Service Provision Assessment Survey 2014-2015
Tanzania, 2014 - 2015
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Reference ID
TZA_2014_SPA_v01_M
Producer(s)
National Bureau of Statistics (NBS), Office of Chief Government Statistician, Zanzibar (OCGS)
Collection(s)
Metadata
Created on
Apr 14, 2016
Last modified
Apr 14, 2016
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Identification
Survey ID Number
TZA_2014_SPA_v01_M
Title
Service Provision Assessment Survey 2014-2015
Country/Economy
| Name | Country code |
|---|---|
| Tanzania | TZA |
Study type
Service Provision Assessments [hh/spa]
Series Information
Tanzania Service Provision Assessment Survey (2014-15 TSPA) is the second facility-based survey to be conducted in Tanzania as it follows the first TSPA which was conducted in 2006. The surveys covered both Tanzania Mainland and Zanzibar.
The 2014-15 TSPA was designed to provide national-level representative results by facility type, that is, hospitals, health centres, clinics, and dispensaries. National-level representative results were also expected by management authorities, that is, public, private, faith based, and parastatals. The survey was also designed to provide representative results for each of the 25 regions in Tanzania Mainland and the 5 regions in Tanzania Zanzibar, for a total number of 30 survey regions.
The 2014-15 TSPA was designed to provide national-level representative results by facility type, that is, hospitals, health centres, clinics, and dispensaries. National-level representative results were also expected by management authorities, that is, public, private, faith based, and parastatals. The survey was also designed to provide representative results for each of the 25 regions in Tanzania Mainland and the 5 regions in Tanzania Zanzibar, for a total number of 30 survey regions.
Abstract
The 2014-15 Tanzania Service Provision Assessment (2014-15 TSPA) is an assessment of all formalsector health facilities in Tanzania. The survey was designed to provide information on the availability of basic and essential health care services and the readiness of health facilities to provide quality services to clients. The 2014-15 TSPA collected information from all facilities managed by the government, private sector, parastatal, and faith-based organisations to provide a comprehensive picture of the strengths and weaknesses of the service delivery environment for each assessed service.
The 2014-15 TSPA provides national and regional-level information for all hospitals, health centres, clinics and dispensaries that offer child health, maternal, and newborn care, family planning, and services for sexually transmitted infections (STI), non-communicable diseases (NCDs) (diabetes, cardiovascular diseases and chronic respiratory diseases), and HIV/AIDS-related conditions. For each of these services, the 2014-15 TSPA assessed whether components considered essential for quality service delivery were present and functioning. The components assessed are those commonly considered important to various programmes supported by the government and development partners. The 2014-15 TSPA also assessed whether more sophisticated components were present, such as higher-level diagnostic and treatment modalities or support systems for health services that are usually introduced after basic-level services have been put in place.
The main objectives of the 2014-15 TSPA were to:
• Assess the availability of basic and essential health services, including maternal and newborn care and child health, family planning, reproductive health services, non-communicable diseases (NCDs), as well as services for certain infectious diseases (HIV/AIDS, STIs, malaria, and TB), in Tanzanian health facilities;
• Assess the preparedness of health facilities in Tanzania to provide quality services;
• Provide comprehensive information on the performance of different types of health facilities that provide these essential services;
• Identify gaps in the support system, resources and processes used to provide health services that may limit the ability of facilities to provide quality services;
• Describe the processes followed in the provision of essential health care services and the extent to which accepted standards for quality service provision are met;
• Compare findings among regions, facility types, and managing authorities.
The 2014-15 TSPA provides national and regional-level information for all hospitals, health centres, clinics and dispensaries that offer child health, maternal, and newborn care, family planning, and services for sexually transmitted infections (STI), non-communicable diseases (NCDs) (diabetes, cardiovascular diseases and chronic respiratory diseases), and HIV/AIDS-related conditions. For each of these services, the 2014-15 TSPA assessed whether components considered essential for quality service delivery were present and functioning. The components assessed are those commonly considered important to various programmes supported by the government and development partners. The 2014-15 TSPA also assessed whether more sophisticated components were present, such as higher-level diagnostic and treatment modalities or support systems for health services that are usually introduced after basic-level services have been put in place.
