but not risk of 

mortality or sepsis (Bhutta et al. 

2014). 

Injectable uterotonic Oxytocin observed in the delivery area and at 

least one dose valid 

NITWG; Gabrysch et 

al 2012; WHO SARA 

Part of EmoNC, which reduces 

risk of intrapartum-related 

neonatal deaths (Bhutta et al. 

2014). 

Skin disinfectant Skin disinfectant available in the delivery area WHO SARA 

Reduces risk of skin infection in 

first week of life, but not neonatal 

sepsis or mortality (Bhutta et al. 

2014) 

Magnesium sulfate Magnesium sulphate available in the delivery 

area and at least one dose valid 

NITWG; Gabrysch et 

al 2012; WHO SARA 

Reduces risk of eclampsia (Bhutta 

et al. 2014). 

IV solution with 

infusion set 

IV solution with infusion set available in the 

delivery area and at least one set valid 

Gabrysch et al 2012; 

WHO SARA Used for (re)hydration. 

Chlorhexidine for cord 

cleaning4

Chlorhexidine solution (4%) for ubilical cord 

cleaning available in delivery area and at least 

one dose valid 

Gabrysch et al 2012 

suggested including 

“infection prevention 

including hygienic cord 

care” as a routine 

practice 

Associated with reduced risk of 

all-cause mortality when applied to 

cord in first 24 hours (Bhutta et al. 

2014). 

Antibiotic eye ointment 

for newborn 

Tetracycline eye ointment for newborn 

available in delivery area and at least one dose 

valid 

WHO SARA Prevents newborn eye infections. 

Continued 

 
11 

Table 3−Continued

Indicator name Definition

Recommended 

as indicator by:

Importance of this 

component of care

Service Readiness 

Domain D: Guidelines and Staffing 

Guidelines: Integrated 

Management of 

pregnancy and childbirth 

(IMPAC) 

Guidelines available in the delivery area NITWG 

WHO guidelines that address factors 

related to access to skilled care before, 

during and after pregnancy and birth. 

Guidelines: CEmOC Guidelines available in the delivery area NITWG Guides provision of comprehensive 

emergency obstetric care. 

Guidelines: Management 

of pre-term labor Guidelines available in delivery area. NITWG Guides management of pre-term labor. 

Training in neonatal 

resuscitation 

At least one provider of delivery/newborn 

care in the facility received training in 

neonatal resuscitation in the past 24 

months 

NITWG; WHO 

SARA 

Neonatal resuscitation reduces risk of 

intrapartum-related death (Bhutta et al. 

2014). 

Training in early and 

exclusive breastfeeding 

At least one provider of delivery/newborn 

care in the facility received training in 

early and exclusive breastfeeding in the 

past 24 months 

NITWG 

Early and exclusive breastfeeding 

prevents diarrhea (Bhutta et al. 2014), 

reduces infants’ risks of respiratory illness 

and other infections (Bachrach 2003; 

Ladomenou 2010), and may set stage for 

continued breastfeeding, which has 

immediate and long-term benefits for 

mothers and children (Victora et al. 2016).

Training in newborn 

infection management 

(including injectable 

antibiotics) 

At least one provider of delivery/newborn 

care in the facility received training in 

newborn infection management (including 

injectable antibiotics) in the past 24 

months 

NITWG Infection is a major cause of neonatal 

mortality (Bhutta et al. 2014). 

Training in thermal care 

At least one provider of delivery/newborn 

care in the facility received training in 

thermal care in the past 24 months 

NITWG 

Hypothermia is a major risk factor for 

neonatal mortality, especially for small 

infants (Bhutta et al. 2014). 

Training in cord care 

At least one provider of delivery/newborn 

care in the facility received training in cord 

care in the past 24 months 

NITWG 

Proper cord care reduces the risk of 

infection, which is a major cause of 

neonatal mortality. 

Training in KMC 

At least one provider of delivery/newborn 

care in the facility received training in 

KMC in the past 24 months 

NITWG 

KMC reduces risk of neonatal mortality, 

hypothermia, and other unfavorable 

outcomes; associated with increase 

weight gain (Bhutta et al. 2014). 

Supervision 

Percentage of facilities with routine 

personal supervision (at least half of 

interviewed providers reported being 

personally supervised at least once during 

the six months preceding the survey 

NITWG 

Supportive supervision can improve 

health worker performance of newborn 

care (Arya 2011). 

Note: Indicators in this report draw from three sources. The primary source is a list of Newborn Care Service Indicators selected by the Newborn 

Indicators Technical Working Group. These indicators are supplemented by additional indicators in the WHO SARA indicators of “Basic obstetric 

and newborn care,” and by Gabrysch and colleagues’ (2012) proposed obstetric and newborn signal functions. The table specifies the source 

of each indicator included in the analysis. 

1 Unlike the indicators for neonatal resuscitation and corticosteroids in preterm later, we do not have information on whether KMC for 

premature/very small babies was carried out in the last 3 months. The KMC indicator is based on the following SPA question: “Does this facility 

practice Kangaroo Mother Care for low birth weight babies?” 

2 We also do not have information on whether the three routine perinatal care indicators were carried out in the last 3 months. The partograph 

indicator is based on the following two SPA questions: “Do providers of delivery services in this facility use partograph to monitor labor and 

delivery” and “Are partographs used routinely (for all cases) or selectively (only for some cases) to monitor labor and delivery in this facility?”. 

The other two indicators (drying and wrapping newborns to keep them warm, and initiation of breastfeeding within the first hour) are based on 

the following SPA question: “Does this facility routinely observe any of the following postpartum or newborn related practices?” 

3 The SPA surveys included in this study did not collect information on the type or brands of injectable antibiotic available in the delivery area.

4 This indicator is assessed for all study countries, regardless of whether the country has a policy of CHX application. 
12 

2.2.2. Composite scores 

In accordance with the WHO SARA approach, composite indicators were computed to assess overall 

newborn care service availability and readiness in the facilities. Indicators within each domain of service 

availability and service readiness were given equal weight to produce a domain score, and each domain 

was in turn weighted equally to produce a summary score for service availability and for service readiness. 

The simple additive scale gives equal weight to each conceptualized dimension of availability and 

readiness, and is easily replicable. 

2.2.3. Facility characteristics 

Newborn care service availability and readiness are examined nationally, as well by type of facility 

(hospital, health center, dispensary/clinic), managing authority (public versus private/other), urban-rural 

location, and (in Appendix tables) region. For managing authority, the private/other category includes 

NGOs, Mission or religious-run health facilities, and parastatal facilities. For region, in Senegal the 14 

regions presented in the 2014 SPA final report are aggregated into six geographic zones, in accordance with 

DHS Analytic Study 55 (Assaf, Wang, and Mallick 2015). For the Tanzania trend analysis, regional 

designations from the most recent SPA survey are used in both surveys. 

2.3. Analysis 

The analysis has several components. First, we present current levels of newborn care quality (i.e. service 

availability and readiness) in the five countries. We present national coverage estimates for the individual 

components that comprise the seven domains of newborn care service availability and readiness, and then 

examine the composite availability and readiness scores disaggregated by facility characteristics4

. For the 

three countries with SPA surveys that were a sample of all health facilities, we present confidence intervals 

around coverage point estimates. The confidence intervals were calculated using svy commands in Stata 

(v. 14), accounting for the SPA complex sample design. For the two countries with SPA surveys that were 

censuses of all formal health facilities, confidence intervals are not needed, since the point estimates 

themselves describe the full population of formal health facilities. 

In addition to standard SPA modules, the Malawi 2013-14 survey includes observation of normal deliveries. 

We use these data to examine the gap between reported availability of commodities in the delivery area 

(i.e. drawing from the facility inventory) and the observed use of those commodities during delivery (i.e. 

drawing from the observation module). To make this comparison, we summarize the information collected 

during observations of deliveries at the facility level. 

We examine recent trends in newborn care quality in Tanzania, the one country with two recent SPA 

surveys available with adequate spacing between them (i.e. roughly five years). Some of the selected 

indicators of newborn care quality were not available in the 2006 Tanzania SPA; thus, the trend analysis is 

limited to the subset of indicators available in both surveys. In particular, we could not examine trends in 

two of the three dimensions of service availability: newborn signal functions and routine care. We appended 

the data from the two survey years and used log probability models to assess the significance of changes in 

newborn care coverage between the two surveys. 

Finally, we combine SPA survey and Demographic and Health Survey (DHS) data to examine the bivariate 

association between newborn care quality scores and neonatal mortality. The analysis is conducted at the 

 

4

 For additional detail, Appendix Tables A2a-A6g show the individual components that comprise the seven dimensions 

of newborn care service availability and readiness disaggregated by facility characteristics, separately for each 

country. 
13 

regional level because SPA surveys that are a sample of facilities rather than a complete census should not 

be linked with DHS data at the individual level due to the potential for misclassification error (Burgert and 

Prosnitz 2014). The analysis is restricted to the three study countries with DHS and SPA surveys conducted 

within three years of one another—Bangladesh, Haiti, and Senegal (Table 4). For these countries, it is 

reasonable to assume that the SPA captures the service environment for births in the five years preceding 

the DHS. 

Table 4. Correspondence between timing of DHS and SPA surveys, most recent SPA and 

closest-timed DHS 

 2010 2011 2012 2013 2014 2015 

Reasonable to 

link SPA/DHS? 

Bangladesh SPA, DHS yes 

Haiti DHS SPA yes 

Senegal SPA, DHS yes 

Malawi DHS SPA1 no 

Tanzania DHS SPA1 no 

1 Malawi 2013-14 SPA is placed between years 2013 and 2014, and the Tanzania 2014-15 SPA between years 

2014 and 2015.

In these three countries, DHS data were used to calculate region-specific neonatal mortality rates. With log 

probability models, we estimated the probability of dying in the first month of life among births that 

occurred in the five years preceding each survey (months 1-60). To assess the magnitude, direction, and 

significance of the linear association between regions’ newborn care quality scores and their neonatal 

mortality rates, simple linear regression models were fit. The analysis was conducted using Stata (v.14). 

15 

3. Results 

3.1. Profile of Facilities with Normal Delivery Services

The study examines characteristics of health facilities that offer normal delivery services in the five study 

countries. This chapter examines data from the most recent SPA conducted in each country. This includes 

280 health facilities with normal delivery services in Bangladesh, 389 in Haiti, 528 in Malawi, 279 in 

Senegal, and 905 in Tanzania. Among these facilities, Figure 2 shows the percent distribution by the type 

of facility, separately by country (see Appendix Table A1 for more detail). A consistent color scheme is 

used throughout the study, with shades of blue used to present results for Bangladesh, orange for Haiti, 

green for Tanzania, yellow for Malawi, and grey for Senegal. In Bangladesh and Haiti there is a fairly even 

distribution of hospitals, health centers, and dispensaries or clinics. In each of the two countries, hospitals 

constitute roughly one-quarter of facilities with normal delivery services. In Senegal and Tanzania the vast 

majority of facilities with normal delivery services are either dispensaries or clinics (89% and 83%, 

respectively), with a small percentage of hospitals (4% in Senegal, 5% in Tanzania) and health centers (7% 

in Senegal, 12% in Tanzania). Malawi stands out as the only country where the majority of facilities with 

normal delivery services are health centers (78%). In Malawi, 18% of such facilities are hospitals, and 4% 

are dispensaries or clinics. 

Note: Dispensary/clinics were combined since some categories of each were quite small in some countries. For Senegal, 

this category also includes health posts. The share of facilities with normal delivery services that are clinics, dispensaries,

and health posts are as follows: Bangladesh: 4% dispensaries, 35% clinics; Haiti, 0% clinic, 33% dispensary; Malawi: 0% 

dispensary, 4% clinic; Senegal: 0% dispensary, 0% clinic, 89% health post; Tanzania: 83% dispensary, 1% clinic. In this 

figure and throughout the study, the countries are ordered in such a way to facilitate meaningful comparison: the African 

countries are grouped together, with Tanzania adjacent to Malawi, given their geographic proximity; non-African countries 

are also grouped together.

Hospital

26%

Health 

Center 

35%

Dispensary/ 

Clinic

39%

Bangladesh 2014 SPA (N=280)

Hospital

24%

Health 

Center 

43%

Dispensary/ 

Clinic

33%

Haiti 2013 SPA (N=389)

Hospital

Health 18%

Center 

78%

Dispensary/ 

Clinic

4%

Malawi 2013-14 (N=528)

Hospital

4% Health 

Center 

7%

Dispensary/ 

Clinic

89%

Senegal 2014 SPA (N=279)

Hospital

5%

Health 

Center 

Dispensar 12%

y/ Clinic

83%

Tanzania 2014-15 (N=905)

Figure 2. Percent distribution of facilities with normal delivery services by type of facility, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal 
16 

Figure 3 shows the urban-rural distribution of facilities with normal delivery services in the study countries. 

In all five countries, the majority of facilities with normal delivery services are in rural areas—ranging from 

61% in Haiti to 85% in Tanzania and Malawi. 

Figure 3. Percent distribution of facilities with normal delivery services by urban-rural location, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal 

Between 50% and 90% of facilities with normal delivery services in the study countries are public (see 

Figure 4). The managing authorities included within “private or other” vary by country, and include private, 

parastatal, NGO, for profit, and religious-affiliated facilities. Haiti has the largest share of private or other 

facilities with normal delivery services, at 50%. In Haiti these are a mix of NGO/private not for profit, 

private for profit, and Mission or faith-based facilities. 

Figure 4. Percent distribution of facilities with normal delivery services by managing authority, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal 

Urban

29%

Rural

71%

Bangladesh 2014 SPA (N=280)

Urban

39% Rural

61%

Haiti 2013 SPA (N=389)

Urban

15%

Rural

85%

Malawi 2013-14 (N=528)

Urban

26%

Rural

74%

Senegal 2014 SPA (N=279)

Urban

15%

Rural

85%

Tanzania 2014-15 (N=905)

Public

80%

Private or 

other

20%

Bangladesh 2014 SPA (N=280)

Public

50% Private 

or other

50%

Haiti 2013 SPA (N=389)

Public

66%

Private 

or other

34%

Malawi 2013-14 (N=528)

Public

90%

Private or 

other

10%

Senegal 2014 SPA (N=279)

Public

84%

Private 

or other

16%

Tanzania 2014-15 (N=905)
17 

3.2. Current Levels of Newborn Care Service Availability and Readiness

As described, the study examines service availability and readiness as components of quality newborn care 

among facilities with normal delivery services. This section examines current levels of newborn care service 

availability and readiness. 

3.2.1. National coverage 

3.2.1.1. Newborn care service availability 

Service Availability Domain A: BEmOC Signal Functions 

The first domain of newborn care service availability is the availability of the six basic emergency obstetric 

care signal functions. As Figure 5 shows, coverage of these components varies widely across countries. 

Overall, parenteral administration of uterotonic drugs and assisted vaginal delivery have the highest 

coverage. At least half of facilities with normal delivery services provided parenteral administration of a 

uterotonic within the three months prior to the assessment, and in Tanzania, Malawi, Senegal over 80% of 

facilities performed this function. Similarly, in each country nearly half of all facilities with normal delivery 

services performed an assisted delivery within the last three months, with over 70% coverage in Haiti, 

Tanzania, and Senegal. 

Coverage of parenteral administration of anticonvulsants is low in all countries; less than half of facilities 

with normal delivery services in each country performed this function in the three months prior to the 

assessment. Coverage is lowest in Tanzania, at 13%, and is under 33% in Bangladesh, Haiti, and Senegal. 

In three countries, Bangladesh, Tanzania, and Malawi, less than half of facilities with normal delivery 

services performed a manual removal of the placenta, and in four countries less than half removed retained 

products in the three months preceding the survey. 

Note: We do not include confidence intervals for the Haiti or Malawi results because these surveys were a census of all facilities, 

rather than a sample of facilities. 

45 50

30

42 48

32

56

68

31

51

74

48

34

84

13

34

70

35

82

98

49

43

51

39

71

95

31

62

99

83

Parenteral

administration of

antibiotics

Parenteral

administration of

uterotonic drugs

Parenteral

administration of

anticonvulsants

Manual removal of

placenta

Assisted vaginal

delivery

Removal of retained

products

Bangladesh Haiti Tanzania Malawi Senegal

Figure 5. National coverage of newborn care service availability Domain A: BEmOC signal 

functions, Bangladesh, Haiti, Tanzania, Malawi, Senegal 
18 

Service Availability Domain B: Newborn Signal Function Availability 

The second domain of newborn care service availability is newborn signal functions. We assessed whether 

the facility performed three newborn signal functions at least once in the three months preceding the day of 

assessment: neonatal resuscitation, provision of corticosteroids during preterm labor, and KMC for 

premature/very small babies. 

Of these three function, coverage of neonatal resuscitation is highest (see Figure 6). In Malawi nearly 90% 

of facilities with normal delivery services performed a neonatal resuscitation in the last three months. In all 

other countries less than two-thirds of such facilities did so. In every county, less than one-quarter of 

facilities provided corticosteroids during preterm labor in the preceding three months. Coverage is lowest 

in Tanzania, at 4%. Roughly half of facilities in Bangladesh, Malawi, and Senegal performed KMC for 

premature/very small babies in the last three months. In Haiti and Tanzania, 25% and 21%, respectively, 

did so. 

Note: We do not include confidence intervals for the Haiti or Malawi results because these surveys were a census of 

all facilities, rather than a sample of facilities. 

43

23

44 42

15

25

52

4

21

88

21

56 60

15

54

Neonatal resuscitation Corticosteroids in preterm labor KMC for premature/very small babies

Bangladesh Haiti Tanzania Malawi Senegal

Figure 6. National coverage of newborn care service availability Domain B: Newborn signal 

functions, Bangladesh, Haiti, Tanzania, Malawi, Senegal 
19 

Service Availability Domain C: Routine Practices 

Routine practices, the third domain of newborn care service availability, includes three components: routine 

use of the partograph to monitor and manage labor, early initiation of breastfeeding, and provision of 

thermal care (drying and wrapping the newborn). Figure 7 shows the national coverage of these indicators 

in the five study countries. 

Routine coverage of both early initiation of breastfeeding and provision of thermal care are nearly universal 

across the study countries, at 95% or higher in nearly all five. Coverage of routine use of the partograph5

varies more widely across the study countries, from less than 20% in Bangladesh and Haiti to more than 

90% in Malawi. 

Figure 7. National coverage of newborn care service availability Domain C: Routine practices, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal 

Note: We do not include confidence intervals for the Haiti or Malawi results because these surveys were a census of 

all facilities, rather than a sample of facilities. 

 

5

 Routine use of the partograph is included as a component of routine perinatal care. However, we note that there is 

no evidence of an effect on newborn survival (Bhutta et al. 2014). 

17

97 95

19

91 95

45

98 98 94 99 100

69

98 100

Partograph routinely used to monitor

and manage labor

Routine early initiation of

breastfeeding

Routine thermal care (drying and

wrapping)

Bangladesh Haiti Tanzania Malawi Senegal
20 

3.2.1.2. Newborn care service readiness 

Service Readiness Domain A: General Requirements 

The first domain of service readiness, general 

requirements, includes five components: 

uninterrupted electricity, an improved water 

source, improved sanitation, skilled birth 

attendance available 24/7, and emergency 

transport. Figure 8 shows the national coverage 

of these tracer indicators in the five countries. 

Although babies can be born at any time of day 

or night, in four of the five countries more than 

two-thirds of facilities with normal delivery 

services do not have skilled birth attendance 

available 24/7. Emergency transport—defined 

as having either a functioning ambulance on 

site (with fuel), or access to an emergency 

vehicle stationed at another facility—is 

available in 89% of facilities with normal 

delivery services in Malawi, and more than half 

of such facilities in Tanzania and Senegal. 

However, less than one-third of facilities in 

Bangladesh or Haiti had emergency transport 

available on the day of the assessment. 

Access to an improved water source onsite or 

within 500 meters of the facility ranges from 

62% in Tanzania to 95% in Malawi. Access to 

improved sanitation varies more widely across 

the countries, from one-quarter of facilities in 

Malawi to 94% in Senegal. Uninterrupted 

electricity, which enables light and 

temperature control and is required for some 

equipment (e.g., ultrasound machines and 

incubators) to function, is available in at least 

two-thirds of facilities with normal delivery 

services in Haiti, Malawi, and Tanzania, more 

than half of facilities in Senegal, and nearly 

half (48%) in Bangladesh. 

Figure 8. National coverage of newborn care service 

readiness Domain A: General requirements, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal 

Note: Confidence intervals are not shown for the Haiti or Malawi 

results because these surveys were a census of all facilities, 

rather than a sample of facilities. 

55

92

94

16

58

68

95

25

54

89

66

62

33

28

62

79

75

47

34

31

48

93

75

31

33

Electricity

Improved

water

source

Improved

sanitation

24/7 skilled

birth

attendance

Emergency

transport

Bangladesh

Haiti

Tanzania

Malawi

Senegal
21 

Service Readiness Domain B: Equipment 

The second domain of service readiness, 

equipment, includes 13 indicators to gauge the 

extent to which facilities with normal delivery 

services have the essential equipment needed to 

support comprehensive delivery and newborn 

care. Figure 9 shows the availability of these 13 

components across the five countries. 

Availability varies widely across country, and 

across pieces of equipment. For example, the 

percentage of facilities with sterilization 

equipment ranges from 6% in Senegal to 51% in 

Haiti. The presence of an examination light 

ranges from 14% in Tanzania to 65% in 

Bangladesh. Delivery packs are more prevalent 

overall, ranging from 60% of facilities in 

Bangladesh to all facilities in Senegal. A suction 

apparatus was present in 23% of facilities in 

Tanzania and 63% of facilities in Malawi on the 

day of the assessment. The presence of a manual 

vacuum extractor ranges from 3% in Senegal to 

40% in Malawi. A vacuum aspirator or D&C kit 

was present in 7% of facilities in Tanzania and 

44% in Senegal. Newborn bags and masks were 

present in 36% of facilities in Haiti and 89% of 

facilities in Malawi. There was a bed in most 

facilities, ranging from 73% in Bangladesh to 

99% in Malawi. Partographs are more variable, 

present in 24% of facilities in Haiti and 88% of 

facilities in Malawi. Latex gloves are quite 

prevalent, ranging from 71% of facilities in 

Bangladesh to 97% in Malawi. Infant scales are 

also quite prevalent, at 59% of facilities in 

Bangladesh and 95% in Malawi. A blood 

pressure apparatus was present in 76% of 

facilities in Malawi and 93% of facilities in Haiti 

on the day of the assessment. Soap and water or 

hand disinfectants are highly prevalent across 

countries, from 67% of facilities in Tanzania to 

96% in Senegal. 

Figure 9. National coverage of newborn care 

service readiness Domain B: Equipment, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal 

Note: We do not include confidence intervals for the Haiti or 

Malawi results because these surveys were a census of all 

facilities, rather than a sample of facilities. 

6

57

100

32

3

44

48

100

82

96

92

82

96

31

32

92

63

41

24

89

99

88

97

95

76

75

21

14

87

23

5

7

76

98

58

86

80

68

67

51

36

79

27

10

20

36

94

24

91

73

93

70

50

65

60

48

25

29

46

73

25

71

59

90

77

Sterilization

equipment

Examination light

Delivery pack

Suction apparatus

Manual vacuum

extractor

Vacuum aspirator or

D&C kit

Newborn bag and

mask

Bed

Partograph

Latex gloves

Infant scale

Blood pressure

apparatus

Soap and water or

hand disinfectant

Bangladesh

Haiti

Tanzania

Malawi

Senegal
22 

Service Readiness Domain C: Medicines and Commodities 

There are eight components in the third domain 

of service readiness, medicines and commodities. 

Their prevalence among facilities varies but, on 

average, is low. For example, at the time of the 

assessment, antibiotic eye ointment was present 

in the delivery area in only 24% of facilities in 

Bangladesh but in 93% of facilities in Malawi. 

Injectable antibiotics were found in 31% of 

facilities in Haiti and 56% of facilities in Malawi. 

Hydrocortisone was present in 13% of facilities 

in Malawi and 57% of facilities in Senegal. The 

prevalence of injectable uterotonics ranges from 

34% in Bangladesh to 95% in Malawi. Skin 

disinfectant was found in 27% of facilities in 

Bangladesh and 93% of facilities in Senegal. The 

assessments found IV solutions with an infusion 

set in 36% of facilities in Bangladesh and 70% of 

facilities in Senegal. The presence of 

chlorhexidine for cord cleaning ranges from only 

12% of facilities in Tanzania to 49% of facilities 

in Senegal. 

Figure 10. National coverage of newborn care 

service readiness Domain C: Medicines and 

commodities, Bangladesh, Haiti, Tanzania, Malawi, 

Senegal 

Note: We do not include confidence intervals for the Haiti or 

Malawi results because these surveys were a census of all 

facilities, rather than a sample of facilities. 

53

53

57

78

93

35

70

49

93

55

13

95

55

85

67

36

28

32

32

79

61

41

48

12

49

31

30

52

64

40

42

44

24

33

20

34

27

22

36

32

Antibiotic eye

ointment for

newborn

Injectable

antibiotic

Hydrocortisone

available at the

facility

Injectable

uterotonic

Skin disinfectant

Magnesium sulfate

IV solution with

infusion set

Chlorhexidine for

cord cleaning

Bangladesh

Haiti

Tanzania

Malawi

Senegal
23 

Service Readiness Domain D: Guidelines and Staffing 

There are 10 components in the fourth domain of 

service readiness, guidelines and staffing. 

Presence of the three types of guidelines is 

generally low throughout the countries (see 

Figure 11). The prevalence of IMPAC guidelines 

ranges from 23% in Haiti to 65% in Senegal. 

CEmOC guidelines are present in 15% of 

facilities in Haiti and 57% of facilities in Senegal. 

The SPA surveys found guidelines for 

management of pre-term labor in 12% of 

facilities in Senegal and Tanzania and 42% in 

Malawi. As for the six types of training, rarely do 

more than 50% of facilities in any of the 

countries have at least one provider of 

delivery/newborn care with recent training in 

those areas. Among the countries studied, 

Bangladesh consistently had the smallest 

percentage of facilities with staff with this 

training, and Malawi almost always had the 

largest percentage. Training in neonatal 

resuscitation ranges from 21% of facilities in 

Bangladesh to 62% in Malawi; training in early 

and exclusive breastfeeding ranges from 21% in 

Bangladesh to 49% in Tanzania. Training in 

newborn infection management ranges from 10% 

in Bangladesh to 40% in Malawi; whereas 

training in thermal care ranges from 14% in 

Bangladesh to 54% in Malawi. Training in cord 

care ranges from 18% in Bangladesh to 55% in 

Malawi, and training in KMC ranges from 15% 

in Bangladesh to 40% in Malawi and Tanzania. 

Supervision has the highest proportions of the 10 

items in this group, ranging from 49% in Senegal 

to 94% in Bangladesh. 

Figure 11. National coverage of newborn care 

service readiness Domain D: Guidelines and 

staffing, Bangladesh, Haiti, Tanzania, Malawi, 

Senegal 

Note: We do not include confidence intervals for the Haiti or 

Malawi results because these surveys were a census of all 

facilities, rather than a sample of facilities. 

65

57

12

32

35

28

34

36

30

49

45

27

42

62

48

40

54

55

40

86

28

9

12

52

49

38

46

47

40

77

23

18

13

34

37

30

34

36

26

87

22

21

21

21

10

14

18

15

94

IMPAC guidelines

CEmOC guidelines

 Guidelines for

management of

pre-term labor

Training in

neonatal

resucitation

Training in early

and exclusive

breastfeeding

Training in

newborn infection

management

Training in thermal

care

Training in cord

care

Training in KMC

Supervision

Bangladesh

Haiti

Tanzania

Malawi

Senegal
24 

3.2.1.3. Service readiness and availability summary scores 

Figure 12 shows national summary scores for service availability and service readiness, as well as national 

scores for each domain of availability and readiness. All scores range from 0 to 100 and indicate the average 

percentage of component tracer items that are available within the domain. Summary scores weight each 

domain equally. 

Summary scores for newborn care service availability range from 40 in Tanzania to about 60 in Malawi 

and Senegal. In all countries, of the three domains of service availability, scores for routine care availability 

are highest and scores for newborn signal function availability are lowest. Routine care scores range from 

about 70 in Bangladesh and Haiti to 97 in Malawi, and newborn signal function scores range from 26 and 

27 in Tanzania and Haiti, respectively, to 55 in Malawi. BEmOC signal function scores range from 41 in 

Haiti to 74 in Senegal. 

Summary scores for newborn care service readiness range from 42 in Tanzania to 62 in Malawi. The 

coverage patterns for the four domains of service readiness are consistent across the countries. Of the four 

domains, scores for guidelines and staffing are lowest, followed by scores for medicines. Guidelines and 

staffing scores range from 27 in Bangladesh to 51 in Malawi. Medicines scores range from 28 in Bangladesh 

to about 60 in Malawi and Senegal. Within each country, scores for general requirements and equipment 

are higher, and are similar to each other. 
25 

Note: Confidence intervals are not shown for Haiti or Malawi, since those surveys were a census of all formal health facilities.

