Service Readiness Index Research Articles

Assessing HIV Care Services in Nigeria: A Comparative Study of the North-East and South-South regions of Nigeria

This study conducted a comparative case study analysis of the HIV program in Nigeria’s South-South and North-East regions of Nigeria to determine the access and quality of HIV care and treatment services. Service delivery is an essential component of the WHO Health systems framework. Data were collected from 385 respondents using structured questionnaires and analysed using descriptive and inferential statistics. The study found that the North-East region of Nigeria had significantly lower numbers of primary healthcare facilities and inpatient beds per 10,000 population compared to the South-South region. The North-East region had an average of 0.02 inpatient beds per 1,000 population, significantly below the WHO standard, while the South-South region had an average of 0.18 inpatient beds per 1,000 population, relatively closer to the WHO standard. The general service readiness score for delivering HIV program services was at least 94% in all health facilities in both the North-East and South-South regions. The HIV service readiness index for the North-East region was higher than that of the South-South region, with some disparities in the availability of national ART guidelines, national HIV counselling and testing guidelines, staff training, and availability of HIV prevention services. HIV testing and counselling services were described as readily available and accessible in both regions, with some communities taking ownership of promoting the availability of these services. However, both regions had a relatively high service readiness score for delivering HIV program services, with some disparities in the availability of national guidelines and training of staff. These findings demonstrate extensive investment of government and donor agencies in delivering quality HIV services with areas to improve to ensure alignment with WHO system strengthening framework. Keywords: Health systems, HIV, North-East, Service delivery, South-South, WHO.

Community and facility-level barriers to achieving UHC in Kono District, Sierra Leone and Maryland County, Liberia.

Universal Health Coverage (UHC) is achieved when individuals and communities receive the health services they need without suffering financial hardship. However, many countries face barriers to building health systems that enable the availability of affordable, accessible care. The goal of this study was to present a model of local monitoring of barriers and to provide a roadmap for designing interventions that improve access to and use of healthcare delivery systems. We conducted household, individual, and health facility surveys in seven catchment areas in Sierra Leone and Liberia between December 2019 and March 2020. A two-stage cluster sampling method was used to sample households and individuals, and all health facilities were included. We divide access barriers into demand (patient-side care seeking behavior), supply (availability of facilities and services), and their intersection (affordability, spending, and use rates). Among the 2,576 respondents within our 1,051 surveyed households, the propensity to seek care when ill was reported at 90% in Sierra Leone (n = 1,283) and 70% in Liberia (n = 806). We estimated that 31% of households spent greater than 10% of their total expenditure on healthcare in a month, and that 14.5% of households spent greater than 25%. Overall, the general service readiness index mean score for all health centers was around 70%. The greatest hindrance to service readiness was the availability of essential medicines, with facilities reporting an average score of 32% in Sierra Leone and 63% in Liberia. Our evidence suggests that the cost of care is both a barrier to care-seeking and a persisting problem among care-seeking patients. Lack of service availability (essential equipment and medicines), poses a risk to high-quality care. The research team recommends deploying interventions (visit cost subsidies, supply chain improvements) targeted at resolving these issues in order to advance the goal of achieving UHC.

Health facility readiness to provide antenatal care (ANC) and non-communicable disease (NCD) services in Nepal and Bangladesh: Analysis of facility-based surveys.