The main objectives of the 2014-15 TSPA were to:
• Assess the availability of basic and essential health services, including maternal and newborn care and child health, family planning, reproductive health services, non-communicable diseases (NCDs), as well as services for certain infectious diseases (HIV/AIDS, STIs, malaria, and TB), in Tanzanian health facilities;
• Assess the preparedness of health facilities in Tanzania to provide quality services;
• Provide comprehensive information on the performance of different types of health facilities that provide these essential services;
• Identify gaps in the support system, resources and processes used to provide health services that may limit the ability of facilities to provide quality services;
• Describe the processes followed in the provision of essential health care services and the extent to which accepted standards for quality service provision are met;
• Compare findings among regions, facility types, and managing authorities.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
Health institutions, hospitals, and health centers
Scope
Notes
The 2014-2015 Tanzania Service Provision Assessment Survey covered the following topics:
FACILITY
• Facility identification
• General information and service availability
• General service readiness
HEALTH WORKER
• Identification
• Education, experience and HVB vaccination
• General training/ malaria/ non-communicable diseases
• Child health services
• Family planning services
• Material health services
• Sexually transmitted infections - TB - HIV/AIDS
• Diagnostic services
• Working conditions in facility
OBSERVATION and EXIT
1) Observation of ANC Consultation
• Facility identification
• Provider information
• Information about observation
• Observation of antenatal-care consultation
2) ANC Client Exit Interview
• Facility identification
• Information about visit - antenatal care
• Client satisfaction
• Client personal characteristics
3) Observation of Family Planning Consultation
• Facility identification
• Provider information
• Information about observation
• Observation of family planning consultation
• Clinical observation
• Pelvic examination
• IUCD insertion and/or removal
• Injectable contraceptives
• Implant insertion and/or removal
• Client's family planning status
4) FP Client Exit Interview
• Facility identification
• Information about visit - family palnning
• Client satisfaction
• Client personal characteristics
• Observation of sick child consultation
• Provider interaction with caretaker and child
• Diagnosis
• Treatment
5) Sick Child Caretaker Exit Interview
• Facility identification
• Information about visit - caretaker of sick child
o Client age
o Signs and symptoms of current illness
o Information provided to caretaker
o Treatment and caretaker comfort level
o Referral
• Client satisfaction
• Client personal characteristics
FACILITY
• Facility identification
• General information and service availability
• General service readiness
HEALTH WORKER
• Identification
• Education, experience and HVB vaccination
• General training/ malaria/ non-communicable diseases
• Child health services
• Family planning services
• Material health services
• Sexually transmitted infections - TB - HIV/AIDS
• Diagnostic services
• Working conditions in facility
OBSERVATION and EXIT
1) Observation of ANC Consultation
• Facility identification
• Provider information
• Information about observation
• Observation of antenatal-care consultation
2) ANC Client Exit Interview
• Facility identification
• Information about visit - antenatal care
• Client satisfaction
• Client personal characteristics
3) Observation of Family Planning Consultation
• Facility identification
• Provider information
• Information about observation
• Observation of family planning consultation
• Clinical observation
• Pelvic examination
• IUCD insertion and/or removal
• Injectable contraceptives
• Implant insertion and/or removal
• Client's family planning status
4) FP Client Exit Interview
• Facility identification
• Information about visit - family palnning
• Client satisfaction
• Client personal characteristics
• Observation of sick child consultation
• Provider interaction with caretaker and child
• Diagnosis
• Treatment
5) Sick Child Caretaker Exit Interview
• Facility identification
• Information about visit - caretaker of sick child
o Client age
o Signs and symptoms of current illness
o Information provided to caretaker
o Treatment and caretaker comfort level
o Referral
• Client satisfaction
• Client personal characteristics
Coverage
Geographic Coverage
National coverage, the survey was also designed to provide representative results for each of the 25 regions in Tanzania Mainland and the 5 regions in Tanzania Zanzibar, for a total number of 30 survey regions.