Figure 12. National service availability and service readiness summary scores, Bangladesh, Haiti, 

Tanzania, Malawi, Senegal 

Service Availability Service Readiness 

Bangladesh 2014 SPA 

Haiti 2012 SPA 

Tanzania 2014-15 SPA 

Malawi 2013 SPA 

Senegal 2014 SPA 

41 37

70

45

A: BEmOC

Signal

Functions

B: Newborn

Signal

Functions

C: Routine

Care

Service

Availability

Summary

Score

56 55

28 27

42

A: General

Requirements

B: Equipment C: Medicines D: Guidelines

and Staffing

Service

Readiness

Summary

Score

55

27

68

45

A: BEmOC

Signal

Functions

B: Newborn

Signal

Functions

C: Routine

Care

Service

Availability

Summary

Score

53 54

44 36

47

A: General

Requirements

B: Equipment C: Medicines D: Guidelines

and Staffing

Service

Readiness

Summary

Score

45

26

80

40

A: BEmOC

Signal

Functions

B: Newborn

Signal

Functions

C: Routine

Care

Service

Availability

Summary

Score

50 53

42 43 47

A: General

Requirements

B: Equipment C: Medicines D: Guidelines

and Staffing

Service

Readiness

Summary

Score

60 55

97

61

A: BEmOC

Signal

Functions

B: Newborn

Signal

Functions

C: Routine

Care

Service

Availability

Summary

Score

66 69 62 51 62

A: General

Requirements

B: Equipment C: Medicines D: Guidelines

and Staffing

Service

Readiness

Summary

Score

74

43

89

60

A: BEmOC

Signal

Functions

B: Newborn

Signal

Functions

C: Routine

Care

Service

Availability

Summary

Score

63 65 61

38

57

A: General

Requirements

B: Equipment C: Medicines D: Guidelines

and Staffing

Service

Readiness

Summary

Score
26 

3.2.2. Service availability and readiness scores by facility characteristics 

Figure 13 shows the variation in BEmOC signal function availability scores by facility type, managing 

authority, and urban-rural location. In all countries but Senegal, scores are significantly6

 higher in hospitals 

than in lower-level facilities, and in all but Tanzania they are significantly higher in urban facilities than in 

rural ones. In Bangladesh, public facilities score far lower than private facilities in BEmOC availability 

(35% and 66%, respectively). However, in the other four countries the public-private differentials are small. 

Figure 13. Service availability Domain A: BEmOC signal functions summary score by facility 

characteristics, Bangladesh, Haiti, Tanzania, Malawi, Senegal 

Note: Confidence intervals are not shown for Haiti or Malawi, since those surveys were a census of all formal health facilities.

 

6

 Here and onward, mention of “significant” differences refer to the three countries with SPA surveys that were a 

sample of health facilities in the country. The significance refers to non-overlapping confidence intervals between 

subgroups. For the two census surveys, the estimates describe the full population of facilities; confidence intervals 

and significance testing are not needed. 

75

30 29

83

57

31

81

59

41

82

56

44

90 88

72

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Bangladesh Haiti Tanzania Malawi Senegal

35

66

56 53

44

50

61 60

74 68

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Bangladesh Haiti Tanzania Malawi Senegal

71

29

74

42

48 44

72

58

82

71

Urban Rural Urban Rural Urban Rural Urban Rural Urban Rural

Bangladesh Haiti Tanzania Malawi Senegal
27 

Figure 14 shows the variation in newborn signal function service availability scores by facility 

characteristics. In all countries but Senegal, scores are significantly higher in urban facilities than in rural 

ones, in hospitals than in lower-level facilities, and in Haiti, Tanzania, and Senegal they are notably higher 

in health centers than in dispensaries or clinics. In three countries—Haiti, Malawi, Senegal—scores are 

similarly low in public and private facilities, while in Bangladesh and Tanzania, private facilities 

score higher. 

Figure 14. Service availability Domain B: Newborn signal functions summary score by facility 

characteristics, Bangladesh, Haiti, Tanzania, Malawi, Senegal 

Note: Confidence intervals are not shown for Haiti or Malawi, since those surveys were a census of all formal 

health facilities.

58

26

33

48

26

14

67

42

21

78

50 46

78

62

40

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Bangladesh Haiti Tanzania Malawi Senegal

33

53

28 27 24

33

55 56

43 39

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Bangladesh Haiti Tanzania Malawi Senegal

57

28

39

20

33

25

67

53 54

39

Urban Rural Urban Rural Urban Rural Urban Rural Urban Rural

Bangladesh Haiti Tanzania Malawi Senegal
28 

Scores for the third domain of service availability, routine care, are strikingly similar across facility 

characteristics (see Figure 15). Only in Tanzania do we see differentials across types of facility, with 

hospitals scoring highest, and dispensaries and clinics scoring lowest in routine perinatal care service 

availability. 

Figure 15. Service availability Domain C: Routine perinatal care summary score by facility 

characteristics, Bangladesh, Haiti, Tanzania, Malawi, Senegal 

Note: Confidence intervals are not shown for Haiti or Malawi, since those surveys were a census of all formal 

health facilities. 

73 70 67

74 70

62

96

88

78

99 97 94 94 95

88

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Bangladesh Haiti Tanzania Malawi Senegal

68 74 70 67

80 83

97 98

89 89

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Bangladesh Haiti Tanzania Malawi Senegal

74

68 73

65

83 80

99 97

91 88

Urban Rural Urban Rural Urban Rural Urban Rural Urban Rural

Bangladesh Haiti Tanzania Malawi Senegal
29 

Figure 16 shows the variation in summary scores for the first domain of service readiness, general facility 

requirements, by facility characteristics. General requirement scores differ notably by all three 

characteristics. By type of facility, hospitals have the highest general readiness scores. In Bangladesh and 

Malawi, health centers and dispensaries/clinics score similarly, while in the other three countries health 

centers score higher than dispensaries and clinics. Urban-rural differentials are evident in all countries, and 

are greatest in Bangladesh. Public-private differentials are also greatest in Bangladesh and are notable in 

Tanzania. 

Figure 16. Service readiness Domain A: General requirements summary score by facility 

characteristics, Bangladesh, Haiti, Tanzania, Malawi, Senegal 

Note: Confidence intervals are not shown for Haiti or Malawi, since those surveys were a census of all formal 

health facilities. 

85

46 45

75

58

31

89

73

45

83

62 68

92 87

60

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Bangladesh Haiti Tanzania Malawi Senegal

49

81

50

57

46

70

64

71

62

67

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Bangladesh Haiti Tanzania Malawi Senegal

86

43

66

45

63

48

80

64

73

59

Urban Rural Urban Rural Urban Rural Urban Rural Urban Rural

Bangladesh Haiti Tanzania Malawi Senegal
30 

Figure 17 shows the differentials in scores for the second domain of service readiness, equipment, which 

follow similar patterns to those for general facility requirements. 

Figure 17. Service readiness Domain B: Equipment summary score by facility characteristics, 

Bangladesh, Haiti, Tanzania, Malawi, Senegal 

Note: Confidence intervals are not shown for Haiti or Malawi, since those surveys were a census of all formal 

health facilities. 

75

49 48

71

56

40

84

65

50

87

65 68

80

74

63

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Bangladesh Haiti Tanzania Malawi Senegal

51

74

52 56 51

64 68 73

64 68

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Bangladesh Haiti Tanzania Malawi Senegal

75

47

64

48

67

51

81

67 70

63

Urban Rural Urban Rural Urban Rural Urban Rural Urban Rural

Bangladesh Haiti Tanzania Malawi Senegal
31 

Figure 18 show the variation in the third domain of service readiness, medicines and commodities, by 

facility characteristics. Here, the variability by facility characteristics is wide across the countries. The 

differentials are greatest in Bangladesh, where the average scores are more than four times higher for 

hospitals than health centers, more than three times higher for urban than rural areas, and three times higher 

for private than public facilities. By contrast, in Senegal there is far less variation by facility type, managing 

authority, and urban-rural location, and virtually no difference between the average scores in urban and 

rural areas. 

Figure 18. Service readiness Domain C: Medicines and commodities summary score by facility 

characteristics, Bangladesh, Haiti, Tanzania, Malawi, Senegal 

Note: Confidence intervals are not shown for Haiti or Malawi, since those surveys were a census of all formal 

health facilities.

59

13

22

60

46

30

69

54

38

74

60 58

73

68

60

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Bangladesh Haiti Tanzania Malawi Senegal

20

60

41 47

39

54

60 66 60

70

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Bangladesh Haiti Tanzania Malawi Senegal

58

16

53

38

52

40

69

61 62 61

Urban Rural Urban Rural Urban Rural Urban Rural Urban Rural

Bangladesh Haiti Tanzania Malawi Senegal
32 

Scores for the fourth domain of service readiness, guidelines and staffing, are low across countries (see 

Figure 19), and overall there is less variation across facility characteristics than for the other three domains. 

Notably, there is very little variation across facility characteristics in Bangladesh, Senegal, and Tanzania. 

Figure 19. Service readiness Domain D: Guidelines and staffing summary score by facility 

characteristics, Bangladesh, Haiti, Tanzania, Malawi, Senegal 

Note: Confidence intervals are not shown for Haiti or Malawi, since those surveys were a census of all formal 

health facilities. 

Figure 20 presents differentials in the composite service availability and service readiness scores side by 

side. The patterns in service availability and service readiness are strikingly similar. Scores for both service 

availability and service readiness tend to be highest in hospitals and in urban areas. There is less difference 

in scores between public and private facilities, except for Bangladesh and Tanzania, where private facilities 

score notably higher for both service availability and service readiness. 

30 26 25

55

37

21

58 57

40

67

48

36

43 46

37

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Bangladesh Haiti Tanzania Malawi Senegal

27 25

35 37 43 40

53

46

38

35

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Bangladesh Haiti Tanzania Malawi Senegal

31 25

47

29

44 43

61

49 43

36

Urban Rural Urban Rural Urban Rural Urban Rural Urban Rural

Bangladesh Haiti Tanzania Malawi Senegal
33

Figure 20. Service availability (panels on left) and service readiness (panels on right) summary scores by facility characteristics, Bangladesh, Haiti, Tanzania, Malawi, Senegal 

Service availability summary score Service readiness summary score 

Note: Confidence intervals are not shown for Haiti or Malawi, since those surveys were a census of all formal health facilities. 

73

34 35

69

47

25

79

58

36

81

56 53

86 79

57

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Bangladesh Haiti Tanzania Malawi Senegal

39

66

45 45 38 51

60 62 60 58

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Bangladesh Haiti Tanzania Malawi Senegal

71

33

60

36

48

39

73

58

70

56

Urban Rural Urban Rural Urban Rural Urban Rural Urban Rural

Bangladesh Haiti Tanzania Malawi Senegal

62

33 35

65

49

30

75

62

43

78

59 58

72 68

55

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Hospital

Health center

Dispensary/clinic

Bangladesh Haiti Tanzania Malawi Senegal

37

60

45 49 45

57 61 64 56 60

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Public

Private/other

Bangladesh Haiti Tanzania Malawi Senegal

62

33

58

40

56

45

73

60 62 55

Urban Rural Urban Rural Urban Rural Urban Rural Urban Rural

Bangladesh Haiti Tanzania Malawi Senegal
34 

3.2.3. Availability of medicines and commodities versus their observed use 

The majority of this study relies on data collected in the SPA facility inventory, which includes information 

on the observed availability of essential medicines and commodities. We use this information to tell us the 

extent to which facilities have the supplies needed to provide essential, appropriate, high-quality delivery 

and newborn care. We rely on commodity availability because in most cases we do not have an observed 

record of what delivery and newborn care is actually provided to women and babies. However, the Malawi 

2013-14 supplemented the standard SPA survey with observations of a sample of the normal deliveries that 

took place in the facility on the day of assessment7

. With these data we can examine the gap between the 

availability of key commodities in the delivery area (i.e. service readiness indicators obtained from the 

inventory questionnaire) and observed service delivery (i.e. information obtained during observations of 

care actually provided to women during normal deliveries). 

As Figure 21 shows, a wide gap exists between the availability of commodities and their actual use in 

delivery. The figure compares the percentage of facilities that have certain items available, specifically, 

equipment (from service readiness Domain B) and medicines and commodities (from service readiness 

Domain C) with the percentage of observed normal deliveries during which the item was used. The gap 

between availability and use is smallest for injectable uterotonics: their availability is high (96%) and they 

were administered after delivery in comparable percentages of normal observed deliveries (87%). The gap 

is greatest between the availability and use of antibiotic eye ointment. While over 90% of facilities have 

the ointment available in the delivery area, the ointment was applied to the newborn in just 35% of observed 

deliveries. The gap is also large between availability and use of latex gloves (99% versus 64%) and soap or 

hand disinfectant (78% versus 45%). 

These findings have several implications. First, they provide information on the interpretability of our 

service readiness indicators. Second, they tell us something about quality of care. A large gap between the 

availability and use of key commodities suggests a missing link or barrier, whether in staff training, 

knowledge of guidelines, access to commodities, or elsewhere. 

Figure 21. Gap between the availability of medicines and commodities and their observed use 

during delivery, Malawi 2013-14 SPA 

 

7

 The SPA Observation Protocol for normal obstetric deliveries and immediate newborn care assessed whether 

observed client–provider consultations met standards for acceptable content and quality. Specially-trained MSPA 

interviewers acted as observers, sitting in on consultations during normal deliveries and recording what processes the 

provider followed when assessing the client, conducting procedures, and providing care and treatment (Ministry of 

Health (MoH) [Malawi] and ICF International 2013-14). 

92 96 99

78 80

92

78

87

64

45

58

35

Partograph Injectable

uterotonic

Latex gloves Soap or hand

disinfectant

Blood pressure

apparatus

Antibiotic eye

ointment

Available in delivery area Used or administered during observed deliveries
35 

3.3. Trends in Newborn Care Service Availability and Readiness in Tanzania 

3.3.1. Trends in newborn care service availability 

In Tanzania, where two SPA surveys have been conducted recently, in 2006 and 2014-15, we are able to 

examine trends in newborn care using the subset of indicators available in both surveys. In this report we 

examine trends in components of one of the three domains of service availability, Domain A8

. As Figure 

22 shows, Tanzanian health facilities that offer normal delivery services showed significant improvements 

in average BEmOC availability9

, from a mean score of 9 in 2006 to 47 in 2014-15. Coverage of all five 

signal functions with complete data improved significantly as well. The signal functions with the greatest 

improvements in coverage are provision of assisted vaginal delivery, which increased from 4% in 2006 to 

70% in 2014-15, and provision of the removal of retained products, which increased from 9% in 2006 to 

32% in 2014-15. Parenteral administration of anticonvulsants improved least, from 4% in 2006 to 13% in 

2014-15. 

Figure 22. National trend in components of service availability Domain A: BEmOC signal functions 

among facilities that offer normal delivery services, Tanzania 2006 and 2014-15 SPA 

Note: A solid line between adjacent surveys indicates a significant change, while a dotted line 

indicates no significant change. The BEmOC availability score presented here may not match 

the score presented in the previous chapter. To preserve comparability across the two surveys, 

the summary excludes parenteral administration of antibiotics, which is not available in the 

2006 survey. 

 

8

 The 2006 Tanzania SPA did not collect comparable information on Domain B, newborn signal functions, or Domain 

C, routine care. 

9

 The 2006 Tanzania SPA did not collect comparable information on one of the six component signal functions, 

parenteral administration of antibiotics. The summary indicator is based on the remaining five signal functions. 
36 

Figure 23 shows the trends in BEmOC service availability disaggregated by the type of facility, managing 

authority, and province10 (see Appendix Table A7a for more detail). Between the 2006 and 2014-5 SPA 

surveys, BEmOC availability scores increased significantly in every subgroup. By type of facility, health 

centers and dispensaries experienced greater improvement in coverage than hospitals, so that the gap in 

coverage by type of facility narrowed between the two surveys. Similarly, the gap in BEmOC availability 

between public and private facilities narrowed between surveys due to the relatively larger improvement in 

public facilities. Improvements were roughly similar across regions of Tanzania; the Central province 

experienced the greatest improvement in BEmOC availability, from a score of 6 in 2006 to 51 in 2014-15. 

Figure 23. Trend in service availability Domain B: BEmOC signal functions summary score among 

facilities that offer normal delivery services, by facility characteristics, Tanzania 2006 and 2014-15 

SPA 

Note: A solid line between adjacent surveys indicates a significant change, while a dotted line indicates no significant change. 

In the panel disaggregated by type of facility, six clinics surveyed in the 2014-15 survey are excluded, because no facilities were 

classified as clinics in the 2006 survey. In the panel disaggregated by province, Zanzibar is excluded do to an insufficient number 

of cases in the 2006 survey. The BEmOC availability score presented here may not match the score presented in the previous 

chapter. To preserve comparability across the two surveys, the summary excludes parenteral administration of antibiotics, which

is not available in the 2006 survey. 

 

10 Since information on urban/rural location is not available in the 2006 Tanzania SPA, we could not disaggregate the 

trend results by this variable. 

0

10

20

30

40

50

60

70

80

90

100

2006 TSPA 2014-15 TSPA

Facility type

Hospital Health Center Dispensary

0

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2006 TSPA 2014-15 TSPA

Managing authority

Public Private or other

0

10

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50

60

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2006 TSPA 2014-15 TSPA

Province

Eastern Western

Southern Southern Highlands

SW Highlands Central

Northern Lake
37 

3.3.2. Trends in newborn care service readiness 

For the first domain of service readiness, general requirements, we are able to assess the trend in coverage 

of three of the five components. As Figure 24 shows, based on these three items, Tanzanian health facilities 

that offer normal delivery services made significant improvements in general requirements, from a mean 

score of 33 in 2006 to 52 in 2014-15 (see Appendix Table A7b for more detail). Coverage of uninterrupted 

electricity availability increased significantly, from 27% in 2006 to 66% in 2014-15, and the availability of 

improved water on-site improved significantly, from 48% to 62%. There was no improvement in coverage 

of skilled birth attendance, which remained low in 2014-15, at 28%. 

Note: A solid line between adjacent surveys indicates a significant change, while a dotted line 

indicates no significant change. The General Requirements Summary Score presented here 

may not match the score presented in the previous chapter. To preserve comparability across 

the two surveys, the summary excludes components that are not available in the 2006 survey 

(emergency transport and improved sanitation). 

Figure 24. National trend in components of newborn care service readiness Domain A: General 

requirements, and trend in the summary score, among facilities that offer normal delivery 

services, Tanzania 2006 and 2014-15 SPA 
38 

Figure 25 shows the trend in general requirements service readiness disaggregated by facility 

characteristics. Between 2006 and 2014-5, the average general requirements score increased significantly 

among health centers and dispensaries, but not among hospitals. Public and private facilities experienced 

improvements of similar magnitude. Significant improvements in coverage were observed in roughly half 

the provinces, but with no evidence of improvement in the Eastern, SW Highlands, or Northern provinces. 

Figure 25. Trend in newborn care service readiness Domain A: General requirements summary 

score among facilities that offer normal delivery services, by facility characteristics, Tanzania 

2006 and 2014-15 SPA 

Note: A solid line between adjacent surveys indicates a significant change, while a dotted line indicates no significant change. 

The General Requirements Summary Score presented here may not match the score presented in the previous chapter. To 

preserve comparability across the two surveys, this summary score excludes components that are not available in the 2006 

survey (emergency transport and improved sanitation). In the panel disaggregated by type of facility, six clinics surveyed in the 

2014-15 survey are excluded, because no facilities were classified as clinics in the 2006 survey. 

0

10

20

30

40

50

60

70

80

90

100

2006 TSPA 2014-15 TSPA

Facility type

Hospital Health Center Dispensary

0

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60

70

80

90

100

2006 TSPA 2014-15 TSPA

Managing authority

Public Private or other

0

10

20

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40

50

60

70

80

90

100

2006 TSPA 2014-15 TSPA

Province

Eastern Western

Southern Southern Highlands

SW Highlands Central

Northern Lake
39 

On average, facilities improved significantly in equipment-related newborn care service readiness (service 

readiness Domain B) from a score of 40 in 2006 to 52 in 2014-15, but the results varied widely in coverage 

of individual components. Huge improvements were made in coverage of newborn bag and mask and 

delivery packs, while coverage of suction apparatus, partographs, and latex gloves decreased significantly. 

Coverage of other pieces of equipment, such as examination lights, manual vacuum extractors, and vacuum 

aspirators or D&C kits remained quite low, with no improvement between surveys. 

Note: A solid line between adjacent surveys indicates a significant change, while a dotted 

line indicates no significant change. The Equipment Summary Score presented here may 

not match the score presented in the previous chapter. To preserve comparability across 

the two surveys, this summary score excludes components that were not available in the 

2006 survey (i.e. blood pressure apparatus). 

Sterilization equipment

Delivery bed

Examination light

Delivery pack

Suction apparatus

Manual vacuum extractor

Vacuum aspirator or D and C 

kit

Partograph

Gloves

Newborn bag and mask

Infant scale

Soap or hand disinfectant

Equipment 

Summary Score

0

10

20

30

40

50

60

70

80

90

100

2006 TSPA 2014-15 TSPA

Figure 26. National trend in components of newborn care service readiness Domain B: Equipment, 

and trend in the summary score, among facilities that offer normal delivery services, Tanzania 

2006 and 2014-15 SPA 
40 

Between 2006 and 2014-15, the equipment-related service readiness score increased for all subgroups 

except hospitals, which already had the highest average score in 2006, at 81 (see Figure 27 and Appendix 

Table A7c). 

Figure 27. Trend in service readiness Domain B: Equipment summary score among facilities that 

offer normal delivery services, by facility characteristics, Tanzania 2006 and 2014-15 SPA 

Note: A solid line between adjacent surveys indicates a significant change, while a dotted line indicates no significant change. In 

the panel disaggregated by type of facility, six clinics surveyed in the 2014-15 survey are excluded, because no facilities were 

classified as clinics in the 2006 survey. The Equipment Summary Score presented here may not match the score presented in 

the previous chapter. To preserve comparability across the two surveys, the summary excludes components that are not available 

in the 2006 survey (i.e. blood pressure apparatus). 

0

10

20

30

40

50

60

70

80

90

100

2006 TSPA 2014-15 TSPA

Facility type

Hospital Health Center Dispensary

0

10

20

30

40

50

60

70

80

90

100

2006 TSPA 2014-15 TSPA

Managing authority

Public Private or other

0

10

20

30

40

50

60

70

80

90

100

2006 TSPA 2014-15 TSPA

Province

Eastern Western

Southern Southern Highlands

SW Highlands Central

Northern Lake
41 

Newborn care readiness related to medicines and commodities (service readiness Domain C) remained low 

in facilities that offer normal delivery services, but readiness improved significantly from an overall score 

of 29 in 2006 to 48 in 2014-15 (see Figure 28). Facilities made substantial improvements in the deliveryroom availability of several key medicines, including injectable uterotonics (from 11% coverage in 2006 to 

79% in 2014-15), injectable antibiotics (from 10% to 32%), and magnesium sulfate (from 4% to 41%). 

However, there were substantial decreases in the availability of other medicines, such as antibiotic eye 

ointment (from 43% to 24%). 

Figure 28. National trend in components of service readiness Domain C: Medicines and 

commodities, and trend in the summary score, Tanzania 2006 and 2014-15 SPA 

Note: A solid line between adjacent surveys indicates a significant change, while a dotted 

line indicates no significant change. The Medicines and Commodities Summary Score 

presented here may not match the score presented in the previous chapter. To preserve 

comparability across the two surveys, the summary excludes components that are not 

available in the 2006 survey (i.e. availability of chlorhexidine for cord cleaning and 

hydrocortisone). 
42 

Figure 29 shows the trend in service readiness for medicines and commodities among health facilities in 

Tanzania disaggregated by facility characteristics (see Appendix Table A7d for more detail). Between the 

2006 and 2014-5 SPA surveys, the average score increased for all subgroups except hospitals, which already 

had the highest score in 2006, at 69. 

Figure 29. Trend in service readiness Domain C: Medicines and commodities summary score 

among facilities that offer normal delivery services, by facility characteristics, Tanzania 2006 and 

2014-15 SPA 

Note: A solid line between adjacent surveys indicates a significant change, while a dotted line indicates no significant change. In 

the panel disaggregated by type of facility, six clinics surveyed in the 2014-15 survey are excluded, because no facilities were 

classified as clinics in the 2006 survey. The Medicines and Commodities Summary Score presented here may not match the score 

presented in the previous chapter. To preserve comparability across the two surveys, the summary excludes components that are 

not available in the 2006 survey (i.e. hydrocortisone available at the facility). 

0

10

20

30

40

50

60

70

80

90

100

2006 TSPA 2014-15 TSPA

Facility type

Hospital Health Center Dispensary

0

10

20

30

40

50

60

70

80

90

100

2006 TSPA 2014-15 TSPA

Managing authority

Public Private or other

0

10

20

30

40

50

60

70

80

90

100

2006 TSPA 2014-15 TSPA

Province

Eastern Western

Southern Southern Highlands

SW Highlands Central

Northern Lake
43 

For the fourth domain of newborn care service readiness, guidelines and staffing, we were able to examine 

trends in 3 of the 10 indicators. The percentage of facilities with at least one delivery or newborn care 

provider with recent in-service training in early and exclusive breastfeeding increased significantly, from 

11% in 2006 to 49% in 2014-15, and the percentage of facilities with at least one delivery or newborn care 

provider with recent in-service training in newborn resuscitation with bag and mask increased from 9% to 

52%. However, the percentage of facilities with routine personal supervision among health workers who 

provide delivery or newborn care decreased between surveys, from 90% to 73%. Overall, the summary 

score for this domain of service readiness increased significantly, from a score of 27 in 2006 to 47 in 2014-

15 (see Figure 30 and Appendix Table A7e). 

Figure 30. National trend in components of service readiness Domain C: Guidelines and staffing, 

and trend in the summary score, among facilities that offer normal delivery services, Tanzania 

2006 and 2014-15 SPA 

Note: A solid line between adjacent surveys indicates a significant change, while a dotted 

line indicates no significant change. The Guidelines and Staffing Summary Score presented 

here may not match the score presented in the previous chapter. To preserve comparability 

across the two surveys, the summary excludes components that are not available in the 

2006 survey (i.e. availability of IMPAC, CEmOC, and pre-term labor guidelines, and 

indicators on recent in-service training on newborn infection management, thermal care, 

cord care, and KMC). 

Training in neonatal resucitation

Training in early and exclusive 

breastfeeding

Supervision

Guidelines and Staffing 

Summary Score

0

10

20

30

40

50

60

70

80

90

100

2006 TSPA 2014-15 TSPA
44 

Significant improvements were made in newborn care service readiness related to guidelines and staffing 

in all subgroups except hospitals and two of Tanzania’s eight provinces, the Southern and Lake provinces 

(see Figure 31). 

Figure 31. Trend in service readiness Domain C: Guidelines and staffing summary score among 

facilities that offer normal delivery services, by facility characteristics, Tanzania 2006 and 2014-15 

SPA 

Note: A solid line between adjacent surveys indicates a significant change, while a dotted line indicates no significant change. In the 

panel disaggregated by type of facility, six clinics surveyed in the 2014-15 survey are excluded, because no facilities were classified 

as clinics in the 2006 survey. The Guidelines and Staffing Summary Score presented here may not match the score presented in the 

previous chapter. To preserve comparability across the two surveys, the summary excludes components that are not available in the 

2006 survey (i.e. availability of IMPAC, CEmOC, and pre-term labor guidelines, and indicators on recent in-service training on newborn 

infection management, thermal care, cord care, and KMC). 

0

10

20

30

40

50

60

70

80

90

100

2006 TSPA 2014-15 TSPA

Facility type

Hospital Health Center Dispensary

0

10

20

30

40

50

60

70

80

90

100

2006 TSPA 2014-15 TSPA

Managing authority

Public Private or other

0

10

20

30

40

50

60

70

80

90

100

2006 TSPA 2014-15 TSPA

Province

Eastern Western

Southern Southern Highlands

SW Highlands Central

Northern Lake
45 

3.4. Linking the SPA and DHS at the Regional Level: Bivariate Association between Newborn 

Care Service Availability, Service Readiness, and Neonatal Mortality 

Thus far, the report has described levels and trends in the readiness of facilities that offer normal delivery 

services to provide newborn care. To address the extent to which readiness to provide newborn care is 

associated with newborn survival, we examine the bivariate correspondence between mean service 

availability and readiness scores and neonatal mortality rates. The analysis is conducted at the regional level 

because SPA surveys that are a sample of facilities, rather than a complete census, should not be linked 

with DHS data at the individual level, due to the potential for misclassification error (Burgert and Prosnitz 

2014). The analysis is restricted to the three study countries with DHS and SPA surveys conducted within 

three years of one another—Bangladesh, Haiti, and Senegal (Table 4). For these countries, it is reasonable 

to assume that the SPA captures the service environment for births in the five years preceding the DHS. 

Figure 32 includes two panels. The panel on the left shows the correspondence between the mean service 

availability summary score and the neonatal mortality rate for the regions of Bangladesh, Haiti, and 

Senegal, based on births in the five years preceding the most recent DHS. The panel on the right shows the 

correspondence between the mean service readiness summary score and the neonatal mortality rate in the 

regions. Each plot includes 23 data points, representing the 23 geographic regions in the three countries. A 

simple linear regression line was fit through the data points. A slope (b) significantly different from 0 would 

indicate an association between regional newborn care service availability or service readiness and neonatal 

survival in the region. 

