Appeendix A Review of HeaRalth IFacfity Sirveyp This appendix provides an overview of health facility surveys. It offers brief descriptions of the respective surveys. This review does not purport to be comprehensive, but seeks to cover important and accessible facility survey initiatives in the health sector. Where appropriate, references to background reading and research output based on survey data are provided.

# _JD)emographic and Health Surveys (DHS and DH$_

The Demographic and Health Surveys (DHS) have been an important source of individual and household level health data since 1984. The design of the DHS drew on the experiences of the World Fertility Surveys<sup>63</sup> (WFS) and the Contraceptive Prevalence Surveys (CPS), but included an expanded set of indicators in the areas of population, health, and nutrition.64 Similarly to the some of the World Fertility Surveys, many of the DHSs included tools to collect community level data. These Service Availability Modules (SAM) were not facility surveys per se, but rather collected information from "community informants". They were aimed at collecting "objective" information on the facilities and services available to women in the community, focusing, in particular, on family planning services.

More recently, detailed facility _surveys-Service Provision Assessments (SPAs)-_ have been collected within the scope of _DHS+_ activities. The objective of the SPA is to provide information about the characteristics of health services including their quality, infrastructure, utilization, and availability. The surveys can be national or subnational and can be implemented as a stand-alone assessment of services or can be linked to household survey data. Also, the SPAs are not necessarily limited to government facilities, but may be used to compare services of various providers, including private for-profit, NGO, and community health workers. Examples of SPAs include Guatemala (1997), Kenya (1999), Bangladesh (1999), and Mexico (2000).

Exaumples of SPAs and IFindings: lKemys and Tanzaniia The 1999 Kenya SPA (KSPA), focused on the availability and quality of services in the areas of family planning, sexually transmitted infections, or maternal and child health. The data were collected through community interviews, visits to health facilities, and observations of consultations. The facility data complements household data from a DHS implemented in 1998. The survey found that although contraceptive services, drugs and materials are widely available, compliance with infection control procedures, including sterilization of equipment and sterilization of needles was often poor. Also, consultation observations revealed that the diagnostic process was often unsatisfactory, clients were frequently provided with incomplete

> 63 The WFSs were a collection of intemationally comparable surveys of human fertility conducted in 41 developing countries in the late seventies and early eighties. The project was conducted by the Intemational Statistical Institute (ISI), with fundmng from USAID and UJNFPA.

> 64 In 1997 DHS changed name to _DHS+_ to reflect the integration of DHS activities under the MEASURE programme. Under this mandate, _DHS+_ is charged with collecting and analyzing demographic and health data for regional and national family planning and health programs.

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