Producers and sponsors
Primary investigators
| Name | Affiliation |
|---|---|
| National Bureau of Statistics (NBS) | Government of Tanzania |
| Office of Chief Government Statistician, Zanzibar (OCGS) | Government of Tanzania |
Producers
| Name | Affiliation | Role |
|---|---|---|
| Ministry of Health and Social Welfare | Government of Tanzania | Collaborated in conducting the study |
| Ministry of Health, Zanzibar | Government of Tanzania | Collaborated in conducting the study |
| ICF International | The DHS Prgram | Provided technical assistance |
Funding Agency/Sponsor
| Name | Abbreviation | Role |
|---|---|---|
| Government of Tanzania | GovTZA | Funded the study |
| United States Agency for International Development | USAID | Funded the study |
Sampling
Sampling Procedure
The 2014-15 TSPA was designed to be a sample survey of all formal-sector health facilities in Tanzania. A master list of health facilities that consisted of 7,102 verified (active) health facilities in Tanzania was obtained from the Ministry of Health and Social Welfare (MoHSW) on the Tanzania Mainland and the Ministry of Health (MOH) in Zanzibar. The list included hospitals, health centres, dispensaries, and clinics. These facilities were managed by the government, private-for-profit, parastatal, and faith-based entities.
A sample of 1,200 facilities was selected to participate in the survey. The sample was designed to provide nationally representative results by facility type and managing authority and regionally representative results for the 25 Tanzania Mainland regions and the 5 Zanzibar regions (a total of 30 survey regions).
A sample of 1,200 facilities was selected to participate in the survey. The sample was designed to provide nationally representative results by facility type and managing authority and regionally representative results for the 25 Tanzania Mainland regions and the 5 Zanzibar regions (a total of 30 survey regions).
Response Rate
1,200 health facilities sampled in the 2014-15 TSPA. Seven sampled facilities refused to be surveyed, 4 had closed down, and one facility could not be reached. The remaining 1,188 facilities were successfully interviewed, with a response rate of 99 percent. Among the surveyed facilities, 256 were hospitals, 379 were health centres, 493 were dispensaries, and 60 were clinics.
Data Collection
Dates of Data Collection
| Start | End |
|---|---|
| 2014-10 | 2015-03 |
Data Collection Mode
Face-to-face [f2f]
Data Collection Notes
Main Training
As part of the preparations for the 2014-15 TSPA main training, the eight health providers and five staff (four from NBS and one from OCGS) who participated during the pre-test were given a training of trainers (TOT) for four days, September 10–13, 2014. The training, led by ICF International survey specialists, was intended to equip participants with the necessary skills for them to be in charge of the main training as facilitators.
Participants were introduced to tablet computers, and then transitioned to the use of the tablet computers for data collection (CAPI) and for data entry and editing (CAFE); this was done using completed paper questionnaires from the facilities visited during the pre-test and from field practice during the first two weeks of main training. For the duration of the third week, participants practiced all questionnaire types and CAPI and CAFE approaches in teams and in pairs.
The training involved about 90 nurses from all over the country who were trained to be interviewers. The number of nurses/interviewers was reduced to 67 after selecting those who performed best on a series of practical tests and examinations.
Data Collection
Following the training of interviewers, 20 teams were formed (2 for Zanzibar and 18 for Tanzania Mainland). Each team consisted of a team leader, 3 interviewers and a driver. Each team was provided two tablet computers. One was dedicated to CAPI for the Facility Inventory, and the other was dedicated to CAFE for entering responses to the paper-based Health Provider Interview and Exit Interview questionnaires as well as observation protocols. Each team was given a list of facilities to visit, including name, type, and location. On average, data collection took one day for a small facility (dispensary clinics and some health centres) and two or three days for large facilities (mostly hospitals). Every effort was made to assure that teams visited facilities on days when ANC, family planning, or sick child services were offered, because the assessment involved observation of these consultations. Whenever any of the services of interest was not being offered on the day of the visit, the teams returned on a day when the service was offered to observe consultations and interview clients. If, however, the service was offered on the day of the visit but no clients came for this service, the team did not revisit the facility.