The mean service availability score was marginally associated (p<0.10) with the region’s NMR (b=-0.29, 

p=0.072), with lower service availability scores tending to be correlated with higher neonatal mortality 

rates. The mean service availability score accounted for 11% of the regional variation in the NMR. We did 

not find evidence of a linear association between mean service readiness and NMR (b=-.20, p=0.311). 

However, for both newborn care service availability and service readiness, the association was in the 

expected direction, with decreasing service availability/readiness associated with higher levels of neonatal 

mortality. 

Figure 32. Association between neonatal mortality and newborn care service availability (left panel) 

and neonatal mortality and service readiness (right panel) for the regions of Bangladesh, Haiti, and 

Senegal 

Note: Haiti is shown in orange, Bangladesh in blue, and Senegal in gray. Linear regression lines were fit through the 23 points. 

P-values for slope coefficients: service availability summary score: p=0.072; service readiness summary score: p=0.311. 
46 

Figure 33 shows the correspondence between each domain of service availability and the NMR. Domain 

A, BEmOC availability, (b=-.20, p=0.060) and Domain C, routine practices, (b=-.29, p=0.054) were each 

marginally associated with the NMR. The scores for BEmOC availability accounted for 12% of the 

variation in the NMR, while the score for routine practices accounted for 13%. We found no evidence of 

an association between Domain B, newborn signal functions service availability, and the NMR. 

Figure 33. Association between newborn care service availability and neonatal mortality for the 

regions of Bangladesh, Haiti, and Senegal 

Note: Haiti is shown in orange, Bangladesh in blue, and Senegal in gray. Linear regression lines were fit through the 23 points. 

P-values for slope coefficients: service availability domain A: p=0.060; domain B: p=0.108, domain C: p=0.054. 20 30 40 50 NMR (Deaths per 1,000 live births

30 40 50 60 70 80 90 Service Availability Domain A: BEmOC Availability Score

20 30 40 50

NMR (Deaths per 1,000 live births

10 20 30 40 50 60 70 Service Availability Domain B: Newborn Signal Functions Score

20 30 40 50

NMR (Deaths per 1,000 live births

50 60 70 80 90 100 Service Availability Domain C: Routine Care Score
47 

Figure 34 shows the association between each domain of service readiness and the NMR. We found no 

evidence of an association between any domain of service readiness and the NMR. However, it is worth 

noting that for three of the four domains the association was in the expected direction, with higher readiness 

scores correlated with lower neonatal mortality rates; the only exception was service readiness Domain D, 

guidelines and staffing. 

Figure 34. Association between newborn care service readiness and neonatal mortality for the 

regions of Bangladesh, Haiti, and Senegal 

 

 Note: Haiti is shown in orange, Bangladesh in blue, and Senegal in gray. Linear regression lines were fit through the 23 points. Linear 

regression lines were fit through the 31 points. P-values for slope coefficients: service readiness domain A: p=0.348: domain B: 

p=0.120, domain C: p=0.140, domain D: p=0.160. 20 30 40 50 NMR (Deaths per 1,000 live births

40 50 60 70 80 Service Readiness Domain A: General Requirements Score

20 30 40 50

NMR (Deaths per 1,000 live births

30 40 50 60 70 80 Service Readiness Domain B: Equipment

20 30 40 50

NMR (Deaths per 1,000 live births

10 20 30 40 50 60 70 80 90 Service Readiness Domain C: Medicine

20 30 40 50

NMR (Deaths per 1,000 live births

10 20 30 40 50 60 Service Readiness Domain D: Staffing and guidelines

49 

4. Discussion 

Given differential access to delivery and newborn care, where you are born strongly affects your chance of 

survival (Lawn et al. 2013). However, previous studies have found that access to delivery care alone is not 

enough to reduce early neonatal mortality rates (e.g., Lohela et al. 2012). Beyond whether a mother has 

access to a health facility and whether she delivers in that facility, it is essential that the available services 

have appropriate content and good quality. Ours is the first study to examine two dimensions of quality of 

newborn care—service availability and service readiness—in five high-burden countries. In all five 

countries, key services, commodities and medicines needed for comprehensive delivery and newborn care 

were missing from a large proportion of facilities that offer normal delivery services. This is important not 

only because it indicates poor quality of care, or possibly even no care, but also because widespread 

perceptions of poor-quality services can deter women from seeking care at a facility (Darmstadt et al. 2014). 

In this chapter we discuss the meaning and implications of our findings by country, as well as the gap 

between service readiness and service delivery in Malawi, the mainly encouraging trend in Tanzania, and 

what we learned about the association between neonatal mortality and service availability and readiness. 

Of the five countries assessed, Malawi has among the highest scores for both service availability and service 

readiness. Service availability scores vary by domain, with the lowest scores for BEmOC signal functions 

and newborn signal functions. Service readiness domain scores are generally consistent, at around 60. Save 

the Children has been instrumental in scaling up newborn care throughout Malawi over the past 15 years, 

with funding from USAID and The Bill and Melinda Gates Foundation, an effort that likely contributed to 

these scores. However, there is still a need for improvement in all domains except routine care. Hospitals 

score the highest for service availability and service readiness, while health centers score much lower. 

Given that health centers constitute nearly 80% of the facilities that provide normal delivery services, they 

have the potential to serve more people than hospitals, so investment in the availability and readiness of 

their newborn care services is greatly needed. Urban facilities generally score higher than rural facilities, 

and there is only a slight difference between public and private facility scores. With most surveyed facilities 

located in rural areas (85%), investments to increase the scores of those facilities in Malawi could have a 

significant impact on the population. Our findings are consistent with a study by Zimba and colleagues 

(2012) that found that most facilities had staff and supply shortages and lacked three or more signal 

functions. 

Our comparison of service readiness and service delivery, using observation data in Malawi, brings a few 

issues to light. First, there is a gap between the commodities available in a facility and their use, a gap of 

57 percentage points in the worst case (antibiotic eye ointment) and 9 percentage points in the best case 

(injectable uterotonic), with an average gap of 28 percentage points for six key commodities. This is an 

important finding regarding availability versus actual service delivery, and it sounds a warning for programs 

and policies that seek to improve service quality. Second, this finding means that our other findings 

regarding service availability and readiness should be interpreted cautiously, as they may overestimate 

actual provision of services. Finally, our findings point to a need for further investigation of barriers to the 

use of available commodities and medicines, to determine whether the gap we identified reflects a lack of 

staff knowledge or skill, or another barrier to effective service delivery. 

Senegal’s newborn care quality scores are nearly as high as those in Malawi, at about 60 points for both 

service availability and service readiness. Senegal’s highest score is for routine care (89); its lowest scores 

are for guidelines and staffing (38) and the availability of newborn signal functions (43). Compared with 

the other countries, disparities are markedly less drastic in Senegal. There is little difference between public 

and private facilities in service availability and readiness, and on average the differences between urban 
50 

and rural facilities are smaller than for other countries except Malawi. Still, health posts11, which constitute 

nearly 90% of all facilities that offer normal delivery services, score substantially lower than hospitals. 

Investments to increase the scores of dispensaries and clinics could have a significant impact on the 

population. 

Bangladesh has shown impressive reductions in neonatal mortality since 1990; in fact is it one of two lowincome countries included in the list of 50 countries with the highest rates of reduction in NMR 

(Oestergaard et al. 2011). However, we find that the country has relatively low scores for newborn care 

quality, with scores below 50 for both service availability and service readiness. Its highest score is for 

routine care (70) and its lowest is for the availability of medicines (28). Of the five countries, Bangladesh 

also shows the widest gaps in coverage across subgroups: hospitals generally have much higher scores than 

health centers or dispensaries/clinics; private facilities have higher scores than public facilities, and urban 

facilities have higher scores than rural facilities, suggesting geographic and economic inequities in access 

to high-quality newborn care. In general, most facilities that offer normal delivery services in Bangladesh 

do not provide comprehensive newborn care services and are not ready to do so. These findings are 

consistent with other studies that report inadequate quality of obstetric care in the country, and marked 

urban-rural gaps in quality (Anwar, Kalim, and Koblinsky 2009). Concentrated efforts to improve the 

quality of newborn care for all are urgently needed. 

Tanzania also scores below 50 for overall service availability and service readiness. Tanzania scores highest 

for routine care (80) and lowest for newborn signal functions (26). Hospitals, which constitute just 5% of 

the country’s health facilities with normal delivery services, have higher scores than health centers or 

dispensaries/clinics; private facilities have higher scores than public facilities; and urban facilities have 

higher scores than rural facilities, suggesting both geographic and economic inequities. However, the main 

finding for Tanzania may be its achievement in narrowing gaps in quality of newborn care between 2006 

and 2014-15. All five of the measurable domains of newborn care service availability and readiness showed 

significant improvement between surveys. The greatest improvements were made in average BEmOC 

availability, with notable increases in assisted vaginal delivery and removal of retained products. Coverage 

of uninterrupted electricity availability and improved water onsite also increased substantially, with the 

largest gains at health centers and dispensaries/clinics, and at public rather than private facilities, indicating 

a narrowing of the equity gap in newborn care in Tanzania. The presence of newborn bag and mask and 

delivery packs, and supplies of injectable uterotonics, injectable antibiotics, and magnesium sulfate also 

increased, although the supply of medicines overall remains low. We observed decreases or stagnation for 

some indicators, presenting a somewhat mixed picture, but in all, an encouraging trend for the indicators 

we measured. As more SPA surveys are completed in Tanzania and in other countries, we will be able to 

conduct more trend analyses to monitor improvements in quality of newborn care. 

Like Bangladesh and Tanzania, Haiti scores below 50 for service availability and service readiness, with a 

high score of 68 for routine care and a low score of 27 for newborn signal functions. Overall in Haiti, public 

and private facilities score similarly, but hospitals score higher than health centers and dispensaries and 

clinics, and urban facilities score higher than rural facilities, signaling geographic inequities and barriers to 

access. These findings are consistent with Wang and colleagues (2014), who also found that lower-level 

facilities in Haiti—and specifically health centers without beds and dispensaries—are poorly prepared to 

provide delivery services. In Haiti, health centers without beds and dispensaries lack a government mandate 

to provide delivery services (Ministère de la Santé Publique et de la Population (MSPP) 2000), yet these 

facilities constitute half of all facilities that report offering delivery care (Wang et al. 2015). Since these 

facilities lack official mandate, they may not receive necessary support from the government. Since in rural 

areas lower-level facilities are often all that is available, the government may do well to formally include 

 

11 In Senegal, the “dispensaries and clinics” category consists entirely of health posts. 
51 

them as providers of delivery care and equip them with the medicines, commodities, personnel, and training 

necessary to provide high-quality delivery and newborn care (Wang et al. 2015). 

In our bivariate analysis of the association between neonatal mortality rates and newborn care service 

availability and service readiness scores in Bangladesh, Haiti, and Senegal, we found regional neonatal 

mortality rates to be marginally significantly associated with service availability scores but not with service 

readiness scores. The associations between NMR and service availability scores are in the expected 

direction, with lower scores tending to be correlated with higher regional neonatal mortality rates, and are 

marginally significant for two of the three domains of service availability: BEmOC availability and routine 

perinatal care availability. This analysis was a simple, unadjusted examination of the association at the 

regional level. It did not consider many important factors, including the density and accessibility of the 

health facilities that offer delivery services and, related, the level of use of delivery and newborn care 

services by women. The analysis did not account for any covariates or country-level characteristics, all of 

which could confound the associations. Nonetheless, the analysis provides a glimpse of an association that 

could be supported through future analyses, using census SPA surveys and multilevel models to examine 

both facility-level and individual-level characteristics, and accounting for facility variance within regions. 

These future analyses could investigate further the relative importance of service availability and service 

readiness dimensions as determinants of newborn survival. 

Another useful area of future research could be to examine facility quality scores alongside population data 

on the use of delivery services: to what extent do women use the types of facilities with higher quality 

scores? In all countries, we found that hospitals have the highest quality scores, and yet hospitals comprise 

the smallest segment of facilities with normal delivery services, indicating that for most women, accessing 

newborn care services at health centers or dispensary/clinics is more likely than receiving hospital care. 

There are equity issues to be further explored and explained. 

In addition to the limitations noted for the analyses of bivariate associations, limitations of the other 

analyses described in this report include the fact that not all relevant indicators were available in our data 

sources. The scores we created condense a great deal of information and need to be “unpacked” for clear 

interpretation and program purposes, but we believe they provide a valid way for us to convey a large 

amount of related information. Our choice of countries was limited by the availability of SPA surveys. 

Strengths of our analysis include our comprehensive definition of newborn care quality and our 

multifaceted analysis, through which we sought to expose the current status of newborn care quality from 

different angles. 

In conclusion, we found some encouraging evidence of newborn care service availability and readiness 

among the countries studied, and also identified a great deal of room for improvement. Of the seven 

domains of service availability and service readiness studied, routine care consistently scores highest, while 

newborn signal functions and guidelines and staffing tend to score lowest. The results point to persistent 

inequity in access to high-quality newborn care between urban and rural areas and between hospitals and 

the more ubiquitous health centers and dispensaries/clinics and clinics. Together, the findings indicate the 

need for broad initiatives that improve staff competence, address systemic barriers to service provision, and 

promote equity in newborn care quality. The trend analysis for Tanzania provides a hopeful sign; more 

studies are needed to understand the extent of this trend more broadly. While the past 10 to 15 years have 

seen an increase in high-profile advocacy, research, and funding for some countries, clearly more can be 

done to increase newborn care service availability and readiness. 

53 

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57 

Appendix 

Table A1. Percent distribution of facilities that offer normal delivery services by facility 

characteristics, Bangladesh, Haiti, Tanzania, Malawi, Senegal 

Bangladesh 

2014 SPA 

Haiti 2013 

SPA 

Tanzania 

2006 SPA 

Tanzania 

2014-15 

SPA 

Malawi 

2013-14 

SPA 

Senegal 

2014 SPA 

 % N % N % N % N % N % N 

Facility type 

Hospital 26.1 73 24.1 94 5.2 24 4.8 44 18.0 95 4.0 11 

Health Center 35.2 99 42.9 167 10.7 48 12.1 110 78.5 414 7.3 20 

Clinic 38.7 109 33.0 128 84.1 379 83.1 751 3.5 19 88.7 248 

Managing Authority 

Public 79.8 224 50.2 195 81.0 365 83.6 756 65.7 347 89.8 251 

Private or other 20.2 57 49.8 194 19.0 85 16.4 149 34.3 181 10.2 29 

Locality 

Urban 29.3 82 38.8 151 n/a 14.6 132 14.8 78 25.9 72 

Rural 70.7 198 61.2 238 85.4 773 85.2 450 74.1 207 

Total 100 280 100 389 100 451 100 905 100 528 100 279
58

Table A2a. Service availability Domain A: BEmOC signal functions, Bangladesh 2014 SPA 

Parenteral 

administration of 

antibiotics 

Parenteral 

administration of 

uterotonic 

drugs 

Parenteral 

administration of anticonvulsants Manual removal of placenta Assisted vaginal delivery Removal of retained products 

Service 

availability 

Domain A 

summary score

% LB UB % LB UB % LB UB % LB UB % LB UB Mean LB UB Mean LB UB N 

Facility type 

Hospital 87.9 82.3 92.0 85.8 80.1 90.1 60.7 53.5 67.5 74.2 67.5 80.0 76.1 69.5 81.7 64.6 57.4 71.2 74.9 70.8 79.0 73Health Center 33.8 24.6 44.5 40.9 31.1 51.6 16.4 10.8 24.1 27.5 19.4 37.3 39.3 29.6 50.0 19.2 12.7 27.9 29.5 23.8 35.2 99Dispensary or clinic 25.8 15.9 39.1 35.4 24.0 48.7 21.4 12.2 34.8 34.1 20.6 50.8 36.8 22.5 53.8 22.4 13.1 35.6 29.3 19.9 38.7 108

Managing authority 

Public 36.0 29.1 43.4 43.7 36.4 51.3 24.4 18.8 31.0 36.4 28.5 45.2 44.2 35.4 53.3 26.2 20.4 33.0 35.1 30.0 40.3 224Private or other 80.1 70.4 87.2 77.4 67.4 85.0 51.9 41.5 62.1 65.4 54.9 74.5 62.7 52.2 72.1 56.3 45.6 66.4 65.6 58.3 72.9 56

Location 

Urban 84.1 77.5 89.0 81.2 74.3 86.6 55.6 48.0 62.9 73.5 66.2 79.7 71.2 63.9 77.5 63.2 55.7 70.2 71.5 66.7 76.3 82Rural 28.6 21.2 37.3 37.7 29.7 46.5 19.3 13.3 27.1 29.3 20.7 39.6 38.3 28.7 48.8 19.4 13.3 27.5 28.8 23.0 34.6 198

Division 

Barisal 47.6 35.0 60.5 46.4 33.8 59.5 19.5 11.4 31.3 45.4 32.9 58.5 41.7 29.5 55.1 29.8 20.8 40.7 38.4 30.6 46.1 15Chittagong 53.0 40.7 64.9 51.9 39.7 63.9 27.0 18.9 36.9 46.3 34.4 58.6 47.3 34.2 60.7 32.8 22.8 44.6 43.0 33.1 53.0 58Chaka 49.3 35.5 63.1 51.0 37.2 64.7 27.5 16.9 41.6 39.0 26.4 53.3 48.8 33.2 64.7 29.6 22.7 37.5 40.9 31.9 49.9 97Khulna 41.5 25.6 59.5 57.6 37.2 75.8 34.4 18.8 54.2 37.5 23.3 54.3 42.7 24.7 62.9 29.0 17.5 44.0 40.4 30.2 50.7 25Rajshahi 31.0 22.9 40.4 30.3 22.1 39.9 20.8 15.6 27.1 42.0 21.7 65.4 48.2 26.3 70.7 32.3 14.7 56.9 34.1 21.6 46.6 35Rangpur 38.2 26.5 51.4 69.2 54.1 81.0 53.8 41.3 65.9 46.3 24.1 70.1 44.8 32.1 58.2 44.5 22.6 68.7 49.5 37.7 61.2 33Sylhet 36.7 22.2 54.1 41.8 25.8 59.7 29.0 15.4 47.9 43.9 25.9 63.6 63.3 39.8 81.8 29.0 17.4 44.2 40.6 26.5 54.7 18

Total 44.8 38.8 51.0 50.5 44.2 56.7 29.9 24.8 35.6 42.3 35.4 49.5 47.9 40.5 55.5 32.3 27.0 38.0 41.3 36.8 45.7 280Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
59 

Table A2b. Service availability Domain B: Newborn signal functions, Bangladesh 2014 SPA

Neonatal 

resuscitation 

Cortisosteroids 

for pre-term 

labor 

Kangaroo Mother 

Care 

Service 

availability 

Domain B 

summary score 

 % LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 69.4 62.5 75.5 47.7 40.8 54.7 57.1 50.1 63.8 58.1 53.4 62.8 73

Health Center 31.6 22.8 42.1 10.6 6.2 17.5 34.6 25.2 45.4 25.6 20.2 31 99

Dispensary or clinic 34.9 21.1 51.9 18.8 8.9 35.4 44 27.9 61.4 32.6 23.8 41.3 108 

Managing authority 

Public 37.9 29.7 47 18.8 13 26.4 41.5 32.4 51.2 32.7 27.9 37.5 224

Private or other 61.8 51.3 71.3 41.9 32.1 52.4 54.6 44.5 64.2 52.8 45.6 59.9 56

Location 

Urban 68.1 60.9 74.5 47.9 40.6 55.2 56 48.7 63.1 57.3 52.5 62.1 82

Rural 32.2 23.3 42.7 13.3 7.4 22.7 39.2 29.1 50.2 28.2 22.8 33.7 198 

Division 

Barisal 31.7 21.4 44.2 15.4 9.4 24 35.6 24.1 49.2 27.6 20 35.1 15

Chittagong 39.2 28.5 51 15.5 9.4 24.5 41.3 29.5 54.2 32 23.7 40.2 58

Chaka 47.1 31.8 63 29.9 18.9 43.7 48.2 32.5 64.3 41.7 33.3 50.1 97

Khulna 57.7 36.8 76.1 27.6 13.3 48.6 48.4 28.7 68.7 44.6 31.1 58.1 25

Rajshahi 29.6 21.1 39.9 18.5 12.6 26.4 37.6 18.5 61.5 28.6 19.8 37.3 35

Rangpur 49.8 26.4 73.2 27.3 10.4 55 47.1 24.3 71.1 41.4 30.1 52.6 33

Sylhet 31.8 20.3 46 17.6 8.8 32.3 39.6 24.7 56.6 29.7 18 41.3 18

Total 42.8 35.7 50.1 23.4 18.2 29.7 44.1 36.4 52.1 36.8 32.6 40.9 280

Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 

Table A2c. Service availability Domain C: Routine perinatal care, Bangladesh 2014 SPA 

Partograph 

routinely used to 

monitor labor 

Routine early 

initiation of 

breastfeeding 

(w/in first hour) Thermal care 

Service 

availability 

Domain C 

summary score 

% LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 24.3 18.8 30.7 97.7 94.9 98.9 96.6 93.8 98.2 72.9 70.6 75.1 73 

Health Center 21.6 14.0 32.0 94.5 90.4 96.9 93.4 88.3 96.4 69.9 66.1 73.6 99 

Dispensary or clinic 8.0 5.4 11.8 99.3 95.3 99.9 94.4 82.4 98.4 67.2 64.5 69.9 108 

Managing authority 

Public 14.4 10.6 19.2 96.9 94.8 98.1 94.1 89.2 96.9 68.4 66.3 70.6 224 

Private or other 27.7 20.4 36.2 98.4 95.3 99.5 96.7 91.6 98.8 74.3 71.3 77.3 56 

Location 

Urban 28.5 22.9 34.8 98.3 96.1 99.2 96.1 92.7 98.0 74.3 72.0 76.6 82 

Rural 12.3 8.3 17.9 96.7 94.4 98.1 94.0 88.3 97.0 67.7 65.3 70.0 198 

Division 

Barisal 11.6 6.3 20.3 92.0 78.5 97.3 90.4 78.0 96.1 64.7 58.8 70.5 15 

Chittagong 12.5 7.1 21.1 97.7 95.0 99.0 91.5 69.8 98.1 67.2 62.4 72.1 58 

Chaka 22.5 15.4 31.8 100.0 98.7 95.6 99.6 73.8 70.9 76.6 97 

Khulna 24.8 12.5 43.3 98.8 91.8 99.8 98.5 92.6 99.7 74.0 68.8 79.2 25

Rajshahi 8.9 4.4 16.9 100.0 96.5 78.5 99.5 68.5 65.4 71.5 35 

Rangpur 17.7 9.4 30.8 91.0 79.3 96.4 87.7 76.2 94.1 65.5 58.7 72.3 33 

Sylhet 10.7 5.8 18.9 88.0 73.3 95.1 89.6 71.3 96.8 62.8 56.7 68.8 18 

Total 17.1 13.6 21.2 97.2 95.5 98.2 94.6 90.7 97.0 69.6 67.8 71.4 280 

Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
60

Table A2d. Service readiness Domain A: General requirements, Bangladesh 2014 SPA 

Electricity 

Improved water 

source 

Improved 

sanitation 

24/7 skilled birth 

attendance 

Emergency 

transport 

Service 

readiness 

Domain A 

summary score 

 % LB UB % LB UB % LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 85.7 80.9 89.5 96.6 92.9 98.4 90.2 85.5 93.5 74.2 67.4 80.0 78.5 72.0 83.8 85.1 82.8 87.3 73 Health Center 38.5 29.1 48.9 93.4 87.4 96.6 73.2 62.9 81.6 12.6 8.6 18.1 13.6 8.2 21.8 46.3 42.9 49.6 99 Dispensary or clinic 30.4 22.1 40.2 89.9 69.3 97.2 65.7 46.1 81.1 17.5 10.8 27.1 19.1 10.1 33.2 44.5 37.4 51.7 108 

Managing authority 

Public 35.8 29.7 42.3 91.9 82.9 96.3 70.5 60.0 79.3 24.1 20.0 28.6 24.7 19.1 31.4 49.4 45.6 53.1 224 Private or other 94.9 87.9 97.9 96.8 91.0 98.9 91.5 84.7 95.4 56.4 45.9 66.4 64.1 53.8 73.3 80.7 76.9 84.6 56 

Location 

Urban 91.1 86.9 94.1 96.7 93.1 98.5 91.5 86.9 94.6 72.8 65.4 79.1 76.2 69.2 82.0 85.7 83.3 88.0 82 Rural 29.6 23.0 37.3 91.3 81.0 96.2 67.8 56.0 77.7 13.1 9.0 18.6 14.6 8.9 23.0 43.3 39.0 47.5 198 

Division 

Barisal 40.1 29.0 52.3 88.8 76.4 95.1 77.7 62.7 87.8 39.5 29.6 50.3 32.3 26.0 39.4 55.7 50.7 60.7 15 Chittagong 51.8 41.3 62.2 95.9 88.0 98.7 86.8 68.9 95.1 28.7 20.3 38.9 32.6 24.6 41.7 59.2 53.4 64.9 58 Chaka 45.4 38.2 52.7 90.4 70.4 97.4 68.2 50.3 81.9 28.3 23.4 33.7 37.2 24.9 51.4 53.9 47.3 60.4 97 Khulna 62.7 44.5 77.9 97.6 91.1 99.4 54.7 32.9 74.8 34.0 25.0 44.3 45.4 28.6 63.3 58.9 50.6 67.1 25 Rajshahi 27.1 18.7 37.6 89.1 47.3 98.7 78.2 45.6 93.9 20.6 17.1 24.5 17.4 12.8 23.2 46.5 41.4 51.5 35 Rangpur 60.0 34.7 80.9 96.7 87.4 99.2 77.2 46.8 92.9 44.9 23.6 68.2 22.2 19.8 24.8 60.2 46.9 73.5 33 Sylhet 50.1 30.0 70.3 93.3 80.9 97.9 86.1 69.7 94.4 30.3 19.9 43.2 40.5 22.7 61.3 60.1 53.4 66.8 18 

Total 47.7 42.6 52.8 92.9 85.8 96.6 74.8 66.1 81.8 30.6 26.7 34.8 32.7 27.5 38.3 55.7 52.6 58.9 280 Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
61

Table A2e. Service readiness Domain B: Equipment, Bangladesh 2014 SPA

Sterilization 

equipment 

Delivery 

bed 

Examination 

light 

Delivery 

pack 

Suction 

apparatus 

Manual vacuum 

extractor 

Vacuum 

aspirator or D 

and C kit Partograph 

% LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB 

Facility type 

Hospital 80.7 74.6 85.7 94.8 90.3 97.3 84.7 79.0 89.1 94.8 90.3 97.3 75.1 68.4 80.8 49.0 42.4 55.6 55.4 48.3 62.2 39.0 32.6 45.9Health Center 40.1 31.0 50.1 69.6 59.5 78.0 49.6 40.1 59.1 69.6 59.5 78.0 39.2 29.7 49.5 17.2 11.1 25.7 18.9 13.2 26.3 20.1 13.2 29.4Dispensary or clinic 39.3 25.4 55.2 61.8 43.0 77.6 66.0 47.6 80.6 50.0 34.3 65.7 37.3 23.4 53.6 14.7 6.6 29.4 19.4 9.5 35.6 20.4 10.2 36.7

Managing authority

Public 41.0 32.7 49.8 69.0 58.7 77.7 59.1 49.6 68.0 69.0 58.7 77.7 41.4 33.0 50.3 20.5 15.0 27.4 23.3 17.1 30.8 22.8 16.3 30.9Private or other 87.7 80.0 92.7 89.3 80.4 94.5 88.8 79.8 94.1 89.3 80.4 94.5 73.3 63.3 81.3 40.5 31.3 50.4 49.8 39.8 59.9 34.6 26.0 44.3

Location 

Urban 85.8 80.2 90.0 91.0 84.8 94.8 87.3 81.1 91.6 91.0 84.8 94.8 77.7 70.6 83.5 45.6 38.7 52.5 54.0 46.7 61.2 40.3 34.0 46.8Rural 35.7 26.7 45.9 65.7 54.2 75.6 55.9 45.3 66.0 65.7 54.2 75.6 35.4 26.3 45.7 15.8 10.0 24.1 18.1 11.6 27.1 18.9 12.0 28.5

Division 

Barisal 46.0 33.2 59.4 79.7 65.0 89.2 43.7 31.7 56.5 79.7 65.0 89.2 41.6 29.1 55.3 23.1 14.8 34.2 28.8 20.0 39.5 26.7 16.9 39.4Chittagong 50.6 39.7 61.4 70.0 54.2 82.2 55.0 40.2 68.9 70.0 54.2 82.2 49.1 36.6 61.7 30.2 21.5 40.7 36.2 26.0 47.9 17.8 11.2 27.1Chaka 62.8 45.7 77.3 77.3 58.6 89.2 67.9 50.0 81.8 77.3 58.6 89.2 55.1 38.8 70.3 19.0 9.2 35.2 22.1 12.2 36.7 29.6 16.6 47.0Khulna 44.8 27.6 63.4 66.6 42.4 84.4 74.0 52.7 87.9 66.6 42.4 84.4 56.2 33.5 76.6 21.8 13.9 32.6 34.9 21.1 51.8 29.2 15.9 47.4Rajshahi 27.6 21.2 35.1 72.0 44.3 89.3 46.8 24.0 70.9 72.0 44.3 89.3 28.2 21.1 36.5 16.4 9.7 26.4 12.5 8.5 18.1 13.6 8.6 21.0Rangpur 47.5 24.9 71.1 69.3 41.2 87.9 93.5 81.5 97.9 69.3 41.2 87.9 49.8 26.7 73.0 41.1 28.9 54.5 46.4 24.1 70.2 35.1 23.5 48.8Sylhet 44.3 32.9 56.4 73.2 49.3 88.5 72.2 53.9 85.2 73.2 49.3 88.5 32.4 21.5 45.7 26.1 16.1 39.5 29.4 18.7 43.1 22.1 11.8 37.7