Antenatal care (ANC) visits provide an important opportunity for diagnostic, preventive, and curative services for non-communicable diseases (NCDs) during pregnancy. There is an identified need for an integrated, system-wide approach to provide both ANC and NCD services to improve maternal and child health outcomes in the short and long term. This study assessed the readiness of health facilities to provide ANC and NCD services in Nepal and Bangladesh, identified as low-and middle-income countries. The study used data from national health facility surveys in Nepal (n = 1565) and Bangladesh (n = 512) assessing recent service provision under the Demographic and Health Survey programs. Using the WHO's service availability and readiness assessment framework, the service readiness index was calculated across four domains: staff and guidelines, equipment, diagnostic, and medicines and commodities. Availability and readiness are presented as frequency and percentages, while factors associated with readiness were examined using binary logistic regression. Of the facilities, 71% in Nepal, and 34% in Bangladesh reported offering both ANC and NCD services. The proportion of facilities which showed readiness for providing ANC and NCD services was 24% in Nepal and 16% in Bangladesh. Gaps in readiness were observed in the availability of trained staff, guidelines, basic equipment, diagnostics, and medicines. Facilities managed by the private sector or a Non-Governmental Organization, located in an urban area, with management systems to support the delivery of quality services were positively associated with readiness to provide both ANC and NCD services. There is a need to strengthen the health workforce by ensuring skilled personnel, having policy, guidelines and standards, and that diagnostics, medicines, and commodities are available/provided in health facilities. Management and administrative systems are also required, including supervision and staff training, to enable health services to provide integrated care at an acceptable level of quality.

Noncommunicable Diseases Healthcare-Specific Service Readiness at the Primary Health-care Centers in Ekiti State, Nigeria

Background: Noncommunicable diseases (NCDs) have been highlighted as a major challenge for sustainable development and an alarming public health challenge of global concern. This study was aimed at assessing the PHC facilities' readiness to provide NCDs management services in Ekiti state, Nigeria. Methodology: A descriptive cross-sectional study was conducted among PHCs in Ekiti state between August and October 2020 in 177 PHC facilities using some components of the World Health Organization's Service Availability and Readiness Assessment tool. Analysis was done using STATA SE 12. Statistical significance was set at a P < 0.05. Results: Majority (95%) of the primary health-care facilities were located in rural areas. Approximately 19% were in Ekiti North II and Ekiti Central II constituencies, and the majority (95%) were health centers. Only 29.4% offer management of NCDs. Among the spacers for inhalers available in 1.7% of the facilities, none were functioning and only 1.4% had equipment for NCD management and control, and 6% had trained staff and guidelines for NCD management. NCD-specific service readiness index was just 11% among the health care, facilities studied. Health-care facilities in the urban areas and the Ekiti North I had statistically significant higher NCD service readiness compared to the rural areas and the other federal constituencies, respectively (P < 0.05). Conclusion: The overall NCD-specific service readiness in Ekiti State was extremely low. The government should provide sufficient tools and equipment with trained workers that will offer adequate management of NCDs in the state.

Hepatitis C prevalence and quality of health services among HIV-positive mothers in the Democratic Republic of the Congo

Hepatitis C virus (HCV) contributes to liver-related morbidity and mortality throughout Africa despite effective antivirals. HCV is endemic in the Democratic Republic of the Congo (DRC) but data on HCV/HIV co-infection in pregnancy is limited. We estimated the prevalence of and risk factors for HCV/HIV co-infection among pregnant women in the Kinshasa province of the DRC. This cross-sectional study was conducted as a sub-study of an ongoing randomized trial to assess continuous quality improvement interventions (CQI) for prevention of mother-to-child transmission (PMTCT) of HIV (CQI-PMTCT study, NCT03048669). HIV-infected women in the CQI-PMTCT cohort were tested for HCV, and risk factors were evaluated using logistic regression. The prevalence of HCV/HIV co-infection among Congolese women was 0.83% (95% CI 0.43-1.23). Women who tested positive for HCV were younger, more likely to live in urban areas, and more likely to test positive during pregnancy versus postpartum. HCV-positive women had significantly higher odds of infection with hepatitis B virus (HBV) (aOR 13.87 [3.29,58.6]). An inverse relationship was noted between HCV infection and the overall capacity of the health facility as measured by the service readiness index (SRI) (aOR:0.92 [0.86,0.98] per unit increase). Women who presented to rural, for-profit and PEPFAR-funded health facilities were more likely to test positive for HCV. In summary, this study identified that the prevalence of HCV/HIV co-infection was < 1% among Congolese women. We also identified HBV infection as a major risk factor for HCV/HIV co-infection. Individuals with triple infection should be linked to care and the facility-related differences in HCV prevalence should be addressed in future studies.

