Abstract
BackgroundService Provision Assessment (SPA) surveys have been conducted to gauge primary health care and family planning clinical readiness throughout East and South Asia as well as sub-Saharan Africa. Intended to provide useful descriptive information on health system functioning to supplement the Demographic and Health Survey data, each SPA produces a plethora of discrete indicators that are so numerous as to be impossible to analyze in conjunction with population and health survey data or to rate the relative readiness of individual health facilities. Moreover, sequential SPA surveys have yet to be analyzed in ways that provide systematic evidence that service readiness is improving or deteriorating over time.MethodsThis paper presents an illustrative analysis of the 2006 Tanzania SPA with the goal of demonstrating a practical solution to SPA data utilization challenges using a subset of variables selected to represent the six building blocks of health system strength identified by the World Health Organization (WHO) with a focus on system readiness to provide service. Principal Components Analytical (PCA) models extract indices representing common variance of readiness indicators. Possible uses of results include the application of PCA loadings to checklist data, either for the comparison of current circumstances in a locality with a national standard, for the ranking of the relative strength of operation of clinics, or for the estimation of trends in clinic service quality improvement or deterioration over time.ResultsAmong hospitals and health centers in Tanzania, indices representing two components explain 32 % of the common variance of 141 SPA indicators. For dispensaries, a single principal component explains 26 % of the common variance of 86 SPA indicators. For hospitals/HCs, the principal component is characterized by preventive measures and indicators of basic primary health care capabilities. For dispensaries, the principal component is characterized by very basic newborn care as well as preparedness for delivery.ConclusionsPCA of complex facility survey data generates composite scale coefficients that can be used to reduce indicators to indices for application in comparative analyses of clinical readiness, or for multi-level analysis of the impact of clinical capability on health outcomes or on survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1203-7) contains supplementary material, which is available to authorized users.
Highlights
Service Provision Assessment (SPA) surveys have been conducted to gauge primary health care and family planning clinical readiness throughout East and South Asia as well as sub-Saharan Africa
We aim to identify this commonality with “principal components analysis,” demonstrate association of indicators in the Tanzania Service Provision Assessment (TSPA) with this index, and posit uses for the index that could be applied to the monitoring of health system strength in Tanzania
Principal Components Analytical (PCA) of complex facility survey data generates composite scale coefficients that can be used to reduce a list of disparate indicators into composite indices for comparative analysis of clinical readiness, or for multi-level analysis of the impact of clinical capability on health outcomes or on survival
Summary
Service Provision Assessment (SPA) surveys have been conducted to gauge primary health care and family planning clinical readiness throughout East and South Asia as well as sub-Saharan Africa. Tanzania is on target to achieve the Millennium Development Goal (MDG) 4 of reducing child mortality by two-thirds by the end of this year [1] Evidence suggests that this trend is due at least in part to successful health system investments. A range of challenging ancillary manpower problems compound staff shortages such as inadequate training, and inappropriate deployment leading to underdevelopment of outreach services [5] Contributing to these challenges are lapses in supporting systems that lead to insufficient equipment, medicines and supplies [6]. The concatenation of these problems is challenging at the lowest tier of health facilities, the dispensary, where the quality of care is so poor that potential clientele often bypass the most convenient facility [7, 8]. Compounding limitations of routine primary health care are weaknesses in the referral, triage, logistics, and care systems that prevent the implementation of adequate emergency health services [5]
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