Total 50.4 43.4 57.5 73.1 64.7 80.2 65.1 57.2 72.2 73.1 64.7 80.2 47.8 40.6 55.1 24.5 19.6 30.3 28.6 23.1 34.8 25.2 19.5 31.8

Gloves 

Newborn bag 

and mask 

Infant 

scale 

Blood pressure 

apparatus, dig 

or manual 

Soap or hand 

disinfectant 

Service 

readiness 

Domain B 

summary score 

% LB UB % LB UB % LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 82.0 75.5 87.1 76.9 70.1 82.6 67.0 59.8 73.4 98.1 95.3 99.2 95.3 91.5 97.5 75.3 72.7 77.9 73Health Center 72.0 61.6 80.5 37.8 28.7 47.8 61.9 52.2 70.8 79.6 68.9 87.2 73.0 62.3 81.6 48.7 44.3 53.1 99Dispensary or clinic 63.6 45.6 78.5 33.4 20.0 50.0 52.1 39.4 64.4 95.2 82.9 98.8 67.0 48.2 81.7 47.7 39.7 55.7 108

Managing authority

Public 69.3 59.4 77.7 40.0 31.7 48.8 57.0 49.5 64.2 88.1 81.9 92.3 71.5 61.1 79.9 50.6 46.2 54.9 224Private or other 79.5 69.7 86.7 71.3 61.1 79.7 69.1 58.9 77.7 99.9 99.0 100.0 96.6 90.8 98.8 73.8 69.4 78.1 56

Location 

Urban 81.6 74.7 86.9 74.9 67.6 81.0 70.2 62.8 76.7 98.1 95.7 99.2 95.4 91.6 97.5 75.3 72.2 78.3 82Rural 67.1 56.1 76.6 34.4 25.5 44.6 54.9 46.5 63.1 87.3 80.3 92.0 68.7 57.2 78.3 46.9 42.1 51.8 198

Division 

Barisal 83.2 68.9 91.7 48.9 35.7 62.2 50.4 37.1 63.6 90.5 76.9 96.4 70.5 55.2 82.2 52.9 46.4 59.4 15Chittagong 66.2 49.0 80.0 43.6 32.7 55.3 53.5 40.7 65.8 83.5 65.5 93.1 71.4 54.3 83.9 52.1 44.5 59.6 58Chaka 59.2 42.5 74.0 47.2 31.9 63.1 49.5 35.9 63.1 89.4 79.9 94.7 75.9 56.8 88.3 55.1 46.5 63.6 97Khulna 82.0 61.8 92.8 51.3 30.6 71.6 57.8 38.1 75.2 82.9 60.1 94.0 74.7 45.4 91.3 55.6 46.8 64.4 25Rajshahi 63.2 35.0 84.5 28.7 20.1 39.1 77.2 64.8 86.2 99.8 98.3 100.0 70.1 40.1 89.1 47.3 41.6 52.9 35Rangpur 98.2 93.4 99.5 62.9 37.5 82.8 89.7 74.7 96.3 100.0 94.8 84.4 98.4 70.6 64.7 76.6 33Sylhet 96.1 91.2 98.4 44.2 28.5 61.3 51.5 32.2 70.4 92.9 73.3 98.4 83.3 53.1 95.6 55.4 48.9 61.8 18

Total 71.4 63.2 78.3 46.3 39.2 53.5 59.4 53.1 65.5 90.5 85.5 93.8 76.5 68.0 83.3 55.3 51.6 58.9 280Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
62

Table A2f. Service readiness Domain C: Medicine and commodities, Bangladesh 2014 SPA 

Injectable 

antibiotic 

Hydrocortisone 

available at 

the facility 

Injectable 

uterotonic 

Skin 

disinfectant 

Magnesium 

sulfate 

IV solution 

with infusion 

set 

Chlorhexidine 

for cord 

cleaning 

Antibiotic eye 

ointment 

Service 

readiness 

Domain C 

summary score 

% LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 75.1 68.6 80.7 56.7 49.5 63.5 72.7 66.2 78.4 54.9 47.8 61.8 51.7 44.7 58.7 82.7 76.8 87.4 50.0 42.9 57.2 28.3 22.2 35.3 59.0 55.0 63.0 73 Health Center 10.1 6.1 16.1 1.7 1.1 2.6 14.4 9.2 21.7 18.1 11.8 26.7 8.6 4.8 15.0 8.5 5.6 12.7 20.0 13.8 28.1 20.3 14.0 28.5 12.7 9.7 15.7 99 Dispensary or 

clinic 24.2 13.3 39.9 11.4 7.7 16.6 26.3 18.2 36.4 15.5 11.4 20.8 14.1 7.8 24.2 28.5 16.1 45.3 30.3 16.8 48.2 24.2 12.1 42.5 21.8 14.2 29.4 108 

Managing 

authority

Public 22.9 16.9 30.3 9.4 7.9 11.1 24.6 19.9 30.0 17.4 13.9 21.6 13.4 9.6 18.5 24.2 17.7 32.2 26.9 19.4 36.0 22.9 15.8 32.0 20.2 16.5 24.0 224 Private or other 70.5 60.4 79.0 61.0 50.1 71.0 72.3 62.2 80.6 63.5 53.0 72.9 55.8 46.0 65.2 80.8 70.9 87.9 51.4 41.2 61.5 27.7 19.6 37.5 60.4 53.6 67.1 56 

Location 

Urban 70.7 63.5 77.0 55.8 48.2 63.3 68.8 61.7 75.2 58.6 51.2 65.7 51.4 44.7 58.0 80.5 73.7 85.9 50.1 42.8 57.4 28.4 22.2 35.5 58.1 53.6 62.5 82 Rural 16.7 10.3 25.7 4.8 3.1 7.4 19.9 14.8 26.2 13.4 9.6 18.4 9.8 5.8 15.9 17.0 10.2 26.8 24.2 16.1 34.8 22.0 14.2 32.4 16.0 11.6 20.3 198 

Division 

Barisal 21.2 15.3 28.5 12.0 7.7 18.1 21.0 13.3 31.6 20.6 14.0 29.2 5.6 3.0 10.3 24.1 17.0 32.8 15.8 10.0 23.9 10.9 5.2 21.4 16.4 12.8 20.0 15 Chittagong 33.1 24.7 42.7 24.9 17.7 33.9 29.7 21.0 40.2 30.4 21.4 41.3 17.3 11.3 25.7 31.7 23.7 41.0 35.4 22.8 50.4 21.1 12.9 32.7 28.0 21.4 34.6 58 Chaka 41.5 29.3 54.8 24.3 20.0 29.2 36.3 30.4 42.8 25.7 20.2 31.9 27.2 21.8 33.3 40.2 28.7 52.9 33.8 20.6 50.2 27.7 15.3 45.0 32.1 25.7 38.5 97 Khulna 20.8 13.8 30.2 16.1 9.3 26.4 33.2 20.0 49.7 37.7 21.0 58.0 17.5 11.3 26.0 33.2 24.5 43.3 24.8 13.3 41.5 8.0 4.0 15.3 23.9 15.7 32.2 25 Rajshahi 28.9 12.3 54.1 11.8 8.0 16.9 30.4 13.2 55.6 15.8 10.5 23.0 24.5 9.0 51.5 33.9 16.0 57.9 16.4 9.2 27.8 23.1 7.5 52.6 23.1 9.1 37.0 35 Rangpur 24.3 17.2 33.1 11.8 7.6 17.8 46.8 37.3 56.7 28.7 18.5 41.6 20.8 12.4 32.8 37.1 18.3 60.8 51.3 27.8 74.3 33.4 21.5 47.8 31.8 25.0 38.6 33 Sylhet 30.6 20.7 42.7 21.3 11.7 35.5 34.0 20.5 50.8 27.9 15.2 45.7 26.4 15.5 41.1 36.9 25.7 49.7 27.1 14.5 44.8 29.0 12.7 53.3 29.1 19.4 38.9 18 

Total 32.5 27.0 38.6 19.8 17.3 22.6 34.2 29.8 39.0 26.7 23.1 30.7 22.0 18.2 26.3 35.6 29.7 42.0 31.8 25.2 39.2 23.9 17.8 31.2 28.3 24.9 31.7 280 Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
63

Table A2g. Service readiness Domain D: Guidelines and staffing, Bangladesh 2014 SPA 

Facility has guidelines, observed: 

At least one provider of delivery or newborn care at facility was trained 

in each the following areas in the last 24 months: 

Supervision 

Service readiness 

Domain D summary 

score

IMPAC 

guidelines CEmOC guidelines 

Guidelines for 

management of 

pre-term labor 

Training in 

neonatal 

resuscitation 

Training in 

early and 

exclusive 

breastfeeding 

Training in 

newborn infection 

management 

Training in 

thermal care 

Training in 

cord care 

Training in 

KMC 

% LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital n/a 22.7 18.0 28.3 27.6 22.2 33.7 28.2 23.1 33.9 26.1 21.1 31.7 15.6 11.5 20.7 17.7 13.7 22.6 23.4 18.7 28.9 20.2 15.7 25.7 89.7 84.1 93.5 30.4 27.0 33.8 73Health Center 21.6 15.7 29.0 20.5 14.0 29.1 22.7 15.6 31.7 15.9 10.3 23.9 10.0 5.0 18.9 11.1 6.8 17.7 18.3 12.3 26.3 12.7 7.8 20.1 92.8 84.9 96.8 25.6 21.8 29.5 99Dispensary 22.4 11.2 39.9 17.6 8.7 32.5 13.5 7.7 22.6 21.7 11.1 38.2 7.2 3.7 13.6 13.1 7.3 22.5 13.0 7.4 21.9 14.5 6.0 31.1 98.2 94.6 99.4 25.5 20.4 30.6 108

Managing 

authority n/a 

Public 23.7 16.9 32.0 21.2 15.3 28.5 21.1 16.7 26.4 21.7 15.4 29.7 9.0 6.1 13.3 13.6 9.9 18.3 17.6 13.6 22.5 16.2 10.7 23.6 95.8 92.2 97.8 27.3 24.5 30.2 224Private or other 16.5 10.3 25.5 21.5 14.6 30.5 18.3 11.6 27.6 17.4 10.9 26.6 15.5 9.4 24.7 13.9 8.1 22.6 17.6 11.1 26.7 12.3 7.0 20.6 87.4 79.9 92.4 24.9 19.4 30.3 56

Location 

Urban n/a 19.9 15.4 25.3 26.2 21.1 32.1 28.7 22.8 35.4 25.7 20.0 32.3 18.4 13.6 24.4 19.7 14.9 25.4 24.0 18.8 30.2 18.4 14.3 23.5 90.2 84.8 93.8 30.6 26.9 34.3 82Rural 23.2 15.8 32.8 19.2 12.8 27.7 17.2 12.4 23.3 18.8 12.0 28.3 7.0 3.9 12.2 11.1 7.2 16.8 14.9 10.6 20.6 14.1 8.3 23.0 95.7 91.7 97.9 25.3 22.0 28.6 198Division Barisal n/a 18.1 10.6 29.3 20.8 12.4 32.6 20.9 12.9 32.3 20.0 12.7 30.0 12.2 7.6 19.1 22.3 14.4 32.9 22.9 14.8 33.5 12.6 7.4 20.5 90.6 76.9 96.5 27.4 22.2 32.7 15Chittagong 21.9 11.5 37.8 16.3 9.4 26.8 24.1 15.8 34.8 26.9 15.4 42.5 12.8 6.9 22.6 14.8 8.5 24.5 18.6 11.2 29.2 16.7 9.7 27.2 96.7 92.0 98.7 29.0 23.1 35.0 58Chaka 16.7 7.5 33.0 20.3 10.1 36.8 12.9 8.5 19.0 16.9 7.7 33.1 8.1 4.0 15.7 8.5 4.8 14.7 14.6 9.6 21.6 15.2 6.4 32.0 93.2 87.7 96.4 23.3 19.0 27.5 97Khulna 20.2 9.0 39.3 12.7 7.0 21.9 48.7 28.0 69.8 34.9 17.2 58.1 21.8 11.2 38.0 35.7 18.2 58.0 45.3 25.9 66.2 36.8 19.3 58.7 90.1 68.5 97.4 41.7 30.0 53.4 25Rajshahi 10.1 5.4 18.1 11.9 6.6 20.6 7.4 2.6 19.2 3.0 1.3 7.0 1.4 0.4 5.4 1.9 0.6 5.3 2.6 0.9 6.8 2.6 0.9 6.8 92.9 78.3 98.0 15.2 12.8 17.7 35Rangpur 56.2 31.2 78.5 42.4 30.4 55.3 17.6 9.3 30.8 20.5 11.2 34.6 9.3 3.4 23.3 8.2 4.1 15.8 11.2 6.0 20.0 10.3 5.3 19.3 95.3 78.4 99.1 28.6 23.3 33.9 33Sylhet 20.5 10.1 36.9 33.8 16.5 56.8 43.5 24.1 65.0 39.5 20.9 61.8 16.8 4.5 46.2 33.1 16.3 55.9 28.9 16.5 45.7 19.4 9.8 34.6 99.5 96.5 99.9 37.7 26.5 48.8 18

Total n/a 22.2 16.6 29.0 21.2 16.2 27.3 20.6 16.7 25.1 20.8 15.5 27.4 10.4 7.6 14.0 13.6 10.4 17.7 17.6 14.0 21.8 15.4 10.8 21.5 94.1 91.2 96.1 26.8 24.3 29.4 280Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
64 

Table A3a. Service availability Domain A: BEmOC signal functions, Haiti 2013 SPA 

Parenteral 

administration of 

antibiotics 

Parenteral 

administration of 

uterotonic 

drugs 

Parenteral 

administration of 

anticonvulsants 

Manual 

removal 

of 

placenta 

Assisted 

vaginal 

delivery 

Removal 

of 

retained 

products 

Service 

availability 

Domain A 

summary 

score 

 % % % % % % Mean N 

Facility type 

Hospital 90.4 98.9 71.3 70.2 94.7 72.3 83.0 94 

Health Center 56.4 74.3 25.7 55.2 80.2 50.9 57.1 167 

Dispensary or clinic 29.7 38.3 7.8 30.5 50.8 27.3 30.7 128 

Managing authority 

Public 53.3 69.7 31.7 55.4 74.3 53.2 56.3 195 

Private 58.2 67.0 29.9 45.9 73.7 43.3 53.0 194 

Location 

Urban 80.2 90.7 52.2 67.6 88.7 66.9 74.4 151 

Rural 40.3 54.2 17.2 39.9 64.7 36.5 42.1 238 

Department 

Ouest 70.6 72.5 35.3 55.9 79.4 53.9 61.3 102 

Sud-Est 40.0 45.7 17.1 34.3 65.7 48.6 41.9 35 

Nord 61.1 66.7 36.1 47.2 80.6 50.0 56.9 36 

Nord-Est 44.4 66.7 25.9 44.4 74.1 44.4 50.0 27 

Artibonite 47.2 62.3 32.1 54.7 64.2 43.4 50.6 53 

Centre 52.2 78.3 34.8 47.8 78.3 56.5 58.0 23 

Sud 75.0 100.0 37.5 58.3 87.5 50.0 68.1 24 

Grand-Anse 42.9 76.2 38.1 66.7 71.4 66.7 60.3 21 

Nord-Ouest 47.1 58.9 23.3 43.3 64.5 33.3 45.1 52 

Nippes 52.9 76.5 23.5 52.9 82.4 41.2 54.9 17 

Total 55.8 68.4 30.8 50.6 74.0 48.3 54.6 389

Note: Confidence intervals are not shown since the Haiti 2013 SPA was a census of all formal health facilities, rather than a 

sample. 

 
65 

Table A3b. Service availability Domain B: Newborn signal functions, Haiti 2013 SPA 

Neonatal 

resuscitation 

Cortisosteroids for 

pre-term labor 

Kangaroo Mother 

Care 

Service availability 

Domain B 

summary score 

 % % % Mean N 

Facility type 

Hospital 66.0 51.1 27.7 48.2 94 

Health Center 45.4 6.7 26.3 26.1 167 

Dispensary or clinic 19.6 0.8 20.3 13.6 128 

Managing authority 

Public 44.0 15.9 24.1 28.0 195 

Private 39.7 14.9 25.3 26.6 194 

Location 

Urban 59.5 30.5 26.4 38.8 151 

Rural 30.7 5.9 23.5 20.0 238 

Department 

Ouest 48.0 23.5 22.5 31.4 102 

Sud-Est 25.7 5.7 20.0 17.1 35 

Nord 38.9 19.4 25.0 27.8 36 

Nord-Est 25.9 7.4 25.9 19.8 27 

Artibonite 39.6 9.4 22.6 23.9 53 

Centre 47.8 26.1 43.5 39.1 23 

Sud 50.0 16.7 20.8 29.2 24 

Grand-Anse 42.9 4.8 23.8 23.8 21 

Nord-Ouest 40.9 13.8 29.2 27.9 52 

Nippes 58.8 11.8 17.6 29.4 17 

Total 41.9 15.4 24.7 27.3 389

Note: Confidence intervals are not shown since the Haiti 2013 SPA was a census of all formal health facilities, rather 

than a sample. 

 
66 

Table A3c. Service availability Domain C: Routine perinatal care, Haiti 2013 SPA 

Partograph 

routinely used to 

monitor labor 

Early initiation of 

breastfeeding 

Thermal 

care 

Service availability 

Domain C 

summary score 

 % % % Mean N 

Facility type 

Hospital 34.0 87.2 100.0 73.8 94 

Health Center 24.5 91.6 92.8 69.7 167 

Dispensary or clinic 1.6 91.4 93.8 62.2 128 

Managing authority 

Public 21.5 92.3 95.4 69.7 195 

Private 17.0 88.7 94.3 66.7 194 

Location 

Urban 32.4 89.4 98.0 73.3 151 

Rural 10.9 91.2 92.9 65.0 238 

Department 

Ouest 22.5 86.3 97.1 68.6 102 

Sud-Est 22.9 85.7 97.1 68.6 35 

Nord 13.9 97.2 94.4 68.5 36 

Nord-Est 11.1 85.2 85.2 60.5 27 

Artibonite 20.8 88.7 88.7 66.0 53 

Centre 26.1 95.7 95.7 72.5 23 

Sud 25.0 100.0 100.0 75.0 24 

Grand-Anse 23.8 90.5 95.2 69.8 21 

Nord-Ouest 5.8 96.1 96.1 66.0 52 

Nippes 29.4 88.2 100.0 72.5 17 

Total 19.2 90.5 94.9 68.2 389

Note: Confidence intervals are not shown since the Haiti 2013 SPA was a census of all formal health facilities, 

rather than a sample. 

 
67 

Table A3d. Service readiness Domain A: General requirements, Haiti 2013 SPA 

Electricity 

Improved 

water 

source 

Improved 

sanitation 

24/7 skilled 

birth 

attendance 

Emergency 

transport 

Service 

readiness 

Domain A 

summary 

score 

 % % % % % Mean N 

Facility type 

Hospital 97.9 77.7 71.3 71.3 58.5 75.3 94 

Health Center 87.4 79.1 55.6 38.3 29.9 58.1 167 

Dispensary or clinic 53.2 67.2 18.7 2.3 13.2 30.9 128 

Managing authority 

Public 73.8 73.3 39.9 34.2 28.6 50.0 195 

Private or other 83.5 76.3 54.6 34.5 34.0 56.6 194 

Location 

Urban 92.7 75.5 62.8 58.8 41.7 66.3 151 

Rural 69.7 74.3 37.3 18.9 24.7 45.0 238 

Department 

Ouest 83.3 72.5 78.4 38.2 41.2 62.7 102 

Sud-Est 68.6 85.7 28.6 22.9 25.7 46.3 35 

Nord 88.9 77.8 36.1 41.7 30.6 55.0 36 

Nord-Est 70.4 66.7 37.0 33.3 14.8 44.4 27 

Artibonite 64.2 64.2 43.4 35.8 43.4 50.2 53 

Centre 87.0 69.6 47.8 47.8 47.8 60.0 23 

Sud 95.8 87.5 45.8 33.3 37.5 60.0 24 

Grand-Anse 90.5 85.7 38.1 52.4 14.3 56.2 21 

Nord-Ouest 74.5 70.6 15.6 17.4 7.8 37.2 52 

Nippes 70.6 94.1 58.8 29.4 35.3 57.6 17 

Total 78.7 74.8 47.2 34.4 31.3 53.3 389

Note: Confidence intervals are not shown since the Haiti 2013 SPA was a census of all formal health facilities, rather than 

a sample. 

 
68

Table A3e. Service readiness Domain B: Equipment, Haiti 2013 SPA 

Sterilization 

equipment 

Delivery 

bed 

Examination 

light 

Delivery 

pack 

Suction 

apparatus 

Manual 

vacuum 

extractor 

Vacuum 

aspirator 

or D and 

C kit Partograph Gloves 

Newborn 

bag and 

mask 

Infant 

scale 

Blood 

pressure 

apparatus, 

dig or 

manual 

Soap or 

hand 

disinfectant 

Service readiness 

Domain B summary 

score 

 % % % % % % % % % % % % % Mean N Facility type 

Hospital 89.4 97.9 52.1 94.7 54.3 28.7 35.1 40.4 92.6 75.5 90.4 92.6 79.8 71.0 94Health Center 55.1 96.4 37.7 83.3 26.9 6.6 22.1 31.1 93.9 35.3 74.8 91.6 69.4 55.7 167Dispensary or clinic 18.8 86.7 23.4 63.3 7.8 0.8 4.7 3.9 87.5 7.8 58.6 94.6 64.0 40.1 128

Managing authority 

Public 46.6 95.4 30.7 75.9 22.0 6.6 17.9 28.6 88.6 30.2 78.4 93.9 64.6 52.3 195Private or other 56.2 91.8 42.3 83.0 32.5 13.4 21.1 20.1 94.3 41.7 68.0 91.8 75.8 56.3 194

Location 

Urban 70.8 98.7 45.0 90.1 40.3 16.5 31.7 39.0 90.7 56.2 86.0 92.1 70.2 63.6 151Rural 39.0 90.3 31.1 72.7 18.9 5.9 11.7 15.1 92.0 23.1 65.1 93.3 70.1 48.3 238

Departement 

Ouest 56.9 93.1 47.1 80.4 45.1 16.7 29.4 23.5 93.1 50.0 72.5 93.1 79.4 60.0 102Sud-Est 45.7 88.6 28.6 82.9 11.4 2.9 20.0 25.7 94.3 25.7 74.3 94.3 71.4 51.2 35Nord 50.0 91.7 27.8 86.1 25.0 13.9 25.0 19.4 88.9 38.9 91.7 91.7 63.9 54.9 36Nord-Est 63.0 92.6 37.0 77.8 14.8 11.1 14.8 25.9 96.3 18.5 66.7 81.5 66.7 51.3 27Artibonite 37.7 92.5 26.4 64.2 24.5 5.7 13.2 26.4 92.5 28.3 62.3 92.5 64.2 48.5 53Centre 78.3 100.0 39.1 95.7 13.0 13.0 4.3 34.8 91.3 47.8 91.3 100.0 78.3 60.5 23Sud 62.5 100.0 50.0 91.7 45.8 4.2 25.0 29.2 87.5 58.3 79.2 91.7 70.8 61.2 24Grand-Anse 28.6 90.5 42.9 85.7 33.3 14.3 14.3 42.9 100.0 28.6 76.2 81.0 52.4 53.1 21Nord-Ouest 44.9 94.1 23.4 70.6 11.6 5.8 11.6 7.8 82.2 13.5 66.6 98.1 64.6 45.8 52Nippes 52.9 100.0 47.1 82.4 17.6 0.0 17.6 35.3 94.1 47.1 64.7 100.0 76.5 56.6 17

Total 51.4 93.6 36.5 79.4 27.2 10.0 19.5 24.4 91.5 35.9 73.2 92.8 70.2 54.3 389Note: Confidence intervals are not shown since the Haiti 2013 SPA was a census of all formal health facilities, rather than a sample. 
69

Table A3f. Service readiness Domain C: Medicine and commodities, Haiti 2013 SPA 

Injectable 

antibiotic 

Hydrocortisone 

available at the 

facility 

Injectable 

uterotonic 

Skin 

disinfectant 

Magnesium 

sulfate 

IV solution with 

infusion set 

Chlorhexidine for 

cord cleaning 

Antibiotic eye 

ointment 

Service readiness 

Domain C 

summary score 

 % % % % % % % % Mean N Facility type 

Hospital 47.9 56.4 75.5 75.5 72.3 48.9 44.7 60.6 60.2 94Health Center 34.7 29.9 51.4 64.0 41.9 44.2 47.9 53.3 45.9 167Dispensary or clinic 14.0 10.9 35.2 56.2 13.3 33.6 38.2 35.1 29.6 128

Managing authority

Public 25.0 22.5 50.2 61.4 40.4 40.9 45.6 45.1 41.4 195Private or other 37.1 37.6 53.6 67.0 39.2 42.8 42.3 53.1 46.6 194

Location 

Urban 44.3 40.3 64.8 71.4 58.8 45.6 45.0 57.6 53.5 151Rural 22.7 23.5 43.7 59.6 27.7 39.5 43.2 43.7 37.9 238

Department 

Ouest 41.2 34.3 52.9 65.7 45.1 41.2 43.1 46.1 46.2 102Sud-Est 20.0 20.0 51.4 51.4 28.6 40.0 51.4 40.0 37.9 35Nord 33.3 36.1 55.6 61.1 36.1 50.0 47.2 63.9 47.9 36Nord-Est 33.3 25.9 51.9 66.7 37.0 51.9 48.1 44.4 44.9 27Artibonite 20.8 26.4 43.4 66.0 35.8 41.5 37.7 60.4 41.5 53Centre 43.5 56.5 56.5 78.3 65.2 52.2 43.5 60.9 57.1 23Sud 37.5 54.2 62.5 75.0 54.2 37.5 66.7 54.2 55.2 24Grand-Anse 28.6 23.8 61.9 66.7 47.6 42.9 47.6 42.9 45.2 21Nord-Ouest 17.5 9.7 46.8 54.6 27.2 31.2 25.5 41.0 31.7 52Nippes 35.3 29.4 47.1 70.6 29.4 41.2 58.8 35.3 43.4 17

Total 31.1 30.0 51.9 64.2 39.8 41.9 43.9 49.1 44.0 389Note: Confidence intervals are not shown since the Haiti 2013 SPA was a census of all formal health facilities, rather than a sample. 
70

Table A3g. Service readiness Domain D: Guidelines and staffing, Haiti 2013 SPA 

Facility has guidelines, observed: 

At least one provider of delivery or newborn care at facility was trained 

in each the following areas in the last 24 months: 

Supervision

Service 

readiness Domain D 

summary 

score 

IMPAC 

guidelines 

CEmOC 

guidelines 

Guidelines for 

management of 

pre-term labor 

Training in 

neonatal 

resuscitation 

Training in 

early and 

exclusive 

breastfeeding 

Training in 

newborn 

infection 

management 

Training in 

thermal 

care 

Training in 

cord care 

Training in 

KMC 

% % % % % % % % % % Mean N 

Facility type 

Hospital 23.4 21.3 20.2 67.0 62.8 51.1 63.8 63.8 54.3 88.3 55.1 94Health Center 22.2 16.7 12.6 34.2 38.3 31.2 34.7 37.7 26.3 90.4 36.8 167Dispensary or clinic 22.6 17.2 7.8 10.9 17.1 13.2 11.7 12.5 5.4 81.2 21.3 128

Managing authority 

Public 24.6 15.9 11.8 30.7 33.7 28.2 33.7 34.2 25.6 89.2 35.1 195Private or other 20.6 20.1 13.9 38.1 40.7 32.0 34.5 37.1 26.8 84.5 37.2 194

Location 

Urban 25.2 17.9 17.2 55.0 52.2 44.4 49.6 50.9 40.3 89.4 47.2 151Rural 21.0 18.1 10.1 21.4 27.7 21.0 24.3 26.0 17.2 85.3 29.1 238

Departement 

Ouest 15.7 15.7 12.7 43.1 51.0 39.2 43.1 46.1 32.4 78.4 40.5 102Sud-Est 31.4 14.3 5.7 20.0 28.6 22.9 31.4 31.4 20.0 94.3 32.7 35Nord 19.4 19.4 16.7 33.3 30.6 25.0 27.8 27.8 25.0 91.7 33.3 36Nord-Est 29.6 18.5 3.7 25.9 37.0 25.9 29.6 33.3 25.9 100.0 36.2 27Artibonite 26.4 17.0 13.2 28.3 34.0 32.1 26.4 30.2 24.5 88.7 34.2 53Centre 21.7 21.7 21.7 43.5 39.1 39.1 47.8 47.8 47.8 95.7 44.9 23Sud 25.0 20.8 12.5 45.8 37.5 29.2 37.5 37.5 33.3 91.7 39.8 24Grand-Anse 19.0 33.3 23.8 38.1 33.3 23.8 38.1 47.6 19.0 81.0 37.0 21Nord-Ouest 25.5 13.7 9.7 21.6 19.4 17.7 17.4 13.6 5.8 80.4 23.9 52Nippes 23.5 23.5 17.6 52.9 52.9 35.3 52.9 52.9 41.2 94.1 47.7 17