Interviewers ensured that respondents to the Facility Inventory questionnaire sections were the most knowledgeable persons for the particular service or system components being assessed.
Fieldwork supervision was coordinated by NBS. Four NBS staff and three MoHSW representatives were responsible for field supervision and made periodic visits to teams to review work and monitor data quality.
Data collection for the 2014-15 TSPA took place from October 20 – February 21. There was a revisit of some facilities that were not covered in Dar es Salaam from March 2-13.
As part of the preparations for the 2014-15 TSPA main training, the eight health providers and five staff (four from NBS and one from OCGS) who participated during the pre-test were given a training of trainers (TOT) for four days, September 10–13, 2014. The training, led by ICF International survey specialists, was intended to equip participants with the necessary skills for them to be in charge of the main training as facilitators.
Participants were introduced to tablet computers, and then transitioned to the use of the tablet computers for data collection (CAPI) and for data entry and editing (CAFE); this was done using completed paper questionnaires from the facilities visited during the pre-test and from field practice during the first two weeks of main training. For the duration of the third week, participants practiced all questionnaire types and CAPI and CAFE approaches in teams and in pairs.
The training involved about 90 nurses from all over the country who were trained to be interviewers. The number of nurses/interviewers was reduced to 67 after selecting those who performed best on a series of practical tests and examinations.
Data Collection
Following the training of interviewers, 20 teams were formed (2 for Zanzibar and 18 for Tanzania Mainland). Each team consisted of a team leader, 3 interviewers and a driver. Each team was provided two tablet computers. One was dedicated to CAPI for the Facility Inventory, and the other was dedicated to CAFE for entering responses to the paper-based Health Provider Interview and Exit Interview questionnaires as well as observation protocols. Each team was given a list of facilities to visit, including name, type, and location. On average, data collection took one day for a small facility (dispensary clinics and some health centres) and two or three days for large facilities (mostly hospitals). Every effort was made to assure that teams visited facilities on days when ANC, family planning, or sick child services were offered, because the assessment involved observation of these consultations. Whenever any of the services of interest was not being offered on the day of the visit, the teams returned on a day when the service was offered to observe consultations and interview clients. If, however, the service was offered on the day of the visit but no clients came for this service, the team did not revisit the facility.
Interviewers ensured that respondents to the Facility Inventory questionnaire sections were the most knowledgeable persons for the particular service or system components being assessed.
Fieldwork supervision was coordinated by NBS. Four NBS staff and three MoHSW representatives were responsible for field supervision and made periodic visits to teams to review work and monitor data quality.
Data collection for the 2014-15 TSPA took place from October 20 – February 21. There was a revisit of some facilities that were not covered in Dar es Salaam from March 2-13.
Data Collectors
| Name | Abbreviation | Affiliation |
|---|---|---|
| National Bureau of Statistics | NBS | Government of Tanzania |
Questionnaires
Questionnaires
Four questionnaires were used to collect the survey data:
• Facility Inventory questionnaire
• Health Provider Interview questionnaire
• Observation Protocols for antenatal care (ANC), family planning, services for sick children, and normal obstetric delivery and immediate newborn care
• Exit Interview questionnaires for ANC and family planning clients and for caretakers of sick children whose consultations were observed.
The Facility Inventory questionnaire was loaded onto tablet computers and administered as computerassisted personal interviews (CAPI). The other questionnaire types were administered as paper questionnaires but with data entry and data editing taking place immediately following data collection and while the team was still in the facility (computer-assisted field editing – CAFE).