Human immunodeficiency virus, tuberculosis and malaria service readiness at the primary healthcare centers in Ekiti State, Nigeria.

access to services encompasses three components: availability, affordability, and acceptability. The physical presence of service delivery, which includes health infrastructure, core health staff, and aspects of service use, is referred to as service availability. This study was conducted to inform the health service availability and preparedness to deliver HIV, TB, and malaria prevention and control services in Ekiti State. this is a descriptive cross-sectional study conducted among all the Primary Health Centres (177) in Ekiti State Nigeria between August and October 2020. Data were collected with the use of the World Health Organization Service Availability and Readiness Assessment tool and were analyzed using STATA SE 12. close to half (49%) of them had a condom in supply. More than 90% of them provided diagnosis and treatment of malaria. The HIV-specific service readiness index was approximately 40/0%. Only 26.6% of health facilities were ready to offer TB prevention and control services. Malaria specific service readiness index was 61.9%. There was a statistically significant difference in the HIV and TB-specific service readiness of facilities in the urban compared to rural locations. Health facilities located in the urban areas had higher mean readiness scores compared to those in the other residential areas (P=0.014). it is evident that HIV and TB-specific service readiness is very poor among PHCs in Ekiti State. Malaria Service Readiness was fair. Ekiti State government needs to expand investments in PHCs by strengthening the diagnostic services, commodities and medicine supply, adequate equipment and staff training.

Does facility readiness promote high-quality of provider-initiated HIV testing and counseling to pregnant women? A national survey for improving policy of prevention of mother-to-child transmission of HIV in Tanzania

BackgroundProvider-initiated HIV testing and counseling (PITC) is a recommended approach to screen for HIV to all pregnant women during antenatal care (ANC) visits, and all with HIV positive results have to be enrolled into prevention of mother-to-child transmission of HIV (PMTCT) program. However, little is known about the relationship between facility readiness and the uptake of PITC to pregnant women attending ANC in Tanzania. Therefore, this study assessed whether the facility readiness promotes the uptake of PITC to the pregnant women attending ANC for the purpose of improving the PMTCT interventions in Tanzania.MethodsThis study analyzed data for health facilities obtained from the 2014–2015 Tanzania service provision assessment survey. The Primary outcome measure was a composite variable (with score of 0–5) in which its higher scores indicates provision of high-quality of PITC. Also, facilities scored higher in the PMTCT service readiness index were considered to have high readiness to provide PMTCT services. In Poisson regression analyses, a series of models were fitted to assess whether there is an association between provision of high-quality of PITC and facility readiness. In all statistical analysis, a P < 0.05 was considered significant.ResultsOut of 1853 included first-visit ANC consultations, only about one-third of pregnant women received all five components required for PITC. The mean percentage of PMTCT readiness score was moderate 63.96 [61.32–66.59]%. In adjusted model, we found that facility with high readiness to provide PMTCT services was significantly associated with the provision of high-quality of PITC (model 2: [β = 0.075, P = 0.00]).ConclusionIn order to increase high-quality of PITC services, efforts should be made to improve the PMTCT facility readiness by increasing availability of trained staffs, diagnostic tools, and ARTs among health facilities in Tanzania.

Health extension workers’ perceived health system context and health post preparedness to provide services: a cross-sectional study in four Ethiopian regions

ObjectiveThe health system context influences the implementation of evidence-based practices and quality of healthcare services. Ethiopia aims at reaching universal health coverage but faces low primary care utilisation and substandard...

Constructing a malaria-related health service readiness index and assessing its association with child malaria mortality: an analysis of the Burkina Faso 2014 SARA data