Total 22.6 18.0 12.8 34.4 37.2 30.1 34.1 35.7 26.2 86.9 36.1 389Note: Confidence intervals are not shown since the Haiti 2013 SPA was a census of all formal health facilities, rather than a sample. 
71

Table A4a. Service availability Domain A: BEmOC signal functions, Tanzania 2014-15 SPA 

Parenteral 

administration of 

antibiotics 

Parenteral 

administration of 

uterotonic drugs 

Parenteral 

administration of 

anticonvulsants 

Manual removal of 

placenta 

Assisted vaginal 

delivery 

Removal of retained 

products 

Service availability 

Domain A summary 

score 

% LB UB % LB UB % LB UB % LB UB % LB UB Mean LB UB Mean LB UB N 

Facility type 

Hospital 83.9 69.7 92.2 96.9 93.8 98.4 77.5 65.3 86.3 69.7 58.8 78.7 88.9 84.2 92.4 68.6 57.9 77.6 80.9 74.5 87.3 44Health Center 60.0 54.5 65.3 90.9 86.8 93.9 31.6 26.7 37.0 45.3 40.0 50.8 72.9 67.7 77.4 51.4 46.2 56.5 58.7 55.7 61.6 109Dispensary or clinic 27.3 22.8 32.4 81.8 77.3 85.5 7.0 4.6 10.4 30.2 25.5 35.5 68.0 62.9 72.7 31.1 26.8 35.8 40.9 38.5 43.2 751

Managing authority 

Public 32.0 27.8 36.7 83.7 79.4 87.2 10.9 8.6 13.7 32.9 28.4 37.6 69.5 64.7 73.9 34.9 30.7 39.3 44.0 41.8 46.2 756Private or other 44.0 33.9 54.7 83.2 73.2 89.9 25.6 18.5 34.4 39.5 30.0 49.8 70.1 59.1 79.2 37.8 28.4 48.2 50.0 44.2 55.8 149

Location 

Urban 42.7 32.8 53.1 76.7 65.5 85.1 24.5 19.4 30.4 38.1 29.6 47.5 72.9 62.3 81.4 32.7 25.4 41.0 47.9 42.5 53.4 132Rural 32.5 28.1 37.2 84.8 80.7 88.2 11.4 8.9 14.5 33.2 28.7 38.1 69.0 64.3 73.4 35.8 31.7 40.1 44.5 42.2 46.7 773

Province 

Eastern 31.1 20.7 43.9 85.2 72.0 92.8 23.6 14.1 36.8 27.8 16.9 42.1 59.1 45.9 71.1 25.9 15.5 40.0 42.1 34.9 49.4 115Western 43.9 32.1 56.5 82.2 68.0 90.9 25.9 16.6 38.0 38.9 26.7 52.6 81.9 70.3 89.7 39.7 27.1 53.9 52.1 45.1 59.1 85Southern 26.4 15.9 40.5 91.8 78.0 97.2 5.3 3.7 7.5 59.7 44.1 73.5 75.9 60.2 86.8 34.8 22.2 49.9 49.0 41.7 56.3 66Southern Highlands 21.7 13.8 32.4 72.4 59.6 82.4 8.1 5.0 13.0 31.2 21.1 43.6 57.6 44.6 69.7 32.7 22.7 44.5 37.3 31.9 42.7 115SW Highlands 43.8 29.8 58.9 95.0 80.3 98.9 7.3 5.3 9.9 27.7 17.5 40.9 56.2 41.7 69.7 26.6 20.7 33.5 42.8 37.2 48.3 103Central 50.9 38.0 63.6 90.4 78.7 96.0 13.5 8.2 21.5 36.9 25.7 49.7 78.6 67.9 86.5 64.1 51.3 75.1 55.7 51.2 60.2 104Northern 32.5 21.5 45.9 89.6 79.6 95.0 18.8 11.3 29.7 31.9 20.0 46.9 78.3 64.6 87.7 22.4 13.4 35.0 45.6 39.3 51.9 110Lake 28.4 20.8 37.4 73.9 63.8 82.0 7.6 4.5 12.4 31.6 23.5 41.1 74.1 64.3 82.0 37.6 29.9 45.8 42.2 38.4 45.9 199Zanzibar 24.3 12.6 41.7 92.5 72.0 98.3 19.3 10.3 33.4 22.8 13.7 35.4 30.7 19.6 44.7 30.9 19.1 45.8 36.7 28.8 44.7 7

Total 34.0 30.1 38.2 83.6 79.9 86.8 13.3 11.1 16.0 34.0 29.9 38.3 69.6 65.3 73.5 35.4 31.6 39.3 45.0 43.0 47.0 905Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
72 

Table A4b. Service availability Domain B: Newborn signal functions, Tanzania 2014-15 SPA 

Neonatal 

resuscitation 

Cortisosteroids 

for pre-term 

labor 

Kangaroo Mother 

Care 

Service availability 

Domain B summary 

score 

% LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 92.0 87.8 94.9 43.4 35.6 51.5 65.6 55.4 74.6 67.0 61.7 72.3 44 

Health Center 73.0 68.1 77.5 9.2 6.4 13.0 44.9 39.5 50.6 42.4 39.5 45.3 109 

Dispensary or clinic 46.8 41.7 51.9 1.0 0.3 2.8 15.5 12.0 19.8 21.1 18.8 23.4 751 

Managing authority 

Public 50.6 45.9 55.4 2.9 2.0 4.3 19.8 16.3 23.7 24.4 22.3 26.6 756 

Private or other 59.8 48.3 70.2 9.7 7.2 12.9 30.2 22.3 39.6 33.2 27.6 38.9 149 

Location 

Urban 58.1 47.3 68.3 12.6 9.5 16.5 29.5 22.5 37.7 33.4 27.9 38.9 132 

Rural 51.1 46.3 55.9 2.6 1.7 3.9 20.1 16.6 24.1 24.6 22.4 26.8 773 

Province 

Eastern 37.1 25.2 50.8 6.0 4.2 8.5 26.6 17.1 38.9 23.3 17.6 28.9 115 

Western 50.9 36.7 65.0 8.2 3.5 18.0 14.4 8.0 24.6 24.5 17.4 31.6 85 

Southern 58.5 43.1 72.4 0.9 0.3 2.7 29.5 18.0 44.4 29.6 22.7 36.5 66 

Southern Highlands 74.7 61.8 84.3 2.2 1.3 3.8 9.0 5.7 13.9 28.6 24.5 32.8 115 

SW Highlands 61.5 46.1 74.9 2.3 1.4 4.0 34.4 22.5 48.6 32.7 26.1 39.3 103 

Central 59.3 47.2 70.3 3.1 2.1 4.5 20.5 13.3 30.2 27.6 23.0 32.3 104 

Northern 56.6 43.9 68.4 3.8 2.5 5.8 34.7 22.4 49.5 31.7 25.1 38.3 110 

Lake 35.7 27.4 45.0 4.4 2.3 8.4 13.0 9.1 18.2 17.7 13.5 22.0 199 

Zanzibar 37.0 22.8 53.8 11.4 4.6 25.7 11.8 4.7 26.6 20.0 10.8 29.3 7 

Total 52.1 47.8 56.5 4.0 3.1 5.2 21.5 18.4 25.0 25.9 23.9 27.9 905

Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 

 
73 

Table A4c. Service availability Domain C: Routine perinatal care, Tanzania 2014-15 SPA 

Partograph routinely 

used to monitor labor 

Routine early 

initiation of 

breastfeeding 

(w/in first hour) Thermal care 

Service availability 

Domain C summary 

score 

% LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 91.1 86.9 94.0 98.0 95.3 99.2 99.2 96.7 99.8 96.1 94.6 97.6 44 

Health Center 69.6 64.6 74.3 97.8 95.1 99.0 97.9 95.1 99.1 88.4 86.4 90.5 109 

Dispensary or clinic 38.5 33.5 43.8 98.5 96.4 99.4 97.8 95.2 99.0 78.3 76.3 80.3 751 

Managing authority 

Public 43.6 38.8 48.6 98.3 96.3 99.2 97.6 95.1 98.8 79.8 77.9 81.7 756 

Private or other 51.1 40.6 61.5 98.9 96.9 99.6 99.4 97.2 99.9 83.1 79.5 86.7 149 

Location 

Urban 56.8 45.0 67.9 96.2 87.9 98.8 95.2 85.5 98.5 82.7 77.1 88.3 132 

Rural 42.8 38.1 47.7 98.8 97.1 99.5 98.4 96.0 99.3 80.0 78.2 81.7 773 

Province 

Eastern 50.8 36.8 64.7 96.5 85.3 99.2 94.0 81.6 98.2 80.4 73.8 87.1 115 

Western 32.9 21.5 46.7 99.7 97.7 100.0 97.6 84.4 99.7 76.7 72.5 80.9 85 

Southern 60.6 44.7 74.5 100.0 100.0 86.9 81.7 92.0 66 

Southern Highlands 39.9 29.1 51.8 100.0 95.8 85.9 98.8 78.6 73.9 83.2 115 

SW Highlands 37.5 24.6 52.5 100.0 96.4 77.6 99.5 78.0 72.3 83.6 103 

Central 35.9 24.7 48.9 92.8 81.2 97.5 99.7 98.2 100.0 76.1 71.4 80.9 104 

Northern 73.8 60.8 83.7 99.6 97.3 99.9 99.6 97.4 99.9 91.0 87.2 94.9 110 

Lake 36.5 28.0 46.1 99.3 95.9 99.9 99.7 98.8 99.9 78.5 75.4 81.6 199 

Zanzibar 48.6 35.5 62.0 86.0 70.1 94.1 96.6 78.6 99.5 77.1 69.3 84.8 7 

Total 44.8 40.5 49.2 98.4 96.8 99.2 97.9 95.8 99.0 80.4 78.7 82.0 905

Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
74

Table A4d. Service readiness Domain A: General requirements, Tanzania 2014-15 SPA 

Electricity Improved water source Improved sanitation 

24/7 skilled birth 

attendance Emergency transport 

Service readiness Domain A 

summary score 

% LB UB % LB UB % LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 90.5 71.5 97.3 86.7 71.1 94.5 74.7 63.2 83.6 97.7 94.9 99 93.4 89.4 96 88.6 82.4 94.8 44Health Center 76.1 71 80.5 82.3 77.7 86.1 49.3 43.9 54.8 82.7 78.4 86.2 75.4 70.4 79.9 73.2 70.7 75.6 109Dispensary or clinic 63.4 58.1 68.5 57.9 52.6 63 27.8 23.5 32.6 16.3 12.7 20.7 57.7 52.4 62.9 44.6 42.1 47.2 751

Managing authority 

Public 62.8 57.8 67.6 57.9 53 62.6 26.6 22.7 30.7 24.7 21.2 28.4 59.4 54.5 64 46.3 44.0 48.5 756Private or other 83.7 73.1 90.7 84.5 73.9 91.3 63.7 52.9 73.3 46.7 36.4 57.2 73.1 62 81.8 70.3 65.7 74.9 149

Location 

Urban 66.2 54.9 75.9 73.3 60.8 82.9 68.3 57.6 77.3 49 39.4 58.7 57.7 45.8 68.8 62.9 56.5 69.3 132Rural 66.3 61.3 70.9 60.4 55.5 65 26.6 22.6 31 24.7 21.2 28.7 62.3 57.4 66.9 48.0 45.7 50.4 773

Province 

Eastern 57.1 42.6 70.4 66 50.5 78.7 46.3 35.2 57.7 27.8 18.9 39 48.9 34.8 63.2 49.2 41.9 56.6 115Western 88.1 76.2 94.5 74.3 59.5 85.1 25.9 16.6 38.1 20.3 12.8 30.6 58.2 43.3 71.7 53.4 48.2 58.5 85Southern 68.9 52.7 81.4 61.6 47.2 74.2 32 19.7 47.4 18.2 10.7 29 36.5 23.7 51.5 43.4 36.9 49.9 66Southern Highlands 64.3 51.1 75.6 66 53.2 76.8 26.1 17.3 37.4 18.8 13.4 25.7 42.9 32.6 53.9 43.6 38.2 49.1 115SW Highlands 56.3 40.9 70.5 41.9 28.7 56.5 19.9 11 33.3 28.5 18.6 41.1 68.5 52.5 81.1 43.0 34.9 51.2 103Central 66.9 53 78.3 66.5 52.6 78 18.8 11.4 29.3 24.2 16.8 33.4 78.2 65.1 87.3 50.9 45.7 56.1 104Northern 54.6 39.9 68.6 69.9 55 81.6 28.6 19.3 40.3 33.4 23.9 44.3 67.5 52.1 79.8 50.8 43.8 57.8 110Lake 73 64.2 80.3 56.1 47.6 64.3 45.6 36.1 55.4 40.2 31.7 49.3 74.6 64.7 82.5 57.9 53.7 62.1 199Zanzibar 87.1 70.7 95.0 88.2 73.5 95.3 92.8 79.5 97.7 22.8 12.9 37.0 44.9 32.7 57.8 67.2 62.2 72.1 7

Total 66.3 61.7 70.5 62.2 57.8 66.5 32.7 28.9 36.6 28.3 25 31.8 61.6 57.1 65.9 50.2 48.1 52.4 905Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
75

Table A4e. Service readiness Dimension B: Equipment, Tanzania 2014-15 SPA

Sterilization 

equipment Delivery Bed Examination light Delivery Pack Suction apparatus 

Manual vacuum 

extractor 

Vacuum aspirator or 

D and C kit Partograph 

 % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB 

Facility type 

Hospital 88.5 71.6 95.9 100.0 53.6 44.9 62.2 98.1 95.4 99.2 51.9 43.4 60.2 51.9 43.4 60.2 39.8 32.6 47.4 96.4 93.2 98.1Health Center 47.9 42.8 53.1 100.0 28.0 23.4 33.1 89.6 86.1 92.3 11.6 8.4 15.7 11.6 8.4 15.7 24.4 20.3 29.1 79.7 75.0 83.6Dispensary or clinic 12.8 9.9 16.5 98.0 95.8 99.1 10.0 7.2 13.8 85.9 81.6 89.3 1.7 0.6 4.3 1.7 0.6 4.3 3.1 1.8 5.5 52.0 46.8 57.2

Managing authority 

Public 14.4 11.9 17.3 98.0 95.9 99.1 9.2 6.9 12.1 85.2 81.1 88.6 3.8 2.6 5.6 3.8 2.6 5.6 6.0 4.6 7.9 57.0 52.1 61.8Private or other 53.1 42.2 63.8 100.0 40.6 30.7 51.3 95.6 85.5 98.8 12.8 8.7 18.6 12.8 8.7 18.6 14.8 9.8 21.6 60.0 48.7 70.3

Location 

Urban 60.8 49.8 70.8 100.0 38.3 28.3 49.3 94.3 85.9 97.9 17.5 12.7 23.7 17.5 12.7 23.7 16.7 11.8 22.9 68.4 56.0 78.7Rural 13.9 11.2 17.1 98.1 95.9 99.1 10.2 7.8 13.4 85.7 81.6 88.9 3.2 2.0 5.0 3.2 2.0 5.0 5.9 4.4 7.8 55.6 50.8 60.4

Province 

Eastern 37.3 29.3 46.2 100.0 26.7 17.3 38.8 88.3 74.9 95.1 9.0 4.8 16.3 9.0 4.8 16.3 9.1 5.7 14.2 59.8 44.8 73.2Western 30.0 20.3 42.0 100.0 7.4 2.9 17.5 88.1 76.1 94.5 4.1 2.7 6.2 4.1 2.7 6.2 12.4 6.3 22.8 60.8 47.9 72.3Southern 11.2 5.6 21.4 89.2 74.5 95.9 10.9 4.7 23.5 85.2 70.4 93.3 2.0 1.2 3.3 2.0 1.2 3.3 2.2 1.2 4.1 77.0 61.1 87.6Southern 

Highlands 13.4 8.1 21.4 98.0 87.0 99.7 6.1 3.1 11.9 92.3 81.4 97.0 1.9 1.2 2.9 1.9 1.2 2.9 5.4 2.6 10.8 62.4 51.4 72.3 

SW Highlands 10.9 5.4 20.8 96.0 78.8 99.3 26.1 16.1 39.5 95.3 80.0 99.0 1.9 1.1 3.3 1.9 1.1 3.3 0.8 0.3 1.9 51.6 37.2 65.8Central 6.8 5.3 8.8 100.0 6.5 3.4 12.2 89.5 78.1 95.3 3.9 2.7 5.7 3.9 2.7 5.7 3.9 2.6 5.8 44.3 32.5 56.6Northern 37.3 25.9 50.2 100.0 21.4 13.8 31.6 86.5 71.2 94.3 7.3 3.5 14.9 7.3 3.5 14.9 9.9 5.2 17.9 74.3 60.0 84.7Lake 16.3 11.0 23.4 99.4 95.5 99.9 9.3 5.0 16.7 78.9 69.4 86.1 7.7 4.2 13.9 7.7 4.2 13.9 10.7 7.2 15.7 46.1 37.1 55.4Zanzibar 60.6 39.5 78.3 100.0 34.3 21.1 50.5 53.6 40.5 66.2 13.7 7.1 24.8 13.7 7.1 24.8 24.8 13.5 41.1 60.8 49.4 71.2

Total 20.7 18.0 23.7 98.4 96.5 99.2 14.3 11.8 17.3 86.9 83.4 89.8 5.3 4.0 6.9 5.3 4.0 6.9 7.5 6.0 9.2 57.5 53.1 61.8

Gloves 

Newborn bag and 

mask 

Infant 

scale 

Blood pressure 

apparatus, dig or 

manual 

Soap or hand 

disinfectant 

Service readiness 

Domain B summary 

score 

% LB UB % LB UB % LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 99.6 97.3 99.9 97.2 94.2 98.7 92.9 69.3 98.7 95.7 92.3 97.6 94.2 90.3 96.5 83.6 79.7 87.5 44Health Center 88.9 85.3 91.7 84.5 80.4 87.8 95.3 92.3 97.2 70.7 65.6 75.4 79.4 74.7 83.5 65.1 63.4 66.8 109Dispensary or clinic 85.1 81.0 88.4 73.7 69.5 77.6 76.5 71.7 80.7 66.5 61.4 71.2 64.0 58.8 68.8 49.7 48.2 51.1 751

Managing authority

Public 84.8 80.9 88.0 75.4 71.5 78.9 79.0 74.4 82.9 68.3 63.5 72.7 63.8 58.9 68.5 51.1 49.7 52.4 756Private or other 93.5 85.8 97.1 80.0 68.6 88.0 82.4 71.7 89.7 69.0 57.6 78.6 85.2 75.2 91.6 63.9 60.0 67.8 149

Location 

Urban 92.1 83.2 96.5 86.0 76.7 91.9 86.3 75.0 92.9 81.0 71.2 88.1 81.9 71.8 88.9 66.9 62.9 70.9 132Rural 85.2 81.4 88.4 74.5 70.4 78.2 78.4 73.9 82.3 66.3 61.5 70.7 64.8 60.0 69.4 50.8 49.5 52.1 773

Division 

Eastern 86.5 73.5 93.7 89.2 77.0 95.3 90.3 76.9 96.3 68.9 55.5 79.7 81.4 67.6 90.1 59.2 55.3 63.0 115Western 73.8 59.0 84.6 76.8 62.6 86.8 82.3 69.4 90.5 52.8 39.9 65.4 47.2 33.4 61.4 50.9 46.9 54.8 85Southern 80.1 66.3 89.2 83.4 70.1 91.5 84.1 68.7 92.8 60.5 44.8 74.2 57.5 41.9 71.7 51.2 47.4 55.1 66Southern Highlands 92.8 82.2 97.3 94.2 83.6 98.1 74.2 61.4 83.9 78.4 65.7 87.3 87.8 76.3 94.1 56.1 53.3 58.9 115SW Highlands 83.1 75.5 88.8 76.5 63.4 85.9 80.7 66.7 89.8 91.4 79.4 96.7 76.1 60.7 86.8 55.0 51.7 58.2 103Central 95.1 84.6 98.5 85.4 73.7 92.4 71.7 57.9 82.3 69.4 55.6 80.4 51.0 38.4 63.4 49.7 46.8 52.5 104Northern 87.9 74.5 94.8 96.0 84.2 99.1 79.7 66.7 88.5 77.5 63.6 87.2 78.5 64.3 88.1 60.2 56.5 63.9 110Lake 85.3 76.8 91.1 40.8 31.7 50.5 77.0 67.4 84.4 53.9 43.9 63.6 56.4 46.2 66.2 46.4 43.3 49.5 199Zanzibar 96.6 78.6 99.5 47.0 33.9 60.6 83.2 57.3 94.8 76.9 60.5 87.9 86.3 71.3 94.1 59.7 54.4 65.0 7

Total 86.2 82.9 89.0 76.2 72.6 79.4 79.6 75.5 83.1 68.4 64.2 72.4 67.3 63.0 71.4 53.2 51.9 54.4 905Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
76

Table A4f. Service readiness Domain C: Medicines and commodities, Tanzania 2014-15 SPA 

Injectable 

antibiotic 

Hydrocortisone 

available at the 

facility 

Injectable 

uterotonic Skin disinfectant 

Magnesium 

sulfate 

IV solution with 

infusion set 

Chlorhexidine for 

cord cleaning 

Antibiotic eye 

ointment 

Service readiness Domain 

C summary score 

% LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 52.7 43.9 61.3 84.0 69.8 92.2 97.2 94.2 98.7 81.2 67.8 89.8 87.3 71.3 95.0 85.8 70.7 93.8 18.3 13.7 23.9 45.7 37.8 53.8 69.0 61.7 76.3 44Health Center 36.0 30.8 41.5 52.3 46.9 57.7 88.1 84.3 91.1 71.6 66.5 76.2 66.8 61.3 71.8 69.0 63.7 73.8 13.8 10.2 18.4 33.5 28.5 39.0 53.9 51.5 56.3 109Dispensary or clinic 30.4 25.6 35.6 25.5 21.1 30.4 76.4 71.4 80.7 58.4 52.9 63.6 34.3 29.4 39.4 42.9 37.5 48.5 11.3 8.4 15.1 26.2 21.9 31.1 38.2 36.0 40.3 751

Managing authority 

Public 32.4 27.8 37.3 23.5 19.9 27.5 78.8 74.2 82.8 59.2 54.0 64.1 39.4 34.9 44.1 44.5 39.5 49.7 11.5 8.7 15.0 24.3 20.3 28.7 39.2 37.2 41.2 756Private or other 30.8 22.5 40.5 72.4 60.4 81.8 78.9 67.4 87.1 70.9 60.2 79.7 47.6 37.2 58.2 66.7 54.7 76.8 14.3 8.5 23.0 47.3 36.7 58.2 53.6 48.0 59.2 149

Location 

Urban 36.1 26.9 46.4 54.3 42.8 65.3 84.7 73.5 91.7 66.8 54.9 76.9 59.4 47.5 70.3 60.5 49.4 70.7 13.8 8.5 21.6 40.9 30.6 52.0 52.1 46.7 57.4 132Rural 31.4 27.0 36.3 27.7 23.6 32.1 77.8 73.2 81.8 60.1 55.1 65.0 37.6 33.1 42.3 46.0 41.0 51.1 11.6 8.8 15.2 25.9 21.8 30.4 39.8 37.7 41.8 773

Province 

Eastern 26.7 15.9 41.2 52.8 39.7 65.4 73.0 59.3 83.4 60.4 45.3 73.7 49.2 35.7 62.9 46.1 32.6 60.3 9.8 4.8 18.7 30.4 19.2 44.5 43.5 37.5 49.6 115Western 42.3 29.1 56.7 26.4 16.1 40.0 71.5 56.6 82.8 63.4 48.7 76.0 41.3 29.5 54.2 41.6 28.5 55.9 6.7 2.5 16.6 9.7 4.2 21.0 37.9 32.6 43.1 85Southern 35.8 22.7 51.5 16.1 9.0 27.3 74.4 58.5 85.7 72.3 56.9 83.8 51.2 36.1 66.0 29.6 18.1 44.5 9.2 3.3 22.7 10.0 3.9 23.1 37.3 30.9 43.8 66Southern Highlands 22.1 13.7 33.5 27.3 18.2 38.8 85.0 73.2 92.1 42.6 31.3 54.7 36.3 25.5 48.8 50.0 37.5 62.5 11.0 5.5 20.9 47.5 36.3 58.9 40.2 35.3 45.1 115SW Highlands 50.0 36.6 63.4 24.6 15.2 37.4 87.5 72.1 95.0 64.9 49.2 77.9 57.2 42.2 71.0 62.7 46.9 76.2 25.4 13.9 41.7 46.2 33.4 59.5 52.3 47.0 57.6 103Central 35.1 24.2 47.8 38.2 27.5 50.1 81.8 69.2 90.0 55.9 44.4 66.8 21.6 13.9 31.8 47.8 35.3 60.5 5.0 1.7 14.0 29.1 18.7 42.2 39.3 34.5 44.1 104Northern 35.6 23.0 50.6 45.1 31.2 59.8 87.8 74.3 94.7 70.5 55.5 82.0 42.3 29.9 55.8 55.5 40.8 69.4 19.7 11.8 31.0 34.5 22.2 49.3 48.9 42.1 55.6 110Lake 23.0 15.7 32.4 21.9 15.3 30.3 71.7 61.3 80.1 62.9 52.6 72.2 34.2 26.6 42.8 44.4 35.1 54.0 9.4 5.6 15.5 16.6 10.6 24.9 35.5 31.9 39.1 199Zanzibar 22.8 12.9 36.9 28.0 15.8 44.7 92.5 73.7 98.2 64.9 41.6 82.7 71.8 53.7 84.9 85.8 67.0 94.7 8.0 2.4 23.6 6.8 2.2 19.3 47.6 41.4 53.8 7

Total 32.1 28.0 36.5 31.5 27.7 35.6 78.8 74.7 82.4 61.1 56.5 65.5 40.8 36.6 45.0 48.2 43.6 52.8 12.0 9.4 15.0 28.0 24.3 32.1 41.6 39.7 43.4 905Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
77

Table A4g. Service readiness Domain D: Guidelines and staffing, Tanzania 2014-15 SPA 

Facility has guidelines, observed: 

At least one provider of delivery or newborn care at facility was trained 

in each the following areas in the last 24 months: 

Supervision

IMPAC 

guidelines 

CEmOC 

guidelines 

Guidelines for 

management of 

pre-term labor 

Training in 

neonatal 

resuscitation 

Training in early 

and exclusive breastfeeding 

Training in 

newborn infection 

management 

Training in 

thermal care 

Training in cord 

care Training in KMC 

% LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB 

Facility type 

Hospital 41.1 33.8 48.8 17.9 13.3 23.6 25.4 19.8 32.0 79.0 73.1 83.9 65.7 58.6 72.3 59.6 51.7 67.0 65.7 58.5 72.2 65.4 58.1 72.0 61.4 53.8 68.5 66.8 56.6 75.6Health Center 48.5 43.2 53.7 20.0 16.0 24.6 14.9 11.3 19.4 70.5 66.1 74.6 62.5 57.3 67.4 52.9 47.6 58.1 62.5 57.6 67.2 64.4 59.5 68.9 57.7 52.5 62.6 76.9 71.9 81.2Dispensary or clinic 24.5 20.4 29.2 6.8 4.6 9.9 10.3 7.5 13.8 47.9 43.3 52.6 45.7 40.7 50.7 34.2 29.5 39.3 42.3 37.8 47.0 42.9 38.4 47.6 36.7 31.9 41.7 77.0 72.2 81.2

Managing authority 

Public 28.2 24.3 32.5 9.1 6.8 12.0 11.3 8.6 14.5 52.0 47.7 56.1 49.2 44.6 53.8 38.8 34.3 43.5 46.7 42.4 51.0 47.4 43.1 51.7 40.1 35.7 44.7 78.3 73.8 82.2Private or other 28.2 19.3 39.2 7.9 4.5 13.3 13.0 7.8 21.0 53.2 42.4 63.7 46.2 35.7 57.1 32.1 23.3 42.4 41.9 32.0 52.5 42.4 32.5 53.0 42.0 31.9 52.9 67.3 56.6 76.5

Location 

Urban 30.5 21.9 40.9 9.9 5.9 16.1 16.0 10.1 24.4 59.3 47.7 69.9 50.2 39.1 61.3 39.2 29.3 50.2 47.9 37.9 58.0 47.8 37.8 58.0 38.7 29.6 48.7 71.2 60.3 80.1Rural 27.8 23.9 32.2 8.7 6.5 11.5 10.8 8.2 14.1 50.9 46.5 55.3 48.4 43.7 53.1 37.4 32.9 42.2 45.5 41.1 50.1 46.4 41.9 50.9 40.7 36.1 45.5 77.4 73.0 81.3