• Facility Inventory questionnaire
• Health Provider Interview questionnaire
• Observation Protocols for antenatal care (ANC), family planning, services for sick children, and normal obstetric delivery and immediate newborn care
• Exit Interview questionnaires for ANC and family planning clients and for caretakers of sick children whose consultations were observed.
The Facility Inventory questionnaire was loaded onto tablet computers and administered as computerassisted personal interviews (CAPI). The other questionnaire types were administered as paper questionnaires but with data entry and data editing taking place immediately following data collection and while the team was still in the facility (computer-assisted field editing – CAFE).
Data Processing
Data Editing
After completing data collection in each facility, the interviewers reviewed the paper questionnaires (Health Provider Interview, Exit Interview and Observation) and the Inventory data that had been collected directly onto the tablet computer before handing the questionnaires and electronic data over to the team leader, who reviewed them a second time. The paper questionnaires were then entered into the second tablet computer. Once data collection and all data entry were completed in a facility, the team leader conducted consistency and structural checks on the data to identify any errors or missing information. When a team was satisfied that data collection and entry were complete for the facility, the team sent the data to the NBS headquarters in Dar es Salaam via the Internet, using ICF International’s Internet File Steaming System (IFSS). Each team was given a modem device that enabled the tablet computer to send the completed data files to the central office. Questionnaires completed during the 2014-15 TSPA fieldwork were periodically gathered up by quality control teams and taken from the field to be processed at the NBS headquarters in Dar es Salaam. Processing consisted of data entry and the editing of computer-identified errors. The data were processed by a team of 5 data entry clerks, 1 questionnaire administrator, and 2 data entry supervisors. The questionnaire administrator was responsible for receiving the questionnaires from the field. A program developed by ICF International using CSPro software was employed for data entry. At the central office, the data from the paper questionnaires were entered twice (100 percent verification). The concurrent processing of the data was a distinct advantage for data quality because 2014-15 TSPA staff were able to advise the field teams of errors detected during data entry. Data entry started in October 2014, two weeks after the beginning of fieldwork, and ended in March 2015, two weeks after fieldwork ended. All responses with “other” category were reviewed by NBS with assistance from the MoHSW staff and were recorded in categories relevant for data analysis.
Access policy
Contacts
Access conditions
Request Dataset Access
The following applies to DHS, MIS, AIS and SPA survey datasets (Surveys, GPS, and HIV).
To request dataset access, you must first be a registered user of the website. You must then create a new research project request. The request must include a project title and a description of the analysis you propose to perform with the data.
The requested data should only be used for the purpose of the research or study. To request the same or different data for another purpose, a new research project request should be submitted. The DHS Program will normally review all data requests within 24 hours (Monday - Friday) and provide notification if access has been granted or additional project information is needed before access can be granted.
DATASET ACCESS APPROVAL PROCESS
Access to DHS, MIS, AIS and SPA survey datasets (Surveys, HIV, and GPS) is requested and granted by country. This means that when approved, full access is granted to all unrestricted survey datasets for that country. Access to HIV and GIS datasets requires an online acknowledgment of the conditions of use.
Required Information
A dataset request must include contact information, a research project title, and a description of the analysis you propose to perform with the data.
Restricted Datasets
A few datasets are restricted and these are noted. Access to restricted datasets is requested online as with other datasets. An additional consent form is required for some datasets, and the form will be emailed to you upon authorization of your account. For other restricted surveys, permission must be granted by the appropriate implementing organizations, before The DHS Program can grant access. You will be emailed the information for contacting the implementing organizations. A few restricted surveys are authorized directly within The DHS Program, upon receipt of an email request.
When The DHS Program receives authorization from the appropriate organizations, the user will be contacted, and the datasets made available by secure FTP.
GPS/HIV Datasets/Other Biomarkers
Because of the sensitive nature of GPS, HIV and other biomarkers datasets, permission to access these datasets requires that you accept a Terms of Use Statement. After selecting GPS/HIV/Other Biomarkers datasets, the user is presented with a consent form which should be signed electronically by entering the password for the user's account.
