interventions and their cost-effectiveness. As a component of this general work program, MEASURE Evaluation project has provided technical support in the design, implementation and analysis of a range of health facility surveys. Examples include Uganda and Paraguay.

# The Uganda D$S1BI suirvey

The DISH project, funded by USAID, is one of the largest reproductive health programs in Uganda. It operates in 12 of the countries 45 districts, and covers approximately 30 percent of the population. Activities under the DISP project include training, support of community reproductive health workers, capacity building in health management information systems, capacity building in financial management, and IEC activities. As a component of ongoing monitoring and evaluation work, a series of surveys have been implemented to measure changes in reproductive, maternal and child health knowledge and behavior. The DISH surveys comprise interim surveys between the 1995 and 2000 Uganda DHSs. Two survey rounds have been carried out, in 1997 and 1999. Each survey collects both household and facility data. The household component is based on reduced DHS-style questionnaires. The 1999 survey collected information from 1766 women, 1057 men and 478 facilities (including health units, drug stores and pharmacies), and information is reported on IEC, family planning, maternal health, child health and nutrition, STDs and HIV/AIDS, and health facilities (Kantende and others 1999). At facility level, survey instruments included facility interview questionnaire and a facility inventory questionnaire. In addition, separate inventory questionnaires were designed for pharmacies and drug shops. Through these instruments, information is collected on general facility characteristics (including services offered), DISH training, availability of supplies and IEC material.

# _Source_

Kantende, C., R. Bessinger, N. Gupta, R. Knight, and C. Laettenmaier. 1999. "Uganda Delivery of Improved Services for Health (DISH) Evaluation Surveys." MEASURE Evaluation Technical Report Series, No. 6.

# HIeaRlth Care Decentrafization _fi_ lParaguay

> The objectives of the study was to identify and quantify the effect of transferring management control for basic health services provision from central to municipal govermment in Paraguay on costs, efficiency, basic health service quality, and patterns of health service use and equity. The main units of analysis were public health facilities, their clients,

> municipality populations. The study uses pre- and post-decentralization design, with a control group, and focused on family planning, maternal health, and infant and child health. The first round in the survey was carried out in 1998. The survey covered 124 public and 19 private facilities and 1261 exit interviews. In addition, with a view to obtain information on socio-

> economic characteristics, health outcomes, and health care seeking behavior, a general household survey was also implemented. This was carried out as a component of the 1998 maternal and infant health survey.

At facility level, three types of questionnaires were administered: (i) short inventory questionnaire; (ii) interview with facility director or other staff member, and (iii) direct observation of availability of supplies, equipment, infrastructure, etc. In addition, a self36