Province 

Eastern 40.2 27.9 53.9 22.8 14.2 34.5 18.4 10.5 30.1 64.9 50.2 77.2 50.5 36.7 64.2 35.2 23.0 49.8 41.8 30.3 54.2 42.0 30.5 54.5 40.2 28.4 53.2 62.0 48.8 73.6Western 41.5 28.8 55.5 14.7 7.4 26.9 8.1 3.0 20.1 79.5 66.8 88.2 74.6 60.5 85.0 66.1 52.7 77.4 76.9 64.3 86.0 76.9 64.3 86.0 59.7 46.6 71.6 81.0 67.0 89.9Southern 32.4 21.0 46.5 4.0 1.0 14.9 13.7 6.3 27.3 46.8 34.5 59.4 35.4 23.1 49.9 31.3 19.9 45.4 43.6 31.2 57.0 43.6 31.2 57.0 34.3 22.7 48.1 82.1 67.1 91.1Southern Highlands 27.3 18.2 38.9 9.4 4.5 18.8 30.8 20.8 43.0 74.6 62.6 83.8 67.6 54.8 78.3 43.6 32.3 55.7 59.8 46.8 71.5 63.7 50.6 75.0 55.7 43.8 66.9 65.9 53.4 76.6SW Highlands 21.8 15.8 29.2 1.5 0.5 4.1 4.9 2.0 11.7 36.2 23.5 51.2 43.6 29.4 59.0 34.7 21.8 50.4 31.3 19.8 45.7 29.8 18.5 44.3 36.9 23.6 52.5 85.9 70.1 94.1Central 16.1 9.2 26.6 7.4 2.7 18.7 8.4 3.4 19.2 43.7 34.7 53.1 43.3 34.3 52.8 34.7 26.3 44.2 41.2 33.4 49.5 43.5 34.5 52.9 38.7 30.5 47.7 77.9 66.1 86.5Northern 36.8 24.6 50.9 5.9 3.9 8.9 7.8 2.9 19.6 78.1 62.7 88.4 69.9 55.0 81.5 51.7 38.0 65.2 76.2 61.0 86.7 79.1 64.3 88.9 55.2 40.5 69.0 75.8 62.6 85.4Lake 19.7 13.4 27.9 6.0 3.0 11.6 4.6 2.3 9.1 19.9 13.8 27.8 23.6 16.7 32.2 20.7 14.1 29.3 20.8 14.4 29.2 19.5 13.3 27.7 19.7 13.2 28.3 81.5 72.9 87.8Zanzibar 31.3 19.7 45.8 8.0 2.4 23.6 6.8 2.2 19.1 65.8 49.8 78.8 56.7 41.4 70.8 45.3 31.1 60.3 52.1 35.8 68.0 54.4 38.0 69.9 51.0 35.8 66.0 89.8 75.0 96.2

Total 28.2 24.7 32.1 8.9 6.9 11.4 11.6 9.2 14.5 52.2 48.2 56.1 48.7 44.5 52.9 37.7 33.6 41.9 45.9 42.0 49.8 46.6 42.7 50.5 40.4 36.4 44.6 76.5 72.5 80.1

Service readiness Domain D 

summary score 

Mean LB UB N

Facility type 

Hospital 58.1 54.4 61.7 44Health Center 57.3 54.1 60.5 109Dispensary or clinic 39.8 36.9 42.6 751

Managing authority 

Public 43.3 40.7 45.9 756Private or other 40.1 33.5 46.7 149

Location 

Urban 43.9 37.2 50.5 132Rural 42.6 39.9 45.3 773

Province 

Eastern 44.4 37.2 51.6 115Western 63.4 55.2 71.7 85Southern 39.3 31.6 46.9 66Southern Highlands 52.0 45.3 58.6 115SW Highlands 35.8 26.8 44.7 103Central 38.5 32.6 44.4 104Northern 58.7 51.7 65.8 110Lake 25.7 21.0 30.4 199Zanzibar 50.5 40.7 60.3 7

Total 42.8 40.4 45.2 905

Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval.
78

Table A5a. Service availability Domain A: BEmOC signal functions, Malawi 2013-14 SPA 

Parenteral administration of 

antibiotics 

Parenteral administration of 

uterotonic drugs 

Parenteral administration of 

anticonvulsants 

Manual removal of 

placenta 

Assisted vaginal 

delivery 

Removal of retained 

products 

Service availability 

Domain A summary 

score 

% % % % % % % N 

Facility type 

Hospital 97.9 99.0 79.6 65.2 81.6 67.4 81.8 95Health Center 78.1 98.1 43.8 39.0 45.2 33.4 56.3 414Dispensary or clinic 77.7 89.0 22.5 22.3 33.6 16.5 43.6 19

Managing authority 

Public 79.7 97.8 49.3 44.0 52.2 42.0 60.8 347Private or other 85.4 98.3 49.6 41.5 49.7 32.9 59.6 181

Location 

Urban 92.4 97.4 68.6 44.7 71.0 56.0 71.7 78Rural 79.8 98.0 46.1 42.9 47.9 35.9 58.4 450

Region 

north 75.6 98.1 46.4 35.8 57.1 42.4 59.2 102central 85.3 97.1 50.4 46.0 53.8 39.6 62.0 198south 81.2 98.7 50.0 43.9 46.6 36.7 59.5 227

Total 81.6 98.0 49.4 43.1 51.3 38.9 60.4 528Note: Confidence intervals are not shown since the Malawi 2013-14 SPA was a census of all formal health facilities, rather than a sample. 
79 

Table A5b. Service availability Domain B: Newborn signal functions, Malawi 2013-14 SPA 

Neonatal 

resuscitation 

Cortisosteroids for 

pre-term labor 

Kangaroo Mother 

Care 

Service availability 

Domain B summary 

score 

 % % % Mean N 

Facility type 

Hospital 92.8 55.2 84.6 77.5 95 

Health Center 87.8 13.2 50.3 50.4 414 

Dispensary or clinic 66.4 27.6 44.5 46.2 19 

Managing authority 

Public 89.6 19.0 55.2 54.6 347 

Private or other 84.7 25.5 58.3 56.1 181 

Location 

Urban 89.8 51.2 59.7 66.9 78 

Rural 87.6 16.0 55.7 53.1 450 

Region 

north 93.2 18.3 56.0 55.8 102 

central 90.7 21.1 51.4 54.4 198 

south 83.2 22.7 60.6 55.5 227 

Total 87.9 21.2 56.3 55.1 528

Note: Confidence intervals are not shown since the Malawi 2013-14 SPA was a census of all formal health facilities, rather 

than a sample. 

Table A5c. Service availability Domain D: Routine perinatal care, Malawi 2013-14 SPA

Partograph 

routinely used to 

monitor labor 

Early initiation of 

breastfeeding Thermal care 

Service availability 

Domain D 

summary score 

 % % % Mean N 

Facility type 

Hospital 98.0 98.9 100.0 99.0 95 

Health Center 92.9 98.8 99.8 97.2 414 

Dispensary or clinic 83.0 100.0 100.0 94.3 19 

Managing authority 

Public 92.7 98.9 99.7 97.1 347 

Private or other 95.0 98.9 100.0 98.0 181 

Location 

Urban 98.7 98.7 100.0 99.1 78 

Rural 92.6 98.9 99.8 97.1 450 

Region 

north 97.1 100.0 100.0 99.0 102 

central 91.2 98.5 99.5 96.4 198 

south 93.9 98.7 100.0 97.5 227 

Total 93.5 98.9 99.8 97.4 528

Note: Confidence intervals are not shown since the Malawi 2013-14 SPA was a census of all formal health facilities, rather 

than a sample. 

 
80 

Table A5d. Service readiness Domain A: General requirements, Malawi 2013-14 SPA 

Electricity 

Improved 

water 

source 

Improved 

sanitation 

24/7 skilled 

birth 

attendance 

Emergency 

transport 

Service 

readiness 

Domain A 

summary 

score 

 % % % % % % N 

Facility type 

Hospital 79.6 98.0 56.2 86.7 95.9 83.3 95 

Health Center 65.2 94.1 16.9 47.2 87.8 62.2 414 

Dispensary or clinic 66.7 100.0 44.5 33.1 94.5 67.7 19 

Managing authority 

Public 67.4 92.6 18.5 49.8 89.3 63.5 347 

Private or other 68.7 99.5 37.3 61.4 89.8 71.3 181 

Location 

Urban 72.3 96.3 57.5 83.4 92.5 80.4 78 

Rural 67.1 94.8 19.3 48.6 88.9 63.7 450 

Region 

North 69.9 88.3 24.1 36.6 89.3 61.6 102 

Central 76.4 95.6 28.9 53.3 88.7 68.6 198 

South 59.5 97.4 21.9 61.9 90.2 66.2 227 

Total 67.9 95.0 24.9 53.8 89.5 66.2 528

Note: Confidence intervals are not shown since the Malawi 2013-14 SPA was a census of all formal health facilities, rather 

than a sample. 
81

Table A5e. Service readiness Domain B: Equipment, Malawi 2013-14 SPA 

Sterilization 

equipment 

Delivery 

bed 

Examination light Delivery pack Suction apparatus 

Manual 

vacuum 

extractor 

Vacuum 

aspirator 

or D and C 

kit 

Partograph Gloves 

Newborn 

bag and 

mask 

Infant 

scale 

Blood 

pressure 

apparatus 

Soap or 

hand 

disinfectant 

Service 

readiness Domain B 

summary 

score 

% % % % % % % % % % % % % Mean N 

Facility type 

Hospital 76.5 99.0 62.4 97.0 87.8 81.6 55.1 94.9 100.0 95.9 97.0 91.9 87.8 86.7 95Health Center 19.7 98.3 23.3 91.3 57.9 32.2 17.4 86.8 97.0 89.0 94.6 71.3 72.7 65.5 414Dispensary or clinic 44.2 100.0 60.6 88.7 50.1 22.0 16.5 83.2 94.3 66.2 100.0 89.2 66.9 67.8 19

Managing authority 

Public 24.0 98.0 26.1 89.3 62.0 42.0 25.7 86.8 98.0 91.9 95.8 69.4 70.5 67.7 347Private or other 43.7 99.5 42.3 97.8 64.8 38.2 21.0 90.7 96.2 84.7 94.1 87.6 84.2 72.7 181

Location 

Urban 63.6 100.0 51.3 97.5 87.3 59.8 44.9 94.9 100.0 86.0 90.1 91.3 84.8 80.9 78Rural 25.1 98.3 28.3 91.3 58.8 37.4 20.5 86.9 97.0 90.0 96.1 72.9 73.5 67.4 450

Region 

North 20.1 98.0 42.5 86.4 64.9 34.7 18.2 86.3 100.0 93.2 95.1 76.6 76.6 68.7 102Central 33.7 99.0 26.5 90.7 65.2 44.5 24.9 87.2 96.6 91.6 94.6 73.5 76.0 69.5 198South 33.0 98.3 31.3 96.1 60.2 40.1 26.0 89.7 97.0 85.8 95.8 77.0 74.0 69.6 227

Total 30.8 98.5 31.7 92.2 63.0 40.7 24.1 88.1 97.4 89.4 95.2 75.6 75.2 69.4 528Note: Confidence intervals are not shown since the Malawi 2013-14 SPA was a census of all formal health facilities, rather than a sample. 
82

Table A5f. Service readiness Domain C: Medicine and commodities, Malawi 2013-14 SPA 

Injectable 

antibiotic 

Hydrocortisone 

available at the 

facility 

Injectable 

uterotonic Skin disinfectant 

Magnesium 

sulfate 

IV solution with 

infusion set 

Chlorhexidine for 

cord cleaning 

Antibiotic eye 

ointment 

Service 

readiness Domain C 

summary score 

 % % % % % % % % Mean N 

Facility type 

Hospital 76.6 48.1 94.9 74.5 90.8 65.4 51 91.9 74.1 95Health Center 50.6 4.5 95.3 51.1 85.6 66.9 32.2 93.7 60 414Dispensary or clinic 55.8 27.6 94.7 49.8 28 78.1 39.1 94.3 58.4 19

Managing authority 0

Public 52.5 5.6 94.9 48.6 87.6 69.1 31.4 94.1 60.5 347Private or other 61.1 27.6 95.7 67.9 78.7 62.9 44.3 91.9 66.3 181

Location 0

Urban 75 36.3 95 61.1 84.8 68.9 42.5 91.3 69.4 78Rural 52.1 9.1 95.2 54.2 84.5 66.7 34.7 93.7 61.3 450

Region 0

North 57.2 13.4 90.3 63 83.5 69 34.8 98.1 63.7 102Central 53.4 11.2 97.1 48 83.3 64.8 30.9 90.7 59.9 198South 56.5 14.7 95.7 58.1 86.1 68 40.6 93.6 64.2 227

Total 55.5 13.1 95.2 55.2 84.5 67 35.8 93.4 62.5 528Note: Confidence intervals are not shown since the Malawi 2013-14 SPA was a census of all formal health facilities, rather than a sample. 
83

Table A5g. Service readiness Domain D: Guidelines and staffing, Malawi 2013-14 SPA 

Facility has guidelines, observed: 

At least one provider of delivery or newborn care at facility was trained 

in each the following areas in the last 24 months: 

Supervision

Service 

readiness 

Domain D 

summary score

IMPAC 

guidelines 

CEmOC 

guidelines 

Guidelines for 

management of 

pre-term labor 

Training in 

neonatal 

resuscitation 

Training in 

early and 

exclusive 

breastfeeding 

Training in 

newborn 

infection 

management 

Training in 

thermal care 

Training in 

cord care 

Training in 

KMC 

% % % % % % % % % % Mean N 

Facility type 

Hospital 52 39.8 55.1 80.5 66.3 62.2 77.5 75.5 57.1 91.8 67.0 95Health Center 43.1 24.8 39.3 59.1 44 36.3 49.9 51.3 37 91.7 48.6 414Dispensary or clinic 44.6 22.3 27.8 38.6 44.5 16.7 27.6 33.1 27.6 72.2 36.4 19

Managing authority 

Public 43 30.1 40.4 65.2 52.5 43.5 56.7 58.4 45.5 90.1 53.9 347Private or other 48.1 22.2 44.2 56.6 39.5 33.9 49 48.5 30.3 92.8 46.8 181

0.0

Location 0.0

Urban 49.8 39.8 47.3 74.8 60 53.7 64.9 64.9 53.6 91 61.4 78Rural 43.9 25.2 40.8 60 46 37.9 52.2 53.3 37.9 91.1 49.7 450

Region 

North 48.6 40.8 40.8 70.7 56.2 46.5 54.2 55.2 42.6 87.3 55.8 102Central 41.6 23 42.1 58.8 45.1 41.1 53.4 55.4 43.6 91.6 50.4 198South 45.7 25.2 41.9 61.4 47 36.7 54.6 54.6 36.3 92.3 50.4 227

Total 44.7 27.4 41.7 62.2 48.1 40.2 54.1 55 40.2 91.1 51.4 528Note: Confidence intervals are not shown since the Malawi 2013-14 SPA was a census of all formal health facilities, rather than a sample. 
84

Table A6a. Service availability Domain A: BEmOC signal functions, Senegal 2014 SPA 

Parenteral 

administration of 

antibiotics 

Parenteral 

administration of 

uterotonic drugs 

Parenteral 

administration of 

anticonvulsants 

Manual removal of 

placenta 

Assisted vaginal 

delivery 

Removal of retained 

products 

Service availability 

Domain A summary 

score 

% LB UB % LB UB % LB UB % LB UB % LB UB Mean LB UB Mean LB UB N 

Facility type 

Hospital 97.9 86.7 99.7 97.9 86.7 99.7 69.7 48.9 84.7 74.6 53.9 88.1 100.0 97.9 86.7 99.7 89.7 84.5 94.9 11Health Center 95.8 84.0 99.0 100.0 62.2 44.6 77.0 73.1 58.7 83.8 100.0 96.6 79.6 99.5 87.9 83.7 92.2 20Clinic 68.0 61.5 73.9 94.1 90.1 96.5 26.4 20.7 33.0 61.0 54.7 67.0 99.3 96.7 99.9 80.9 75.3 85.5 71.6 69.0 74.2 248

Managing Authority 

Public 71.1 64.8 76.7 94.7 91.0 96.9 31.7 26.0 37.9 64.0 58.0 69.6 99.3 96.8 99.9 84.0 78.6 88.2 74.1 71.7 76.6 251Private or other 72.5 52.5 86.3 94.4 74.2 99.0 22.7 10.6 42.1 48.2 30.1 66.8 100.0 71.8 51.6 85.9 68.3 60.2 76.4 29

Locality 

Urban 87.4 75.9 93.8 97.8 88.7 99.6 47.9 36.5 59.6 65.5 53.4 75.8 100.0 92.4 81.8 97.0 81.8 77.8 85.8 72Rural 65.6 58.3 72.2 93.6 89.1 96.3 24.7 18.8 31.9 61.3 54.4 67.8 99.2 96.1 99.8 79.4 73.3 84.4 70.6 67.8 73.5 207

Region 

North 61.9 47.4 74.6 95.9 84.4 99.0 30.3 19.2 44.3 91.3 80.4 96.4 100.0 97.9 86.1 99.7 79.5 75.2 83.8 63Dakar 93.3 72.1 98.7 100.0 55.0 35.6 73.0 72.0 51.2 86.3 100.0 90.1 67.5 97.6 85.1 78.2 92.0 28Thies 84.7 65.2 94.2 96.2 76.4 99.5 46.0 28.4 64.6 62.5 43.0 78.7 100.0 84.4 64.6 94.1 79.0 73.1 84.8 35Central 74.8 62.8 83.9 91.5 82.4 96.2 19.6 12.3 29.8 58.0 45.7 69.5 98.3 88.9 99.8 84.1 73.0 91.1 71.1 66.3 75.9 79East 68.8 50.7 82.6 93.5 85.0 97.3 30.8 16.0 51.0 51.1 32.2 69.7 98.6 90.3 99.8 83.7 64.3 93.6 71.1 63.1 79.0 29South 55.8 41.9 68.8 94.8 81.4 98.7 24.0 13.7 38.7 31.1 20.5 44.1 100.0 53.1 38.0 67.6 59.8 53.8 65.9 46

Total 71.2 65.4 76.5 94.7 91.1 96.9 30.8 25.4 36.6 62.4 56.7 67.8 99.4 97.1 99.9 82.7 77.7 86.8 73.5 71.0 76.1 279Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
85 

Table A6b. Service availability Domain B: Newborn signal functions, Senegal 2014 SPA 

Neonatal 

resuscitation 

Cortisosteroids for 

pre-term labor 

Kangaroo Mother 

Care 

Service availability 

Domain B 

summary score 

% LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 82.6 61.8 93.3 87.5 68.9 95.6 63.7 42.3 80.7 77.9 67.0 88.8 11 

Health Center 90.4 76.0 96.5 41.5 28.8 55.5 54.7 41.1 67.6 62.2 55.0 69.4 20 

Clinic 56.6 49.8 63.2 9.1 5.9 13.8 53.7 46.8 60.4 39.8 36.0 43.6 248 

Managing Authority 

Public 61.2 54.8 67.3 12.9 9.6 17.3 56.0 49.4 62.4 43.4 39.8 47.0 251 

Private or other 50.5 31.7 69.1 29.2 15.7 47.8 37.8 21.7 57.1 39.2 26.5 51.9 29 

Locality 

Urban 71.2 58.8 81.1 38.8 29.0 49.6 50.9 39.1 62.6 53.6 45.8 61.5 72 

Rural 56.3 48.9 63.4 6.2 3.4 10.9 55.3 47.8 62.6 39.2 35.3 43.2 207 

Region 

North 44.2 31.1 58.1 1.8 0.6 5.8 64.9 51.9 76.1 37.0 31.1 42.9 63 

Dakar 80.0 58.9 91.8 48.0 30.7 65.8 46.8 28.5 66.0 58.3 44.3 72.2 28 

Thies 86.7 67.6 95.3 29.3 16.3 46.9 47.7 30.0 66.0 54.6 44.8 64.3 35 

Central 61.6 49.2 72.8 7.7 4.0 14.3 59.2 47.2 70.2 42.9 36.0 49.7 79 

East 60.5 42.4 76.2 18.1 7.4 37.9 49.1 30.5 68.0 42.6 32.4 52.8 29 

South 46.8 31.8 62.4 10.2 4.6 21.2 43.2 28.8 58.8 33.4 24.7 42.1 46 

Total 60.1 54.0 66.0 14.6 11.3 18.7 54.2 47.9 60.3 43.0 39.5 46.4 279

Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 

 
86 

Table A6c. Service availability Domain C: Routine perinatal care, Senegal 2014 SPA

Partograph 

routinely used to 

monitor labor 

Routine early 

initiation of 

breastfeeding 

(w/in first hour) Thermal care 

Service availability 

Domain C 

summary score 

% LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 85.1 66.1 94.4 95.7 74.1 99.4 100.0 93.6 87.2 100.0 11 

Health Center 93.3 80.5 98.0 92.9 79.0 97.8 100.0 95.4 91.7 99.2 20 

Clinic 66.0 59.5 72.0 98.6 95.5 99.6 100.0 88.2 86.1 90.3 248 

Managing Authority 

Public 68.7 62.6 74.2 98.2 95.4 99.3 100.0 89.0 87.0 91.0 251 

Private or other 69.2 49.2 83.9 96.8 87.4 99.2 100.0 88.7 82.4 94.9 29 

Locality 

Urban 78.5 66.7 87.0 93.5 84.4 97.4 100.0 90.7 86.9 94.4 72 

Rural 65.3 58.2 71.8 99.7 97.8 100.0 100.0 88.3 86.1 90.6 207 

Region 

North 59.6 46.9 71.1 97.8 85.7 99.7 100.0 85.8 81.7 89.9 63 

Dakar 84.9 65.1 94.5 91.6 72.2 97.9 100.0 92.2 86.3 98.0 28 

Thies 76.7 56.7 89.2 98.8 91.9 99.8 100.0 91.8 86.3 97.4 35 

Central 71.2 59.8 80.4 98.4 93.8 99.6 100.0 89.9 86.3 93.4 79 

East 76.4 55.4 89.4 100.0 100.0 92.1 86.4 97.9 29 

South 56.4 41.5 70.2 100.0 100.0 85.5 80.5 90.4 46 

Total 68.8 62.9 74.1 98.1 95.6 99.2 100.0 88.9 87.0 90.9 279

Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
87

Table A6d. Service readiness Domain A: General requirements, Senegal 2014 SPA 

Electricity Improved water source Improved sanitation 

24/7 skilled birth 

attendance Emergency transport 

Service readiness 

Domain A summary score 

% LB UB % LB UB % LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 97.9 86.7 99.7 100.0 100.0 70.5 50.8 84.6 89.5 68.3 97.1 91.6 87.3 95.9 11Health Center 74.0 57.9 85.4 100.0 100.0 68.6 52.4 81.3 92.8 79.2 97.7 87.1 83.2 90.9 20Clinic 51.6 45.0 58.0 90.9 86.7 93.9 93.5 89.8 95.9 8.8 5.7 13.4 53.9 46.9 60.7 59.7 57.4 62.0 248

Managing authority 

Public 55.1 48.7 61.4 91.4 87.2 94.3 94.1 90.5 96.5 14.6 11.1 19.0 57.1 50.4 63.6 62.5 60.3 64.7 251Private or other 54.3 34.9 72.4 96.7 79.9 99.6 94.8 79.0 98.9 24.7 12.5 42.9 67.0 45.9 82.9 67.5 59.5 75.5 29

Locality 

Urban 58.9 47.3 69.5 100.0 94.5 84.0 98.3 44.5 33.6 56.0 67.8 55.2 78.2 73.1 68.8 77.5 72Rural 53.7 46.5 60.8 89.1 84.1 92.7 94.1 90.4 96.4 5.6 3.1 10.0 54.8 47.2 62.1 59.5 57.0 62.0 207

Region 

North 39.4 27.1 53.2 96.1 86.0 99.0 100.0 6.9 3.2 14.4 55.4 41.8 68.2 59.6 55.9 63.2 63Dakar 56.2 38.6 72.3 100.0 94.9 70.0 99.3 58.1 38.4 75.6 79.8 58.5 91.7 77.8 71.1 84.5 28Thies 64.0 44.5 79.8 100.0 100.0 18.9 8.9 35.7 41.9 25.8 60.0 65.0 58.3 71.7 35Central 40.5 29.6 52.4 97.6 89.9 99.4 94.9 87.5 98.0 15.2 9.2 24.0 57.3 45.0 68.8 61.1 57.1 65.0 79East 73.9 52.9 87.7 81.9 60.6 93.0 85.2 69.7 93.5 4.4 1.3 14.1 63.6 43.4 79.9 61.8 54.9 68.7 29South 82.4 68.7 90.9 71.6 56.6 83.0 85.8 72.2 93.4 7.2 2.9 16.7 59.2 43.5 73.2 61.3 55.5 67.0 46

Total 55.1 49.1 60.9 91.9 88.2 94.6 94.2 90.9 96.4 15.7 12.3 19.7 58.1 51.8 64.2 63.0 60.9 65.1 279Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
88

Table A6e. Service readiness Domain B: Equipment, Senegal 2014 SPA

Sterilization 

equipment 

Delivery 

bed 

Examination 

light 

Delivery 

pack 

Suction 

apparatus 

Manual vacuum 

extractor 

Vacuum aspirator 

or D and C kit Partograph 

% LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB 

Facility type 

Hospital 57.4 36.1 76.3 100.0 75.3 56.0 88.0 100.0 77.8 58.7 89.6 26.1 11.9 48.1 39.4 23.4 58.1 89.4 70.5 96.7Health Center 9.9 4.6 19.9 100.0 73.9 59.8 84.3 100.0 71.6 55.8 83.4 16.2 8.3 29.3 33.0 22.1 46.1 97.9 86.3 99.7Dispensary or clinic 3.6 1.7 7.4 100.0 55.0 47.9 61.8 100.0 26.5 20.9 33.0 1.1 0.3 4.5 45.2 38.6 52.0 80.9 75.0 85.7

Managing authority

Public 41.0 32.7 49.8 69.0 58.7 77.7 59.1 49.6 68.0 100.0 29.4 24.0 35.3 2.7 1.5 4.7 44.3 38.0 50.7 83.4 77.9 87.7Private or other 87.7 80.0 92.7 89.3 80.4 94.5 88.8 79.8 94.1 100.0 53.5 34.4 71.7 8.2 2.2 26.5 42.8 25.3 62.3 74.6 54.3 87.9

Location 100.0

Urban 85.8 80.2 90.0 91.0 84.8 94.8 87.3 81.1 91.6 100.0 53.9 42.0 65.3 10.0 5.6 17.2 39.9 29.0 51.9 86.2 75.1 92.9Rural 35.7 26.7 45.9 65.7 54.2 75.6 55.9 45.3 66.0 100.0 24.1 18.3 31.2 0.9 0.2 4.0 45.6 38.5 52.8 81.2 74.6 86.3

Division 100.0 

North 46.0 33.2 59.4 79.7 65.0 89.2 43.7 31.7 56.5 100.0 27.5 17.2 41.0 4.7 1.6 12.8 52.0 38.1 65.6 76.8 63.5 86.4Dakar 50.6 39.7 61.4 70.0 54.2 82.2 55.0 40.2 68.9 100.0 64.7 44.6 80.7 6.2 2.4 15.3 36.8 20.4 57.0 91.8 73.5 97.8Thies 62.8 45.7 77.3 77.3 58.6 89.2 67.9 50.0 81.8 100.0 48.3 30.3 66.8 5.3 1.0 23.2 57.8 39.1 74.5 88.2 68.6 96.2Central 44.8 27.6 63.4 66.6 42.4 84.4 74.0 52.7 87.9 100.0 32.2 22.2 44.2 3.1 1.5 6.5 34.3 24.5 45.6 88.8 78.8 94.4East 27.6 21.2 35.1 72.0 44.3 89.3 46.8 24.0 70.9 100.0 18.1 8.4 34.8 0.0 19.2 7.8 40.3 84.4 63.2 94.5South 47.5 24.9 71.1 69.3 41.2 87.9 93.5 81.5 97.9 100.0 13.0 6.5 24.2 0.0 59.5 44.1 73.2 68.1 52.9 80.3

Total 50.4 43.4 57.5 73.1 64.7 80.2 65.1 57.2 72.2 100.0 31.8 26.6 37.6 3.2 1.9 5.6 44.1 38.1 50.3 82.5 77.2 86.7

Gloves 

Newborn bag and 

mask 

Infant 

scale 

Blood pressure 

apparatus, dig or 

manual 

Soap or hand 

disinfectant 

Service readiness 

Domain B summary 

score 

% LB UB % LB UB % LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 100.0 81.4 66.2 90.7 97.9 86.7 99.7 100.0 100.0 80.4 75.9 84.8 11Health Center 100.0 69.6 53.5 82.0 97.7 85.0 99.7 87.7 72.0 95.2 100.0 73.7 70.8 76.5 20Dispensary or clinic 95.6 91.7 97.7 44.8 38.0 51.7 91.4 86.6 94.6 81.1 76.4 85.0 95.4 91.4 97.5 63.1 61.6 64.7 248

Managing authority

Public 96.7 93.1 98.4 45.6 39.1 52.1 92.5 88.0 95.3 82.2 77.5 86.1 95.9 92.1 97.9 64.2 62.7 65.6 251Private or other 91.1 70.4 97.8 70.0 50.5 84.2 89.2 67.9 97.0 83.5 62.8 93.8 95.9 76.0 99.4 68.2 63.0 73.4 29