Dataset Terms of Use
Once downloaded, the datasets must not be passed on to other researchers without the written consent of The DHS Program. All reports and publications based on the requested data must be sent to The DHS Program Data Archive in a Portable Document Format (pdf) or a printed hard copy.
Download Datasets
Datasets are made available for download by survey. You will be presented with a list of surveys for which you have been granted dataset access. After selecting a survey, a list of all available datasets for that survey will be displayed, including all survey, GPS, and HIV data files. However, only data types for which you have been granted access will be accessible. To download, simply click on the files that you wish to download and a "File Download" prompt will guide you through the remaining steps.
The following applies to DHS, MIS, AIS and SPA survey datasets (Surveys, GPS, and HIV).
To request dataset access, you must first be a registered user of the website. You must then create a new research project request. The request must include a project title and a description of the analysis you propose to perform with the data.
The requested data should only be used for the purpose of the research or study. To request the same or different data for another purpose, a new research project request should be submitted. The DHS Program will normally review all data requests within 24 hours (Monday - Friday) and provide notification if access has been granted or additional project information is needed before access can be granted.
DATASET ACCESS APPROVAL PROCESS
Access to DHS, MIS, AIS and SPA survey datasets (Surveys, HIV, and GPS) is requested and granted by country. This means that when approved, full access is granted to all unrestricted survey datasets for that country. Access to HIV and GIS datasets requires an online acknowledgment of the conditions of use.
Required Information
A dataset request must include contact information, a research project title, and a description of the analysis you propose to perform with the data.
Restricted Datasets
A few datasets are restricted and these are noted. Access to restricted datasets is requested online as with other datasets. An additional consent form is required for some datasets, and the form will be emailed to you upon authorization of your account. For other restricted surveys, permission must be granted by the appropriate implementing organizations, before The DHS Program can grant access. You will be emailed the information for contacting the implementing organizations. A few restricted surveys are authorized directly within The DHS Program, upon receipt of an email request.
When The DHS Program receives authorization from the appropriate organizations, the user will be contacted, and the datasets made available by secure FTP.
GPS/HIV Datasets/Other Biomarkers
Because of the sensitive nature of GPS, HIV and other biomarkers datasets, permission to access these datasets requires that you accept a Terms of Use Statement. After selecting GPS/HIV/Other Biomarkers datasets, the user is presented with a consent form which should be signed electronically by entering the password for the user's account.
Dataset Terms of Use
Once downloaded, the datasets must not be passed on to other researchers without the written consent of The DHS Program. All reports and publications based on the requested data must be sent to The DHS Program Data Archive in a Portable Document Format (pdf) or a printed hard copy.
Download Datasets
Datasets are made available for download by survey. You will be presented with a list of surveys for which you have been granted dataset access. After selecting a survey, a list of all available datasets for that survey will be displayed, including all survey, GPS, and HIV data files. However, only data types for which you have been granted access will be accessible. To download, simply click on the files that you wish to download and a "File Download" prompt will guide you through the remaining steps.
Citation requirements
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
Access authority
| Name | URL | |
|---|---|---|
| The DHS Program | archive@dhsprogram.com | Link |
Location of Data Collection
The DHS Program
Archive where study is originally stored
The DHS Program
http://dhsprogram.com/data/available-datasets.cfm
Cost: None
http://dhsprogram.com/data/available-datasets.cfm
Cost: None
Disclaimer and copyrights
Disclaimer
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
Metadata production
DDI Document ID
DDI_TZA_2014_SPA_v01_M_WB
Producers
| Name | Abbreviation | Affiliation | Role |
|---|---|---|---|
| Development Data Group | DECDG | The World Bank | Documentation of the DDI |
Date of Metadata Production
2016-04-14
DDI Document version
Version 01 (March 2016). Metadata is excerpted from "Tanzania Service Provision Assessment Survey 2014-2015" Report.