BackgroundThe Service Availability and Readiness Assessment surveys generate data on the readiness of health facility services. We constructed a readiness index related to malaria services and determined the association between health facility malaria readiness and malaria mortality in children under the age of 5 years in Burkina Faso.MethodsData on inpatients visits and malaria-related deaths in under 5-year-old children were extracted from the national Health Management Information System in Burkina Faso. Bayesian geostatistical models with variable selection were fitted to malaria mortality data. The most important facility readiness indicators related to general and malaria-specific services were determined. Multiple correspondence analysis (MCA) was employed to construct a composite facility readiness score based on multiple factorial axes. The analysis was carried out separately for 112 medical centres and 546 peripheral health centres.ResultsMalaria mortality rate in medical centres was 4.8 times higher than that of peripheral health centres (3.5% vs. 0.7%, p < 0.0001). Essential medicines was the domain with the lowest readiness (only 0.1% of medical centres and 0% of peripheral health centres had the whole set of tracer items of essential medicines). Basic equipment readiness was the highest. The composite readiness score explained 30 and 53% of the original set of items for medical centres and peripheral health centres, respectively. Mortality rate ratio (MRR) was by 59% (MRR = 0.41, 95% Bayesian credible interval: 0.19–0.91) lower in the high readiness group of peripheral health centres, compared to the low readiness group. Medical centres readiness was not related to malaria mortality. The geographical distribution of malaria mortality rate indicate that regions with health facilities with high readiness show lower mortality rates.ConclusionPerformant health services in Burkina Faso are associated with lower malaria mortality rates. Health system readiness should be strengthened in the regions of Sahel, Sud-Ouest and Boucle du Mouhoun. Emphasis should be placed on improving the management of essential medicines and to reducing delays of emergency transportation between the different levels of the health system.

Readiness of health facilities for the outpatient management of non-communicable diseases in a low-resource setting: an example from a facility-based cross-sectional survey in Tanzania

ObjectiveThis study assessed the readiness of health facilities to provide outpatient management of non-communicable diseases using a nationally representative sample of health facilities from Tanzania as an example of a...

General and tuberculosis-specific service readiness in two states in Nigeria

BackgroundTuberculosis is the world’s deadliest infectious disease and a leading cause of death in Nigeria. The availability of a functional healthcare system is critical for effective TB service delivery and attainment of national and global targets. This study was designed to assess readiness for TB service delivery in Oyo and Anambra states of Nigeria.MethodsThis was a facility-based study with a mixed-methods convergent parallel design. A multi-stage sampling technique was used to select 42 primary, secondary, and tertiary healthcare facilities in two TB high burden states. Data were collected using key informant interviews, a semi-structured instrument adapted from the WHO Service Availability and Readiness Assessment tool and facility observation using a checklist. Quantitative data were analysed using descriptive and inferential statistics while qualitative data were transcribed and analysed thematically. Data from both sources were integrated to generate conclusions.ResultsThe domain score for basic amenities in both states was 48.8%; 47.0% in Anambra and 50.8% in Oyo state with 95% confidence interval [− 15.29, 7.56]. In Oyo, only half of the facilities (50%) had access to constant power supply compared to 72.7% in Anambra state. The overall general service readiness index for both states was 69.2% with Oyo state having a higher value (73.3%) compared to Anambra with 65.4% (p = 0.56). The domain score for availability of staff and TB guidelines was 57.1% for both states with 95% confidence interval [− 13.8, 14.4]. Indicators of this domain with very low values were staff training for the management of HIV and TB co-infection and training on MDR -TB. Almost half (47.6%) of the facilities experienced a stock out of TB drugs in the 3 months preceding the study. The overall tuberculosis-specific service readiness index for both states was 75%; this was higher in Oyo (76.5%) than Anambra state (73.6%) (p = 0.14). Qualitative data revealed areas of deficiencies for TB service delivery such as inadequate infrastructure, poor staffing, and gaps with continuing education on TB management.ConclusionsThe weak health system remains a challenge and there must be concerted actions and funding by the government and donors to improve the TB healthcare systems.