Location 

Urban 98.1 87.6 99.7 62.4 50.4 73.0 97.3 89.9 99.3 85.7 74.6 92.4 100.0 70.3 67.3 73.3 72Rural 95.4 90.9 97.7 43.1 35.8 50.6 90.3 84.8 94.0 81.2 75.7 85.6 94.4 89.7 97.1 62.6 60.9 64.2 207

Division 

North 87.7 74.9 94.4 48.2 34.7 62.0 85.8 73.0 93.1 47.0 34.5 59.8 89.8 77.6 95.8 59.2 56.0 62.3 63Dakar 100.0 60.0 40.3 76.9 98.3 88.8 99.8 93.3 72.1 98.7 100.0 72.9 69.2 76.6 28Thies 100.0 61.2 42.1 77.4 92.0 72.5 98.1 92.3 73.4 98.1 100.0 70.5 66.1 74.8 35Central 96.7 87.3 99.2 40.5 29.7 52.4 95.1 85.7 98.4 85.7 77.1 91.4 96.7 87.3 99.2 64.3 61.4 67.1 79East 98.3 88.6 99.8 24.4 11.9 43.3 88.8 67.3 96.8 100.0 96.6 87.7 99.1 60.0 57.4 62.6 29South 100.0 58.1 43.0 71.9 94.2 84.0 98.1 100.0 96.8 79.7 99.6 65.9 62.4 69.3 46

Total 96.1 92.6 98.0 48.1 41.9 54.2 92.1 87.9 95.0 82.3 78.1 85.9 95.9 92.3 97.8 64.6 63.2 66.0 279Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval.
89

Table A6f. Service readiness Domain C: Medicine and commodities, Senegal 2014 SPA 

Injectable 

antibiotic 

Hydrocortisone 

available at the 

facility 

Injectable 

uterotonic Skin disinfectant 

Magnesium 

sulfate 

IV solution with 

infusion set 

Chlorhexidine for 

cord cleaning 

Antibiotic eye 

ointment 

Service readiness 

Domain C 

summary score 

% LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 66.9 47.5 81.9 57.8 36.0 76.9 82.7 60.3 93.8 95.9 76.2 99.4 84.7 63.2 94.7 86.9 65.9 95.8 61.2 40.2 78.6 46.5 30.7 63.1 72.8 63.5 82.2 11Health Center 64.2 49.8 76.4 66.1 50.8 78.5 81.9 66.7 91.1 90.7 76.4 96.7 55.5 40.4 69.7 74.8 60.8 85.0 52.5 40.2 64.6 54.8 43.0 66.1 67.6 60.7 74.4 20Clinic 51.8 46.6 56.9 56.1 49.0 62.8 77.2 71.9 81.7 93.5 89.2 96.2 31.4 25.3 38.1 68.3 61.8 74.1 48.4 43.7 53.2 52.6 47.9 57.3 59.9 57.3 62.5 248

Managing Authority 

Public 50.4 45.4 55.4 58.0 51.3 64.5 76.9 71.6 81.5 92.7 88.5 95.4 33.0 27.2 39.3 68.4 62.1 74.1 48.6 43.8 53.4 51.5 46.9 56.1 59.9 57.3 62.6 251Private or other 78.5 59.1 90.2 46.6 28.3 66.0 84.8 65.1 94.3 100.0 55.2 35.8 73.1 79.1 56.3 91.8 55.0 35.7 73.0 61.5 42.1 77.8 70.1 61.4 78.8 29

Locality 

Urban 57.9 46.0 68.8 50.7 39.1 62.2 77.3 65.7 85.9 86.1 75.3 92.6 45.9 34.8 57.5 75.1 63.5 84.0 49.2 37.8 60.7 51.3 39.9 62.5 61.7 55.4 67.9 72Rural 51.7 46.1 57.3 59.0 51.4 66.2 77.9 71.9 82.9 96.0 91.9 98.1 31.5 25.1 38.8 67.5 60.3 74.0 49.3 44.1 54.4 53.0 47.8 58.0 60.7 57.9 63.6 207

Zone 

North 9.4 4.1 20.2 63.6 49.1 76.1 57.6 43.2 70.8 94.5 84.2 98.2 28.7 17.7 43.1 53.2 39.3 66.7 10.2 4.4 22.1 2.0 0.3 12.9 39.9 34.3 45.4 63Dakar 63.2 42.8 79.7 43.6 26.4 62.5 79.8 58.6 91.6 79.6 57.7 91.8 45.8 28.9 63.8 76.4 56.1 89.2 59.9 40.0 77.0 55.1 35.7 73.1 62.9 53.4 72.5 28Thies 60.5 41.2 76.9 75.9 56.6 88.4 85.8 67.5 94.6 91.2 73.2 97.5 34.5 19.4 53.6 79.3 59.8 90.8 55.0 36.2 72.5 47.6 29.8 66.1 66.2 56.9 75.6 35Central 55.2 46.5 63.5 48.8 36.9 60.9 74.3 68.7 79.2 94.3 86.3 97.8 33.7 24.3 44.5 64.0 53.4 73.5 44.8 37.2 52.7 61.3 54.5 67.6 59.6 56.4 62.8 79East 91.8 83.3 96.1 59.8 39.6 77.2 93.4 73.0 98.7 100.0 34.8 19.5 54.2 80.5 59.5 92.0 84.5 75.5 90.6 79.6 58.9 91.4 78.1 71.7 84.4 29South 75.3 61.4 85.5 52.7 37.6 67.4 94.3 81.2 98.4 96.6 85.9 99.3 41.4 27.9 56.4 82.8 68.3 91.5 78.0 70.3 84.2 92.9 79.2 97.8 76.8 71.8 81.7 46

Total 53.3 48.6 58.0 56.8 50.5 63.0 77.7 72.9 81.9 93.4 89.6 95.9 35.3 29.7 41.3 69.5 63.6 74.8 49.3 44.9 53.7 52.5 48.2 56.8 61.0 58.6 63.4 279Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
90

Table A6g. Service readiness Domain D: Guidelines and staffing, Senegal 2014 SPA 

Facility has guidelines, observed: 

At least one provider of delivery or newborn care at facility was trained 

in each the following areas in the last 24 months: 

 Supervision

Service readiness 

Domain D summary 

score

IMPAC 

guidelines 

CEmOC 

guidelines 

Guidelines 

for 

management 

of pre-term 

labor 

Training in 

neonatal 

resuscitation 

Training in 

early and 

exclusive 

breastfeeding 

Training in 

newborn infection 

management 

Training in 

thermal care 

Training in 

cord care 

Training in 

KMC 

% LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB % LB UB Mean LB UB N 

Facility type 

Hospital 45.5 26.1 66.4 48.1 28.3 68.5 35.5 18.1 57.9 54.3 33.5 73.6 48.1 28.5 68.3 40.1 21.8 61.6 44.3 25.3 65.3 44.3 25.3 65.3 46.9 27.6 67.2 26.3 13.2 45.6 43.4 31.7 55.0 11 Health Center 66.7 49.8 80.3 64.7 48.1 78.3 22.7 12.8 37.0 49.2 36.0 62.5 43.7 31.3 56.9 32.8 21.1 47.2 47.0 34.4 60.0 45.0 32.8 57.8 42.9 31.2 55.5 41.7 30.4 54.1 45.6 38.4 52.9 20 Clinic 66.2 59.4 72.4 56.5 49.7 63.0 9.6 6.2 14.7 30.1 24.3 36.7 34.2 28.1 41.0 26.5 21.0 32.9 32.6 26.5 39.4 34.6 28.5 41.2 28.5 22.9 34.9 50.4 43.7 57.1 36.9 33.1 40.8 248 

Managing Authority 

Public 68.4 61.9 74.2 59.5 53.0 65.7 11.5 8.0 16.2 31.9 26.3 38.2 34.5 28.5 40.9 26.8 21.5 32.9 33.8 27.9 40.2 35.1 29.3 41.4 30.7 25.3 36.7 49.8 43.4 56.2 38.2 34.6 41.8 251 Private or other 39.6 22.9 59.1 32.5 17.5 52.2 13.1 4.4 33.3 37.0 20.4 57.3 44.2 26.1 63.9 33.8 17.8 54.6 37.0 20.4 57.3 41.1 23.6 61.1 27.0 12.8 48.1 40.1 23.0 60.0 34.5 21.5 47.6 29 

Locality 

Urban 67.1 55.5 76.9 58.5 46.5 69.6 20.1 12.5 30.9 41.2 30.3 53.0 42.0 30.9 53.9 35.4 24.8 47.6 40.0 29.0 52.0 41.4 30.3 53.4 37.5 26.9 49.5 46.3 34.9 58.0 42.9 35.5 50.3 72 Rural 64.8 57.4 71.6 56.1 48.8 63.2 8.7 5.3 13.9 29.4 23.2 36.5 33.2 26.6 40.5 24.8 19.0 31.6 32.1 25.6 39.4 33.8 27.3 40.9 27.8 21.9 34.5 49.7 42.5 56.8 36.0 32.0 40.1 207 

Zone 

North 66.3 52.0 78.1 72.2 58.3 82.9 21.0 11.9 34.4 38.0 25.7 52.0 40.1 27.6 54.0 35.0 23.1 49.1 37.9 25.8 51.8 37.9 25.8 51.8 35.8 23.9 49.7 59.9 45.6 72.7 44.4 36.1 52.7 63 Dakar 63.4 44.9 78.6 51.7 32.9 70.1 19.9 8.7 39.3 34.8 19.2 54.5 43.1 25.8 62.2 35.1 19.0 55.3 38.4 21.7 58.3 38.4 21.7 58.3 38.2 21.6 58.2 36.7 20.2 57.0 40.0 28.0 52.0 28 Thies 44.7 27.4 63.4 37.0 21.2 56.2 14.0 5.2 32.7 36.2 20.4 55.7 40.0 23.4 59.3 31.2 16.5 50.9 32.3 17.5 51.9 31.2 16.5 50.9 31.8 17.2 51.2 59.2 40.8 75.4 35.8 23.0 48.5 35 Central 66.6 55.0 76.4 48.6 37.3 60.1 7.5 3.5 15.4 42.2 31.3 54.0 42.8 31.9 54.4 34.1 24.4 45.4 39.6 29.0 51.4 46.5 35.9 57.4 35.3 26.8 44.9 43.7 32.4 55.8 40.7 34.7 46.7 79 East 70.2 50.2 84.6 64.7 44.6 80.7 0.0 15.2 6.0 33.6 17.4 7.3 36.2 13.9 5.6 30.2 29.9 15.9 49.1 25.7 12.6 45.4 25.3 11.7 46.4 30.7 18.7 46.2 29.3 20.2 38.4 29 South 76.5 60.7 87.3 62.7 46.9 76.2 6.2 2.0 17.7 14.5 8.0 24.9 19.6 10.6 33.4 7.1 2.1 21.4 20.9 11.8 34.4 22.4 13.0 36.0 11.3 4.9 23.8 52.7 39.3 65.7 29.4 23.4 35.4 46 

Total 65.4 59.3 71.1 56.7 50.6 62.7 11.6 8.2 16.2 32.5 27.1 38.4 35.5 29.8 41.5 27.5 22.4 33.3 34.1 28.5 40.2 35.7 30.2 41.7 30.3 25.2 36.0 48.8 42.8 54.8 37.8 34.3 41.3 279 Note: LB and UB refer to the lower and upper bounds of the 95% confidence interval. 
91

Table A7a. Trend in service availability Domain A: BEmOC signal functions, Tanzania 2006 and 2014-15 SPA

Parenteral administration of uterotonic drugs Parenteral administration of anticonvulsants Manual removal of placenta 

2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 

 % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig 

Facility type3 

Hospital 77.0 63.5 86.5 24 96.9 93.8 98.4 44 19.9 *** 57.5 42.6 71.1 24 77.5 65.3 86.3 44 20.0 * 74.2 60.0 84.7 24 69.7 58.8 78.7 44 -4.5Health Center 11.0 4.7 23.6 48 90.9 86.8 93.9 109 79.9 *** 3.3 0.6 16.2 48 31.6 26.7 37.0 109 28.3 ** 42.3 26.3 60.0 48 45.3 40.0 50.8 109 3.0Dispensary 0.7 0.2 2.9 379 81.7 77.2 85.5 746 81.0 *** 1.1 0.4 3.4 379 6.9 4.6 10.4 746 5.8 ** 13.0 9.6 17.5 379 30.3 25.5 35.6 746 17.3 ***

Managing authority 

Public 2.9 2.0 4.1 365 83.7 79.4 87.2 756 80.8 *** 3.0 1.9 4.7 365 10.9 8.6 13.7 756 7.9 *** 15.5 11.9 20.0 365 32.9 28.4 37.6 756 17.4 ***Private or other 18.5 11.8 27.7 85 83.2 73.2 89.9 149 64.7 *** 9.6 5.2 17.1 85 25.6 18.5 34.4 149 16.0 * 35.9 25.6 47.7 85 39.5 30.0 49.8 149 3.6

Province4

Eastern 14.0 8.0 23.4 56 85.2 72.0 92.8 115 71.2 *** 8.2 3.6 17.4 56 23.6 14.1 36.8 115 15.4 27.0 18.8 37.1 56 27.8 16.9 42.1 115 0.8Western 5.6 1.4 19.8 37 82.2 68.0 90.9 85 76.6 *** 5.9 1.6 19.6 37 25.9 16.6 38.0 85 20.0 * 30.4 16.1 49.7 37 38.9 26.7 52.6 85 8.5Southern 5.1 2.8 8.8 30 91.8 78.0 97.2 66 86.7 *** 3.8 1.8 8.0 30 5.3 3.7 7.5 66 1.5 25.7 12.2 46.2 30 59.7 44.1 73.5 66 34.0 *Southern Highlands 1.8 0.7 4.4 55 72.4 59.6 82.4 115 70.6 *** 5.9 1.8 17.4 55 8.1 5.0 13.0 115 2.2 14.0 5.8 30.1 55 31.2 21.1 43.6 115 17.2 *SW Highlands 5.9 2.4 13.7 49 95.0 80.3 98.9 103 89.1 *** 3.8 1.4 10.4 49 7.3 5.3 9.9 103 3.5 11.8 5.2 24.6 49 27.7 17.5 40.9 103 15.9Central 3.0 0.9 9.0 54 90.4 78.7 96.0 104 87.4 *** 2.7 0.8 9.1 54 13.5 8.2 21.5 104 10.8 * 16.2 7.9 30.3 54 36.9 25.7 49.7 104 20.7Northern 8.6 4.5 16.0 60 89.6 79.6 95.0 110 81.0 *** 4.1 2.0 8.3 60 18.8 11.3 29.7 110 14.7 ** 10.1 4.9 19.8 60 31.9 20.0 46.9 110 21.8 *Lake 3.0 1.3 7.1 107 73.9 63.8 82.0 199 70.9 *** 1.5 1.0 2.2 107 7.6 4.5 12.4 199 6.1 *** 22.5 14.9 32.5 107 31.6 23.5 41.1 199 9.1

Total 5.8 4.4 7.7 451 83.6 79.9 86.8 905 77.8 *** 4.3 3.0 6.1 451 13.3 11.1 16.0 905 9.0 *** 19.4 15.7 23.6 451 34.0 29.9 38.3 905 14.6 ***

Assisted vaginal delivery Manual removal of placenta BEmOC summary score2 

2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 

 % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig 

Facility type3 

Hospital 49.2 35.2 63.2 24 88.9 84.2 92.4 44 39.7 *** 76.8 63.8 86.1 24 68.6 57.9 77.6 44 -8.2 66.9 59.7 74.1 24 80.3 77.5 83.1 44 13.4 **Health Center 11.0 3.0 32.8 48 72.9 67.7 77.4 109 61.9 *** 30.9 16.0 51.3 48 51.4 46.2 56.5 109 20.5 19.7 10.8 28.6 48 58.4 54.9 62 109 38.7 ***Dispensary 0.0 379 68.0 62.9 72.7 746 68.0 2.2 1.0 4.8 379 31.2 26.8 35.9 746 29.0 *** 3.4 2.4 4.4 379 43.6 40.6 46.6 746 40.2 ***

Managing authority 

Public 1.8 1.2 2.7 365 69.5 64.7 73.9 756 67.7 *** 6.1 4.2 8.8 365 34.9 30.7 39.3 756 28.8 *** 5.9 4.7 7 365 46.4 43.6 49.1 756 40.5 ***Private or other 12.1 6.0 22.8 85 70.1 59.1 79.2 149 58.0 *** 22.4 14.2 33.5 85 37.8 28.4 48.2 149 15.4 * 19.7 13.8 25.6 85 51.2 43.8 58.7 149 31.5 ***

Province4

Eastern 4.7 1.8 11.7 56 59.1 45.9 71.1 115 54.4 *** 14.0 7.4 24.9 56 25.9 15.5 40.0 115 11.9 13.6 8.6 18.5 56 44.3 35.1 53.6 115 30.7 ***Western 4.5 1.0 17.5 37 81.9 70.3 89.7 85 77.4 *** 5.0 1.4 17.0 37 39.7 27.1 53.9 85 34.7 ** 10.3 4.9 15.7 37 53.7 45.1 62.3 85 43.4 ***Southern 4.2 2.1 8.3 30 75.9 60.2 86.8 66 71.7 *** 4.6 2.5 8.5 30 34.8 22.2 49.9 66 30.2 *** 8.7 4.3 13.1 30 53.5 43.6 63.4 66 44.8 ***Southern Highlands 8.7 2.6 25.8 55 57.6 44.6 69.7 115 48.9 *** 9.2 2.8 25.7 55 32.7 22.7 44.5 115 23.5 *** 7.9 2 13.8 55 40.4 32.9 47.9 115 32.5 ***SW Highlands 3.0 0.8 11.0 49 56.2 41.7 69.7 103 53.2 *** 6.5 2.4 16.9 49 26.6 20.7 33.5 103 20.1 * 6.2 2.4 10 49 42.6 36.3 48.8 103 36.4 ***Central 3.6 1.4 8.9 54 78.6 67.9 86.5 104 75.0 *** 5.0 1.8 13.4 54 64.1 51.3 75.1 104 59.1 *** 6.1 2.2 10 54 56.7 51.2 62.2 104 50.6 ***Northern 2.9 1.0 8.0 60 78.3 64.6 87.7 110 75.4 *** 11.7 6.0 21.5 60 22.4 13.4 35.0 110 10.7 7.5 4.2 10.8 60 48.2 40.4 56.1 110 40.7 ***Lake 1.0 0.5 1.7 107 74.1 64.3 82.0 199 73.1 *** 10.7 5.9 18.4 107 37.6 29.9 45.8 199 26.9 *** 7.7 5 10.4 107 45 40.2 49.7 199 37.3 ***

Total 3.7 2.4 5.9 451 69.6 65.3 73.5 905 65.9 *** 9.2 6.9 12.2 451 35.4 31.6 39.3 905 26.2 *** 8.5 7 10 451 47.2 44.6 49.7 905 38.7 ***LB and UB are the lower and upper boundaries of 95% confidence intervals. 1 Percentage point difference between survey years with significance tests for the difference in proportions. P-values *<0.05 **<0.01 ***<0.001 

2 Note: The BEmOC availability score presented here may not match the score presented in the previous chapter. To preserve comparability across the two surveys, the summary score excludes parenteral administration of antibiotics, which is not available in the 2006 survey. 3 In general, this report uses the categories, Hospital, Health Center, and Dispensary or Clinic. However, the 2014-15 TSPA included 19 clinics while the 2006 TSPA included none. To examine trends by type of facility, we 

exclude the 19 clinics and examine the trend in just dispensaries. The 19 clinics are still included in the Total. 4 Trends are not shoN for Zanzibar due to the small number of normal-delivery facilities included in the 2006 TSPA sample (10 facilities, unweighted) and the relatively high sampling error. The facilities in Zanzibar are included in the Totals row.
92

Table A7b. Trend in service readiness Domain A: General requirements, Tanzania 2006 and 2014-15 SPA 

Electricity Improved water source 24/7 skilled birth attendance General requirements summary score2 

2006 TSPA 2014-15 TSPA 2006 2014-15 2006 2014-15 2006 TSPA 2014-15 TSPA 

 % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig

Facility type3 

Hospital 81.7 66.9 90.8 24 90.5 71.5 97.3 44 8.8 96.2 92.5 98.2 24 86.7 71.1 94.5 44 -9.5 ** 98.6 95.9 99.5 24 97.7 94.9 99.0 44 -0.9 92.2 88.2 96.2 24 91.6 90.2 93.0 44 -0.6Health Center 49.3 31.9 66.8 48 76.1 71.0 80.5 109 26.8 ** 65.0 47.2 79.4 48 82.3 77.7 86.1 109 17.3 * 74.2 53.2 87.9 48 82.7 78.4 86.2 109 8.5 62.8 52.7 72.9 48 80.3 77.1 83.5 109 17.5 **Dispensary 21.2 16.8 26.4 379 63.6 58.2 68.7 746 42.4 *** 42.5 36.9 48.4 379 57.7 52.4 62.8 746 15.2 *** 13.4 10.0 17.7 379 16.1 12.5 20.6 746 2.7 25.7 22.7 28.7 379 45.8 42.1 49.5 746 20.1 ***

Managing authority 

Public 21.1 16.9 26.0 365 62.8 57.8 67.6 756 41.7 *** 41.3 35.7 47.0 365 57.9 53.0 62.6 756 16.6 *** 21.3 17.4 25.9 365 24.7 21.2 28.4 756 3.4 27.9 24.9 30.9 365 48.5 45.2 51.7 756 20.6 ***Private or other 54.1 41.9 65.9 85 83.7 73.1 90.7 149 29.6 ** 75.4 63.5 84.4 85 84.5 73.9 91.3 149 9.1 37.2 27.2 48.5 85 46.7 36.4 57.2 149 9.5 55.6 48.1 63.1 85 71.6 64.3 78.9 149 16 **

Province4

Eastern 39.1 26.2 53.8 56 57.1 42.6 70.4 115 18 51.9 37.9 65.6 56 66.0 50.5 78.7 115 14.1 27.2 19.0 37.3 56 27.8 18.9 39.0 115 0.6 39.4 31.1 47.7 56 50.3 39.6 61.0 115 10.9Western 40.0 23.4 59.2 37 88.1 76.2 94.5 85 48.1 *** 60.9 41.9 77.2 37 74.3 59.5 85.1 85 13.4 16.6 7.3 33.3 37 20.3 12.8 30.6 85 3.7 39.2 27.3 51.0 37 60.9 53.5 68.3 85 21.7 **Southern 13.2 5.1 30.2 30 68.9 52.7 81.4 66 55.7 *** 43.7 25.1 64.2 30 61.6 47.2 74.2 66 17.9 22.7 9.4 45.6 30 18.2 10.7 29.0 66 -4.5 26.6 18.8 34.3 30 49.5 40.2 58.9 66 22.9 ***Southern Highlands 19.5 9.6 35.6 55 64.3 51.1 75.6 115 44.8 *** 70.9 55.2 82.7 55 66.0 53.2 76.8 115 -4.9 15.0 7.6 27.4 55 18.8 13.4 25.7 115 3.8 35.1 27.4 42.8 55 49.7 42.0 57.4 115 14.6 **SW Highlands 23.4 12.8 39.1 49 56.3 40.9 70.5 103 32.9 * 50.2 34.6 65.8 49 41.9 28.7 56.5 103 -8.3 11.6 5.5 22.6 49 28.5 18.6 41.1 103 16.9 28.4 20.0 36.8 49 42.3 31.2 53.3 103 13.9Central 23.0 14.0 35.4 54 66.9 53.0 78.3 104 43.9 *** 34.3 21.7 49.7 54 66.5 52.6 78.0 104 32.2 ** 14.1 6.5 28.1 54 24.2 16.8 33.4 104 10.1 23.8 15.7 31.9 54 52.5 44.2 60.8 104 28.7 ***Northern 36.5 24.2 50.7 60 54.6 39.9 68.6 110 18.1 63.5 48.8 76.1 60 69.9 55.0 81.6 110 6.4 31.2 21.9 42.3 60 33.4 23.9 44.3 110 2.2 43.7 35.9 51.5 60 52.6 43.7 61.6 110 8.9Lake 23.3 15.5 33.4 107 73.0 64.2 80.3 199 49.7 *** 25.9 17.6 36.4 107 56.1 47.6 64.3 199 30.2 *** 37.5 28.0 48.1 107 40.2 31.7 49.3 199 2.7 28.9 22.7 35.1 107 56.4 50.0 62.8 199 27.5 ***

Total 27.4 23.0 32.1 451 66.3 61.7 70.5 905 38.9 *** 47.7 42.6 52.9 451 62.2 57.8 66.5 905 14.5 *** 24.4 20.7 28.4 451 28.3 25 31.8 905 3.9 33.1 30.3 36.0 451 52.3 49.2 55.3 905 19.2 ***LB and UB are the lower and upper boundaries of 95% confidence intervals. 1 Percentage point difference between survey years with significance tests for the difference in proportions. P-values *<0.05 **<0.01 ***<0.001 

2 The General Requirements Summary Score presented here may not match the score presented in the previous chapter. To preserve comparability across the two surveys, this summary score excludes components that are 

not available in the 2006 survey (emergency transport and improved sanitation). 3 In general, this report uses the categories, Hospital, Health Center, and Dispensary or Clinic. However, the 2014-15 TSPA included 19 clinics while the 2006 TSPA included none. To examine trends by type of facility, we 

exclude the 19 clinics and examine the trend in just dispensaries. The 19 clinics are still included in the Total. 4 Trends are not shown for Zanzibar due to the small number of normal-delivery facilities included in the 2006 TSPA sample (10 facilities, unweighted) and the relatively high sampling error. The facilities in Zanzibar are 

included in the Totals row. 
93

Table A7c. Trend in service readiness Domain B: Equipment among facilities that offer normal delivery services, Tanzania 2006 and 2014-15 SPA 

Sterilization equipment Delivery bed Examination light Delivery pack 

2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 

% LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig

Facility type3 

Hospital 91.5 77.1 97.2 24 88.5 71.6 95.9 44 -3.0 100.0 24 100.0 44 0.0 57.4 43.5 70.3 24 53.6 44.9 62.2 44 -3.8 64.4 50.7 76.0 24 98.1 95.4 99.2 44 33.7 *** Health Center 28.2 14.3 48.1 48 47.9 42.8 53.1 109 19.7 97.7 84.8 99.7 48 100.0 109 2.3 30.4 18.6 45.4 48 28.0 23.4 33.1 109 -2.4 37.8 21.4 57.6 48 89.6 86.1 92.3 109 51.8 *** Dispensary 1.5 0.5 3.8 379 12.5 9.6 16.3 746 11.0 *** 95.5 92.4 97.4 379 98.0 95.8 99.1 746 2.5 5.9 3.7 9.4 379 9.6 6.8 13.4 746 3.7 24.2 19.6 29.4 379 85.8 81.4 89.3 746 61.6 *** 

Managing authority 

Public 4.4 3.1 6.0 365 14.4 11.9 17.3 756 10.0 *** 95.8 92.7 97.7 365 98.0 95.9 99.1 756 2.2 6.3 4.2 9.5 365 9.2 6.9 12.1 756 2.9 24.0 19.5 29.1 365 85.2 81.1 88.6 756 61.2 *** Private or other 29.0 19.5 40.8 85 53.1 42.2 63.8 149 24.1 ** 96.8 88.1 99.2 85 100.0 149 3.2 32.1 22.4 43.8 85 40.6 30.7 51.3 149 8.5 43.7 32.1 56.1 85 95.6 85.5 98.8 149 51.9 *** 

Province4

Eastern 15.4 8.5 26.2 56 37.3 29.3 46.2 115 21.9 * 95.0 81.7 98.8 56 100.0 115 5.0 21.7 12.1 35.8 56 26.7 17.3 38.8 115 5.0 26.0 15.2 40.7 56 88.3 74.9 95.1 115 62.3 *** Western 2.4 1.4 3.9 37 30.0 20.3 42.0 85 27.6 *** 100.0 37 100.0 85 0.0 1.2 0.5 2.8 37 7.4 2.9 17.5 85 6.2 ** 23.0 10.7 42.6 37 88.1 76.1 94.5 85 65.1 *** Southern 3.7 2.2 6.3 30 11.2 5.6 21.4 66 7.5 * 100.0 30 89.2 74.5 95.9 66 -10.8 1.7 0.7 4.1 30 10.9 4.7 23.5 66 9.2 ** 25.7 12.2 46.2 30 85.2 70.4 93.3 66 59.5 *** Southern Highlands 9.8 3.3 25.7 55 13.4 8.1 21.4 115 3.6 100.0 55 98.0 87.0 99.7 115 -2.0 8.8 3.6 20.2 55 6.1 3.1 11.9 115 -2.7 65.3 49.6 78.2 55 92.3 81.4 97.0 115 27.0 ** SW Highlands 8.9 3.8 19.2 49 10.9 5.4 20.8 103 2.0 94.5 80.2 98.6 49 96.0 78.8 99.3 103 1.5 12.8 5.7 26.2 49 26.1 16.1 39.5 103 13.3 19.3 9.5 35.2 49 95.3 80.0 99.0 103 76.0 *** Central 3.6 1.4 9.0 54 6.8 5.3 8.8 104 3.2 97.4 83.4 99.7 54 100.0 104 2.6 2.4 0.6 9.5 54 6.5 3.4 12.2 104 4.1 2.9 0.9 8.9 54 89.5 78.1 95.3 104 86.6 *** Northern 16.8 9.7 27.6 60 37.3 25.9 50.2 110 20.5 * 91.2 78.5 96.8 60 100.0 110 8.8 24.8 14.9 38.2 60 21.4 13.8 31.6 110 -3.4 18.8 10.2 32.1 60 86.5 71.2 94.3 110 67.7 *** Lake 6.7 3.6 12.1 107 16.3 11.0 23.4 199 9.6 * 94.9 87.1 98.1 107 99.4 95.5 99.9 199 4.5 8.4 4.1 16.4 107 9.3 5.0 16.7 199 0.9 33.2 23.6 44.3 107 78.9 69.4 86.1 199 45.7 *** 

