covering four thematic areas: health service facilities, personnel, supplies, and excess mortality (Appendix Table 1).

Evidence to aid such comprehensive planning, however, is scarce. For instance, globally there is a particular concern about health facility capacity for infection control and protection of health workers at the frontline of diagnosing and treating COVID-19. In absence of reliable, real-time data on these indicators, large-scale health facility surveys could be utilized to gauge health system preparedness in these matters. Likewise, health service delivery assessments (such as the Service Availability and Readiness Assessment (SARA),<sup>6</sup> Service Provision Assessment (SPA)<sup>7</sup> and Service Delivery Indicator (SDI) survey<sup>8</sup> ) can also help measure overall system strength for maintaining core functions while absorbing surge cases, and resilience to withstand shocks during pandemics.

# Background on the SDI surveys

Service Delivery Indicator (SDI) surveys generate nationally representative data on the quality of education and health services. The indicators enable governments and citizens to identify gaps and track progress within and across countries over time. They transform the way quality of social sector services is measured, and in so doing, how countries develop policies and design interventions to improve health and education outcomes around the globe.

The SDI program is a product of a partnership between the World Bank Group, the African Economic Research Consortium (AERC) and the William and Flora Hewlett Foundation. Since the inception of the initiative in 2010, 24 surveys have been completed in 12 countries in Africa, capturing the health and primary education service delivery experience of more than 500 million people. The surveys have been extended not only in Africa but around the globe: data collection for the first SDI surveys in Latin America, East Asia/Pacific, and South Asia is currently underway.

Information available through health SDI surveys is not readily or reliably available through routinely collected administrative data even when they exist. In some countries with weak health systems, health management information systems (HMIS) capacity is severely lacking, if not absent altogether. SDI health survey data can fill the evidence gap in such scenarios. In particular, the health SDI surveys focus on three key areas: _(i) Providers’ knowledge:_ Are health care providers accurately diagnosing and treating common health conditions, adhering to clinical guidelines?

_(ii) Providers’ effort:_ Are health care providers present at their facilities during their shifts? Are there enough staff available to see all patients?

_(iii) Inputs:_ Do health facilities have the equipment (e.g., medicines, infrastructure, supplies) and resources they need to deliver high-quality care? Are providers receiving adequate on-the-job training?

> 6 Service Availability and Readiness Assessment (SARA)

> <u>https://www.who.int/healthinfo/systems/sara_methods/en/</u>

> 7 SPA Overview https://dhsprogram.com/What-We-Do/Survey-Types/SPA.cfm

> 8 Service Delivery Indicators https://www.sdindicators.org/

3