Free and universal access to primary healthcare in Mongolia: the service availability and readiness assessment

BackgroundThe government of Mongolia mandates free access to primary healthcare (PHC) for its citizens. However, no evidence is available on the physical presence of PHC services within health facilities. Thus, the present study assessed the capacity of health facilities to provide basic services, at minimum standards, using a World Health Organization (WHO) standardized assessment tool.MethodsThe service availability and readiness assessment (SARA) tool was used, which comprised a set of indicators for defining whether a health facility meets the required conditions for providing basic or specific services. The study examined all 146 health facilities in Chingeltei and Khan-Uul districts of Ulaanbaatar city, including private and public hospitals, family health centers (FHCs), outpatient clinics, and sanatoriums. The assessment questionnaire was modified to the country context, and data were collected through interviews and direct observations. Data were analyzed using SPSS 21.0, and relevant nonparametric tests were used to compare median parameters.ResultsA general service readiness index, or the capacity of health facilities to provide basic services at minimum standards, was 44.1% overall and 36.3, 61.5, and 62.4% for private clinics, FHCs, and hospitals, respectively. Major deficiencies were found in diagnostic capacity, supply of essential medicines, and availability of basic equipment; the mean scores for general service readiness was 13.9, 14.5 and 47.2%, respectively. Availability of selected PHC services was 19.8%. FHCs were evaluated as best capable (69.5%) to provide PHC among all health facilities reviewed (p < 0.001). Contribution of private clinics and sanatoriums to PHC service provisions were minimal (4.1 and 0.5%, respectively). Service-specific readiness among FHCs for family planning services was 44.0%, routine immunization was 83.6%, antenatal care was 56.5%, preventive and curative care for children was 44.5%, adolescent health services was 74.2%, tuberculosis services was 53.4%, HIV and STI services was 52.2%, and non-communicable disease services was 51.7%.ConclusionsUniversal access to PHC is stipulated throughout various policies in Mongolia; however, the present results revealed that availability of PHC services within health facilities is very low. FHCs contribute most to providing PHC, but readiness is mostly hampered by a lack of diagnostic capacity and essential medicines.

Health system measurement: Harnessing machine learning to advance global health.

BackgroundFurther improvements in population health in low- and middle-income countries demand high-quality care to address an increasingly complex burden of disease. Health facility surveys provide an important but costly source of information on readiness to provide care. To improve the efficiency of health system measurement, we applied unsupervised machine learning methods to assess the performance of the service readiness index (SRI) defined by the World Health Organization and compared it to empirically derived indices.MethodsWe drew data from nationally representative Service Provision Assessment surveys conducted in 10 countries between 2007 and 2015. We extracted 649 items in domains such as infrastructure, medication, and management to calculate an index using all available information and classified facilities into quintiles. We compared three approaches against the full item set: the SRI, a new index based on sequential backward selection, and an enriched SRI that added empirically selected items to the SRI. We evaluated index performance with a cross-validated kappa statistic comparing classification using the candidate index against the 649-item index.Results9238 facilities were assessed. The 49-item SRI performed poorly against the index using all 649 items, with a kappa value of 0.35. New empirically derived indices with 50 and 100 items captured much more information, with cross-validated kappa statistics of 0.71 and 0.80, respectively. Items varied across the indices and in sensitivity analyses. A 100-item enriched SRI reliably captured the information from the full index: 83% of the facilities were classified into correct quintiles of service readiness based on the full index.ConclusionA facility readiness measure developed by global health experts performed poorly in capturing the totality of readiness information collected during facility surveys. Using a machine learning approach with sequential selection and cross-validation to identify the most informative items dramatically improved performance. Such approaches can make assessment of health facility readiness more efficient. Further improvements in measurement will require identification of external criteria—such as patient outcomes—to guide and validate measure development.

General service and child immunization-specific readiness assessment of healthcare facilities in two selected divisions in Bangladesh