Total 9.0 6.9 11.8 451 20.7 18.0 23.7 905 11.7 *** 96.0 93.3 97.7 451 98.4 96.5 99.2 905 2.4 11.2 8.6 14.5 451 14.3 11.8 17.3 905 3.1 27.7 23.3 32.6 451 86.9 83.4 89.8 905 59.2 *** 

Suction apparatus Manual vacuum extractor Vacuum aspirator or D and C kit Partograph 

2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 

% LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig

Facility type3 

Hospital 91.7 77.9 97.2 24 79.3 66.5 88.1 44 -12.4 59.1 44.3 72.5 24 51.9 43.4 60.2 44 -7.2 68.5 54.1 80.1 24 39.8 32.6 47.4 44 -28.7 ** 85.9 70.8 93.8 24 96.4 93.2 98.1 44 10.5 * Health Center 70.6 52.1 84.1 48 46.3 40.9 51.8 109 -24.3 * 19.3 7.7 40.7 48 11.6 8.4 15.7 109 -7.7 38.9 22.4 58.5 48 24.4 20.3 29.1 109 -14.5 65.9 48.7 79.8 48 79.7 75.0 83.6 109 13.8Dispensary 28.3 23.3 33.8 379 16.1 12.3 20.7 746 -12.2 *** 0.4 0.1 2.5 379 1.6 0.6 4.3 746 1.2 3.3 1.7 6.2 379 3.0 1.7 5.4 746 -0.3 59.8 54.4 65.0 379 52.1 46.9 57.3 746 -7.7 * 

Managing authority 

Public 30.3 25.3 35.7 365 18.8 15.4 22.7 756 -11.5 ** 3.0 1.9 4.6 365 3.8 2.6 5.6 756 0.8 6.6 4.5 9.5 365 6.0 4.6 7.9 756 -0.6 65.1 59.5 70.4 365 57.0 52.1 61.8 756 -8.1 Private or other 61.2 49.0 72.2 85 43.8 33.7 54.5 149 -17.4 16.0 8.8 27.3 85 12.8 8.7 18.6 149 -3.2 27.4 18.0 39.3 85 14.8 9.8 21.6 149 -12.6 47.6 36.0 59.5 85 60.0 48.7 70.3 149 12.4 

Province4

Eastern 55.3 40.8 69.1 56 22.6 14.0 34.4 115 -32.7 ** 7.8 3.3 17.3 56 9.0 4.8 16.3 115 1.2 18.0 9.6 31.3 56 9.1 5.7 14.2 115 -8.9 67.2 51.2 79.9 56 59.8 44.8 73.2 115 -7.4Western 20.1 9.4 38.0 37 25.5 15.3 39.3 85 5.4 5.0 1.4 17.0 37 4.1 2.7 6.2 85 -0.9 8.0 2.3 24.6 37 12.4 6.3 22.8 85 4.4 65.4 45.9 80.7 37 60.8 47.9 72.3 85 -4.6Southern 30.4 15.4 51.1 30 22.8 13.0 36.7 66 -7.6 3.8 1.8 8.0 30 2.0 1.2 3.3 66 -1.8 4.6 2.5 8.5 30 2.2 1.2 4.1 66 -2.4 73.8 52.4 87.9 30 77.0 61.1 87.6 66 3.2Southern Highlands 41.1 27.2 56.6 55 22.5 14.2 33.7 115 -18.6 9.0 2.7 25.8 55 1.9 1.2 2.9 115 -7.1 *** 12.2 4.9 27.4 55 5.4 2.6 10.8 115 -6.8 90.2 76.6 96.2 55 62.4 51.4 72.3 115 -27.8 ** SW Highlands 30.9 18.7 46.3 49 24.4 13.9 39.3 103 -6.5 3.0 0.8 11.0 49 1.9 1.1 3.3 103 -1.1 5.2 1.4 17.2 49 0.8 0.3 1.9 103 -4.4 * 86.9 71.6 94.6 49 51.6 37.2 65.8 103 -35.3 * Central 23.8 13.5 38.6 54 18.2 10.8 29.1 104 -5.6 3.6 1.4 8.9 54 3.9 2.7 5.7 104 0.3 10.2 4.3 22.1 54 3.9 2.6 5.8 104 -6.3 60.7 44.7 74.7 54 44.3 32.5 56.6 104 -16.4Northern 52.1 38.2 65.6 60 26.3 17.3 38.0 110 -25.8 * 5.0 1.9 12.5 60 7.3 3.5 14.9 110 2.3 11.3 6.2 19.6 60 9.9 5.2 17.9 110 -1.4 40.1 27.2 54.5 60 74.3 60.0 84.7 110 34.2 ** Lake 29.9 21.1 40.5 107 21.3 15.1 29.2 199 -8.6 5.2 2.4 10.9 107 7.7 4.2 13.9 199 2.5 9.8 5.4 17.2 107 10.7 7.2 15.7 199 0.9 41.1 30.8 52.3 107 46.1 37.1 55.4 199 5.0

Total 36.1 31.5 41.1 451 22.9 19.5 26.6 905 -13.2 *** 5.5 3.7 8.0 451 5.3 4.0 6.9 905 -0.2 10.5 8.0 13.8 451 7.5 6.0 9.2 905 -3.0 61.8 56.9 66.5 451 57.5 53.1 61.8 905 -4.3 

Continues... 
94

Table A7c—Continued 

Gloves Newborn bag and mask Infant scale Soap or hand disinfectant 

2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 

% LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig

Facility type3  Hospital 97.6 94.7 99.0 24 99.6 97.3 99.9 44 2.0 ** 78.4 63.1 88.5 24 97.2 94.2 98.7 44 18.8 ** 95.4 77.1 99.2 24 92.9 69.3 98.7 44 -2.5 79.8 68.6 87.7 24 94.2 90.3 96.5 44 14.4 **  Health Center 80.4 65.9 89.7 48 88.9 85.3 91.7 109 8.5 35.6 19.7 55.5 48 84.5 80.4 87.8 109 48.9 *** 88.6 75.8 95.1 48 95.3 92.3 97.2 109 6.7 48.3 32.8 64.1 48 79.4 74.7 83.5 109 31.1 *** Dispensary 92.4 88.6 95.0 379 85.0 81.0 88.3 746 -7.4 ** 10.2 7.1 14.4 379 73.7 69.5 77.6 746 63.5 *** 65.8 60.0 71.1 379 76.5 71.7 80.7 746 10.7 ** 38.3 33.1 43.9 379 63.8 58.6 68.7 746 25.5 ***Managing authority  Public 92.4 88.6 95.0 365 84.8 80.9 88.0 756 -7.6 * 13.0 9.7 17.1 365 75.4 71.5 78.9 756 62.4 *** 70.8 65.2 75.9 365 79.0 74.4 82.9 756 8.2 * 37.0 31.8 42.6 365 63.8 58.9 68.5 756 26.8 *** Private or other 87.0 77.9 92.7 85 93.5 85.8 97.1 149 6.5 31.5 21.5 43.6 85 80.0 68.6 88.0 149 48.5 *** 65.1 52.9 75.5 85 82.4 71.7 89.7 149 17.3 * 61.1 49.1 71.8 85 85.2 75.2 91.6 149 24.1 ***Province4 Eastern 89.8 80.3 95.0 56 86.5 73.5 93.7 115 -3.3 25.0 14.6 39.4 56 89.2 77.0 95.3 115 64.2 *** 85.7 71.3 93.5 56 90.3 76.9 96.3 115 4.6 54.4 39.0 69.0 56 81.4 67.6 90.1 115 27.0 *  Western 100.0 37 73.8 59.0 84.6 85 -26.2 23.1 11.9 40.0 37 76.8 62.6 86.8 85 53.7 *** 54.2 35.8 71.5 37 82.3 69.4 90.5 85 28.1 * 23.3 11.3 42.0 37 47.2 33.4 61.4 85 23.9 Southern 91.0 71.0 97.7 30 80.1 66.3 89.2 66 -10.9 8.9 3.2 22.6 30 83.4 70.1 91.5 66 74.5 *** 78.5 57.1 91.0 30 84.1 68.7 92.8 66 5.6 33.9 17.7 54.8 30 57.5 41.9 71.7 66 23.6 Southern Highlands 97.6 84.9 99.7 55 92.8 82.2 97.3 115 -4.8 18.9 9.1 35.2 55 94.2 83.6 98.1 115 75.3 *** 63.7 47.9 77.0 55 74.2 61.4 83.9 115 10.5 75.1 60.0 85.8 55 87.8 76.3 94.1 115 12.7 SW Highlands 97.2 82.5 99.6 49 83.1 75.5 88.8 103 -14.1 17.5 8.7 32.2 49 76.5 63.4 85.9 103 59.0 *** 75.2 58.5 86.7 49 80.7 66.7 89.8 103 5.5 61.0 44.9 75.0 49 76.1 60.7 86.8 103 15.1 Central 86.5 71.1 94.3 54 95.1 84.6 98.5 104 8.6 11.3 4.9 23.8 54 85.4 73.7 92.4 104 74.1 *** 69.0 53.1 81.4 54 71.7 57.9 82.3 104 2.7 31.2 19.1 46.6 54 51.0 38.4 63.4 104 19.8 Northern 90.8 77.9 96.5 60 87.9 74.5 94.8 110 -2.9 16.7 9.1 28.5 60 96.0 84.2 99.1 110 79.3 *** 65.6 51.2 77.6 60 79.7 66.7 88.5 110 14.1 47.9 34.0 62.2 60 78.5 64.3 88.1 110 30.6 *  Lake 86.8 77.2 92.8 107 85.3 76.8 91.1 199 -1.5 12.3 7.0 20.7 107 40.8 31.7 50.5 199 28.5 *** 67.8 56.8 77.1 107 77.0 67.4 84.4 199 9.2 18.5 11.5 28.2 107 56.4 46.2 66.2 199 37.9 ***Total 91.4 88.0 93.9 451 86.2 82.9 89.0 905 -5.2 16.5 13.1 20.6 451 76.2 72.6 79.4 905 59.7 *** 69.8 64.7 74.4 451 79.6 75.5 83.1 905 9.8 ** 41.6 36.7 46.6 451 67.3 63.0 71.4 905 25.7 ***

Equipment summary score2 

2006 TSPA 2014-15 TSPA 

% LB UB N % LB UB N Diff.1 Sig

Facility type3  Hospital 80.8 76.0 85.6 24 82.6 81.2 84.0 44 0.4 Health Center 53.5 45.0 62.0 48 64.6 62.6 66.7 109 9.1 *  Dispensary 35.5 34.1 36.9 379 48.1 46.5 49.8 746 11.0 ***Managing authority  Public 37.4 35.9 38.8 365 49.6 48.1 51.1 756 10.7 *** Private or other 49.9 44.2 55.5 85 63.5 59.1 67.9 149 9.2 ***Province4 Eastern 46.8 41.9 51.6 56 58.4 54.0 62.8 115 7.2 **  Western 35.5 31.5 39.4 37 50.7 46.1 55.3 85 10.6 *** Southern 38.0 34.7 41.3 30 50.5 46.0 55.0 66 8.0 *** Southern Highlands 49.3 43.7 54.9 55 54.3 50.9 57.6 115 1.6 *  SW Highlands 42.7 38.4 47.0 49 52.0 48.1 55.8 103 5.4 **  Central 33.5 29.6 37.5 54 48.0 44.8 51.3 104 11.3 *** Northern 40.1 35.3 44.9 60 58.8 54.4 63.1 110 14.3 *** Lake 34.5 31.6 37.5 107 45.8 42.3 49.2 199 7.8 ***Total 39.8 38.2 41.3 451 51.9 50.5 53.3 905 10.7 ***LB and UB are the lower and upper boundaries of 95% confidence intervals. 1 Percentage point difference between survey years with significance tests for the difference in proportions. P-values *<0.05 **<0.01 ***<0.001 2 The Equipment Summary Score presented here will not match the score presented in the previous chapter. To preserve comparability across the two surveys, the summary excludes components that are not available in the 2006 survey (i.e. blood pressure apparatus). 3 In general, this report uses the categories, Hospital, Health Center, and Dispensary or Clinic. However, the 2014-15 TSPA included 19 clinics while the 2006 TSPA included none. To examine trends by type of facility, we exclude the 19 clinicsand examine the trend in just dispensaries. The 19 clinics are still included in the Total. 4 Trends are not shown for Zanzibar due to the small number of normal-delivery 

facilities included in the 2006 TSPA sample (10 facilities, unweighted) and the relatively high sampling error. The facilities in Zanzibar are included in the Totals row. 
95

Table A7d. Trend in service readiness Domain C: Medicines and commodities among facilities that offer normal delivery services, Tanzania 2006 and 2014-15 SPA 

Injectable antibiotic Injectable uterotonic Skin disinfectant Magnesium sulfate 

2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 

% LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig

Facility type3 

Hospital 58.3 43.9 71.3 24 52.7 43.9 61.3 44 -5.6 88.4 76.0 94.9 24 97.2 94.2 98.7 44 8.8 87.1 71.1 94.9 24 81.2 67.8 89.8 44 -5.9 55.5 40.8 69.2 24 87.3 71.3 95.0 44 31.8 ***Health Center 14.4 6.0 30.5 48 36.0 30.8 41.5 109 21.6 * 18.4 7.5 38.4 48 88.1 84.3 91.1 109 69.7 *** 75.1 58.4 86.6 48 71.6 66.5 76.2 109 -3.5 0.0 48 66.8 61.3 71.8 109 66.8Dispensary 6.5 4.1 10.0 379 30.3 25.5 35.6 746 23.8 *** 4.7 2.8 7.9 379 76.2 71.3 80.6 746 71.5 *** 69.3 63.6 74.4 379 58.3 52.8 63.6 746 -11.0 ** 0.7 0.2 2.9 379 34.2 29.4 39.4 746 33.5 ***

Managing authority 

Public 4.6 2.9 7.2 365 32.4 27.8 37.3 756 27.8 *** 3.6 2.5 5.2 365 78.8 74.2 82.8 756 75.2 *** 72.9 67.3 77.8 365 59.2 54.0 64.1 756 -13.7 ** 2.8 1.8 4.2 365 39.4 34.9 44.1 756 36.6 ***Private or other 33.3 23.1 45.4 85 30.8 22.5 40.5 149 -2.5 40.0 29.2 52.0 85 78.9 67.4 87.1 149 38.9 *** 62.0 49.5 73.1 85 70.9 60.2 79.7 149 8.9 6.7 3.3 12.9 85 47.6 37.2 58.2 149 40.9 ***

Province4

Eastern 14.8 7.5 27.1 56 26.7 15.9 41.2 115 11.9 15.4 8.0 27.4 56 73.0 59.3 83.4 115 57.6 *** 52.8 37.4 67.7 56 60.4 45.3 73.7 115 7.6 5.9 2.8 11.7 56 49.2 35.7 62.9 115 43.3 ***Western 5.0 1.1 20.4 37 42.3 29.1 56.7 85 37.3 ** 2.1 1.1 3.7 37 71.5 56.6 82.8 85 69.4 *** 58.2 39.0 75.3 37 63.4 48.7 76.0 85 5.2 6.2 1.8 19.4 37 41.3 29.5 54.2 85 35.1 **Southern 3.8 1.8 8.0 30 35.8 22.7 51.5 66 32.0 *** 5.1 2.8 8.8 30 74.4 58.5 85.7 66 69.3 *** 78.1 56.8 90.7 30 72.3 56.9 83.8 66 -5.8 1.7 0.7 4.1 30 51.2 36.1 66.0 66 49.5 ***Southern Highlands 18.0 9.3 32.1 55 22.1 13.7 33.5 115 4.1 14.3 6.0 30.1 55 85.0 73.2 92.1 115 70.7 *** 92.7 79.5 97.7 55 42.6 31.3 54.7 115 -50.1 *** 1.5 0.5 4.3 55 36.3 25.5 48.8 115 34.8 ***SW Highlands 6.1 2.0 16.9 49 50.0 36.6 63.4 103 43.9 *** 5.7 2.3 13.8 49 87.5 72.1 95.0 103 81.8 *** 75.8 59.3 87.1 49 64.9 49.2 77.9 103 -10.9 3.2 0.9 10.7 49 57.2 42.2 71.0 103 54.0 ***Central 5.3 1.7 15.2 54 35.1 24.2 47.8 104 29.8 ** 5.9 2.4 13.5 54 81.8 69.2 90.0 104 75.9 *** 71.4 55.5 83.2 54 55.9 44.4 66.8 104 -15.5 6.1 2.2 15.7 54 21.6 13.9 31.8 104 15.5 *Northern 12.8 6.3 24.5 60 35.6 23.0 50.6 110 22.8 * 12.1 6.4 21.8 60 87.8 74.3 94.7 110 75.7 *** 75.0 60.3 85.6 60 70.5 55.5 82.0 110 -4.5 1.8 1.0 3.0 60 42.3 29.9 55.8 110 40.5 ***Lake 9.0 4.5 17.4 107 23.0 15.7 32.4 199 14.0 * 13.9 8.3 22.4 107 71.7 61.3 80.1 199 57.8 *** 66.2 54.8 75.9 107 62.9 52.6 72.2 199 -3.3 2.5 1.5 4.3 107 34.2 26.6 42.8 199 31.7 ***

Total 10.0 7.5 13.3 451 32.1 28.0 36.5 905 22.1 *** 10.5 8.0 13.7 451 78.8 74.7 82.4 905 68.3 *** 70.8 65.8 75.4 451 61.1 56.5 65.5 905 -9.7 * 3.5 2.5 5.0 451 40.8 36.6 45.0 905 37.3 ***

IV solution with infusion set Antibiotic eye ointment 

Medicines and commodities 

summary score2 

2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 2006 TSPA 2014-15 TSPA 

% LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig

Facility type3 

Hospital 82.7 69.2 91.0 24 85.8 70.7 93.8 44 3.1 41.4 28.4 55.7 24 45.7 37.8 53.8 44 4.3 68.9 61.8 76.0 24 75.0 72.6 77.4 44 6.1Health Center 56.3 38.9 72.3 48 69.0 63.7 73.8 109 12.7 27.2 13.8 46.6 48 33.5 28.5 39.0 109 6.3 31.9 24.1 39.7 48 60.8 57.7 64.0 109 28.9 ***Dispensary 27.4 22.6 32.9 379 42.6 37.2 48.2 746 15.2 *** 45.6 40.4 50.9 379 25.9 21.6 30.9 746 -19.7 *** 25.7 23.7 27.7 379 44.6 41.5 47.7 746 18.9 ***

Managing authority 

Public 28.9 23.9 34.4 365 44.5 39.5 49.7 756 15.6 *** 46.9 41.5 52.4 365 24.3 20.3 28.7 756 -22.6 *** 26.6 24.7 28.5 365 46.4 43.5 49.3 756 19.8 ***Private or other 52.9 40.8 64.7 85 66.7 54.7 76.8 149 13.8 ns 28.3 18.9 40.1 85 47.3 36.7 58.2 149 19.0 37.2 30.4 44.0 85 57.0 49.6 64.5 149 19.8 ***

Province4

Eastern 35.1 22.2 50.5 56 46.1 32.6 60.3 115 11.0 2.2 0.4 10 56 30.4 19.2 44.5 115 28.2 ** 21.0 14.8 27.2 56 47.6 38.5 56.8 115 26.6 ***Western 28.0 14.6 46.9 37 41.6 28.5 55.9 85 13.6 88.5 70.4 96.1 37 9.7 4.2 21.0 85 -78.8 *** 31.3 25.5 37.2 37 45.0 36.7 53.2 85 13.7 **Southern 43.8 24.9 64.7 30 29.6 18.1 44.5 66 -14.2 74.3 53.8 87.8 30 10.0 3.9 23.1 66 -64.3 *** 34.5 28.5 40.4 30 45.6 36.4 54.8 66 11.1 *Southern Highlands 48.4 33.6 63.5 55 50.0 37.5 62.5 115 1.6 54.7 39.0 69.5 55 47.5 36.3 58.9 115 -7.2 38.3 32.9 43.7 55 47.2 40.6 53.9 115 8.9 *SW Highlands 27.8 15.9 43.9 49 62.7 46.9 76.2 103 34.9 * 82.4 67.1 91.5 49 46.2 33.4 59.5 103 -36.2 ** 33.5 28.9 38.1 49 61.4 54.0 68.9 103 27.9 ***Central 14.1 6.3 28.4 54 47.8 35.3 60.5 104 33.7 ** 31.1 18.9 46.5 54 29.1 18.7 42.2 104 -2.0 22.3 17.4 27.2 54 45.2 38.0 52.4 104 22.9 ***Northern 36.9 24.4 51.5 60 55.5 40.8 69.4 110 18.6 30.4 18.8 45.1 60 34.5 22.2 49.3 110 4.1 28.2 23.2 33.2 60 54.4 46.3 62.5 110 26.2 ***Lake 34.0 24.6 44.8 107 44.4 35.1 54.0 199 10.4 30.5 21.5 41.4 107 16.6 10.6 24.9 199 -13.9 26.0 21.2 30.9 107 42.1 36.9 47.3 199 16.1 ***

Total 33.4 28.8 38.4 451 48.2 43.6 52.8 905 14.8 *** 43.4 38.6 48.3 451 28.0 24.3 32.1 905 -15.4 *** 28.6 26.7 30.6 451 48.2 45.6 50.8 905 19.6 ***LB and UB are the lower and upper boundaries of 95% confidence intervals. 1 Percentage point difference between survey years with significance tests for the difference in proportions. P-values *<0.05 **<0.01 ***<0.001 2 The Equipment Summary Score presented here will not match the score presented in the previous chapter. To preserve comparability across the two surveys, the summary excludes components that are 

not available in the 2006 survey (i.e. blood pressure apparatus). 3 In general, this report uses the categories, Hospital, Health Center, and Dispensary or Clinic. However, the 2014-15 TSPA included 19 clinics while the 2006 TSPA included none. To examine trends by type of facility, we exclude the 19 clinics and examine the trend in just dispensaries. The 19 clinics are still included in the Total. 4 Trends are not shown for Zanzibar due to the small number of normal-delivery facilities included in the 2006 TSPA sample (10 facilities, unweighted) and the relatively high sampling error. The facilities in Zanzibar are included in the Totals row.
96

Table A7e. Trend in service readiness Domain D: Guidelines and staffing among facilities that offer normal delivery services, Tanzania 

2006 and 2014-15 SPA 

At least one provider of delivery or newborn care at facility was trained 

in each the following areas in the last 24 months: 

Training in neonatal resuscitation Training in early and exclusive breastfeeding Supervision Guidelines and staffing summary score2 

2006 TSPA 2014-15 TSPA 2006 2014-15 2006 2014-15 2006 TSPA 2014-15 TSPA 

 % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig % LB UB N % LB UB N Diff.1 Sig

Facility type3 

Hospital 41.3 28.3 55.6 24 79.0 73.1 83.9 44 37.7 *** 56.8 42.7 69.8 24 65.7 58.6 72.3 44 8.9 77.7 61.0 88.6 24 66.8 56.6 75.6 44 -10.9 48.2 39.7 56.8 24 57.4 54.2 60.5 44 9.2Health Center 11.1 4.1 26.5 48 70.5 66.1 74.6 109 59.4 *** 5.8 1.4 21.4 48 62.5 57.3 67.4 109 56.7 *** 97.1 81.6 99.6 48 76.9 71.9 81.2 109 -20.2 28.2 23.1 33.3 48 57.5 54.0 60.9 109 29.3 ***Dispensary 7.2 4.7 10.9 379 48.1 43.4 52.8 746 40.9 *** 8.3 5.6 12.2 379 45.8 40.8 50.9 746 37.5 *** 89.9 85.7 92.9 379 77.1 72.3 81.3 746 -12.8 ** 25.7 23.9 27.5 379 44.4 41.2 47.7 746 18.7 ***

Managing 

authority 

Public 8.4 5.7 12.1 365 52.0 47.7 56.1 756 43.6 *** 9.8 6.9 13.7 365 49.2 44.6 53.8 756 39.4 *** 91.0 87.0 93.9 365 78.3 73.8 82.2 756 -12.7 27.0 25.2 28.8 365 47.1 44.2 50.1 756 20.1 ***Private or other 13.7 7.7 23.3 85 53.2 42.4 63.7 149 39.5 *** 13.8 8.0 22.8 85 46.2 35.7 57.1 149 32.4 *** 85.5 74.9 92.1 85 67.3 56.6 76.5 149 -18.2 * 27.7 23.2 32.2 85 43.6 36.5 50.8 149 15.9 **

Province4

Eastern 7.2 2.8 17.2 56 64.9 50.2 77.2 115 57.7 *** 9.2 4.2 18.9 56 50.5 36.7 64.2 115 41.3 *** 77.4 61.8 87.8 56 62.0 48.8 73.6 115 -15.4 24.0 18.7 29.3 56 50.0 41.1 58.9 115 26.0 ***Western 11.8 4.1 29.7 37 79.5 66.8 88.2 85 67.7 *** 20.0 8.8 39.2 37 74.6 60.5 85.0 85 54.6 *** 88.5 69.7 96.3 37 81.0 67.0 89.9 85 -7.5 30.2 23.1 37.3 37 62.4 53.1 71.8 85 32.2 ***Southern 25.3 11.9 45.8 30 46.8 34.5 59.4 66 21.5 25.7 12.2 46.2 30 35.4 23.1 49.9 66 9.7 91.0 71.0 97.7 30 82.1 67.1 91.1 66 -8.9 35.6 28.9 42.3 30 42.0 34.4 49.7 66 6.4Southern 

Highlands 3.5 0.9 13.4 55 74.6 62.6 83.8 115 71.1 *** 1.6 0.6 4.3 55 67.6 54.8 78.3 115 66.0 *** 95.3 83.1 98.8 55 65.9 53.4 76.6 115 -29.4 ** 25.1 23.0 27.2 55 54.4 46.7 62.1 115 29.3 *** 

SW Highlands 8.9 3.1 23.2 49 36.2 23.5 51.2 103 27.3 * 12.1 4.9 26.8 49 43.6 29.4 59.0 103 31.5 * 75.2 58.8 86.6 49 85.9 70.1 94.1 103 10.7 26.8 20.5 33.1 49 41.8 31.6 52.0 103 15.0 *Central 1.9 0.3 10.5 54 43.7 34.7 53.1 104 41.8 *** 2.3 0.5 9.6 54 43.3 34.3 52.8 104 41.0 *** 83.2 69.2 91.6 54 77.9 66.1 86.5 104 -5.3 22.6 19.4 25.8 54 43.1 36.4 49.8 104 20.5 ***Northern 11.6 5.4 23.0 60 78.1 62.7 88.4 110 66.5 *** 11.6 5.4 23.0 60 69.9 55.0 81.5 110 58.3 *** 90.6 78.8 96.1 60 75.8 62.6 85.4 110 -14.8 28.6 24.5 32.6 60 57.4 49.1 65.8 110 28.8 ***Lake 11.2 5.9 20.3 107 19.9 13.8 27.8 199 8.7 11.5 6.2 20.1 107 23.6 16.7 32.2 199 12.1 87.1 77.6 92.9 107 81.5 72.9 87.8 199 -5.6 27.9 24.2 31.6 107 32.8 28.3 37.2 199 4.9

Total 9.4 6.9 12.7 451 52.2 48.2 56.1 905 42.8 *** 10.6 7.9 14.0 451 48.7 44.5 52.9 905 38.1 *** 90.0 86.4 92.8 451 76.5 72.5 80.1 905 -13.5 ** 27.1 25.5 28.8 451 46.6 43.9 49.3 905 19.5 ** LB and UB are the lower and upper boundaries of 95% confidence intervals. 1 Percentage point difference between survey years with significance tests for the difference in proportions. P-values *<0.05 **<0.01 ***<0.001 2 The Equipment Summary Score presented here will not match the score presented in the previous chapter. To preserve comparability across the two surveys, the summary excludes components that are not available in the 2006 survey (i.e. blood pressure 

apparatus). 3 In general, this report uses the categories, Hospital, Health Center, and Dispensary or Clinic. However, the 2014-15 TSPA included 19 clinics while the 2006 TSPA included none. To examine trends by type of facility, we exclude the 19 clinics and examine 

the trend in just dispensaries. The 19 clinics are still included in the Total.

4 Trends are not shown for Zanzibar due to the small number of normal-delivery facilities included in the 2006 TSPA sample (10 facilities, unweighted) and the relatively high sampling error. The facilities in Zanzibar are included in the Totals row.