BackgroundService readiness of health facilities is an integral part of providing comprehensive quality healthcare to the community. Comprehensive assessment of general and service-specific (i.e. child immunization) readiness will help to identify the bottlenecks in healthcare service delivery and gaps in equitable service provision. Assessing healthcare facilities readiness also helps in optimal policymaking and resource allocation.MethodsA health facility survey was conducted between March 2015 and December 2015 in two purposively selected divisions in Bangladesh; i.e. Rajshahi division (high performing) and Sylhet division (low performing). A total of 123 health facilities were randomly selected from different levels of service, both public and private, with variation in sizes and patient loads from the list of facilities. Data on various aspects of healthcare facility were collected by interviewing key personnel. General service and child immunization specific service readiness were assessed using the Service Availability and Readiness Assessment (SARA) manual developed by World Health Organization (WHO). The analyses were stratified by division and level of healthcare facilities.ResultsThe general service readiness index for pharmacies, community clinics, primary care facilities and higher care facilities were 40.6%, 60.5%, 59.8% and 69.5%, respectively in Rajshahi division and 44.3%, 57.8%, 57.5% and 73.4%, respectively in Sylhet division. Facilities at all levels had the highest scores for basic equipment (ranged between 51.7% and 93.7%) and the lowest scores for diagnostic capacity (ranged between 0.0% and 53.7%). Though facilities with vaccine storage capacity had very high levels of service readiness for child immunization, facilities without vaccine storage capacity lacked availability of many tracer items. Regarding readiness for newly introduced pneumococcal conjugate vaccine (PCV) and inactivated polio vaccine (IPV), most of the surveyed facilities reported lack of sufficient funding and resources (antigen) for training programs.ConclusionsOur study suggested that health facilities suffered from lack of readiness in various aspects, most notably in diagnostic capacity. Conversely, with very few challenges, nearly all the health facilities designated to provide immunization services were ready to deliver routine childhood immunization services as well as newly introduced PCV and IPV.

A cross-sectional study of malaria endemicity and health system readiness to deliver services in Kenya, Namibia and Senegal.

Despite good progress towards elimination, malaria continues to contribute substantially to the sub-Saharan African disease burden. Sustaining previous gains requires continued readiness to deliver malaria services in response to actual disease burden, which in turn contributes to health systems strengthening. This study investigates a health system innovation. We examined whether malaria prevalence, or endemicity, is a driver of health facility readiness to deliver malaria services. To estimate this association, we geo-linked cross-sectional facility survey data to endemicity data for Kenya, Namibia and Senegal. We tested the validity and reliability of the primary study outcome, the malaria service readiness index and mapped service readiness components in a geographic information system. We conducted a weighted multivariable linear regression analysis of the relationship between endemicity and malaria service readiness, stratified for urban or rural facility location. As endemicity increased in rural areas, there was a concurrent, modest increase in service readiness at the facility level [β: 0.028; (95% CI 0.008, 0.047)], whereas no relationship existed in urban settings. Private-for-profit facilities were generally less prepared than public [β: -0.102; (95% CI - 0.154, -0.050)]. Most facilities had the necessary supplies to diagnose malaria, yet availability of malaria guidelines and adequately trained staff as well as medicines and commodities varied. Findings require cautious interpretation outside the study sample, which was a more limited subset of the original surveys' sampling schemes. Our approach and findings may be used by national malaria programs to identify low performing facilities in malarious areas for targeted service delivery interventions. This study demonstrates use of existing data sources to evaluate health system performance and to identify within- and cross-country variations for targeted interventions.

A Study on Service Availability and Readiness Assessment of Non-Communicable Diseases Using the WHO Tool for Gazipur District in Bangladesh

Non-communicable diseases (NCDs) disproportionately affect low and middle-income countries where nearly three quarters of NCD deaths occur. Bangladesh is also in NCD burden. This cross-sectional study was done on 50 health facilities centres at Gazipur district in Bangladesh from July 2015 to December 2015 to introduce SARA for better monitoring and evaluation of non-communicable diseases health service delivery. The General Service readiness index score was 61.52% refers to the fact that about 62% of all the facilities were ready to provide general services like basic amenities, basic equipment, standard precautions for infection prevention, and diagnostic capacity and essential medicines to the patients. But in case of non-communicable diseases, among all the health facilities 40% had chronic respiratory disease and cardiovascular diseases diagnosis/ management and only 32% had availability of diabetes diagnosis/management. Overall readiness score was 52% in chronic respiratory disease, 73% in cardiovascular disease and 70% in diabetes. Therefore, service availability and readiness of the health facilities to provide NCD related health services were not up to the mark for facing future targets. A full-scale census survey of all the facilities of the study area would give a better understanding of the availability and service readiness.