Health Facility Survey 2015
Nepal, 2015
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NPL_2015_SPA_v01_M
Health Facility Survey 2015
| Name | Country code |
|---|---|
| Nepal | NPL |
Demographic and Health Survey, Special [hh/dhs-sp]
The Service Provision Assessment (SPA) survey is a health facility assessment that provides a comprehensive overview of a country’s health service delivery. SPA surveys fill an urgent need for monitoring health system strengthening in developing countries. They collect information on the overall availability of different facility-based health services in a country and their readiness to provide those services.
The 2015 Nepal Health Facility Survey (2015 NHFS) is the first comprehensive assessment of health facilities in Nepal that harmonizes various health facility among the Ministry of Health and health development partners. It 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 main objectives of the 2015 NHFS were to:
- Assess the availability of basic and essential services in Nepal health facilities, including maternal and newborn care and child health, family planning, and reproductive health services, as well as services for NCDs and certain infectious diseases (HIV/AIDS, STIs, malaria, and TB).
- Assess the preparedness of health facilities in Nepal to provide quality services.
- Provide a comprehensive body of information on the performance of different types of health facilities that provide these essential services.
- Identify gaps in the support services, 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.
- Identify differences in service readiness among ecological regions, facility types, and managing authorities and in the 14 earthquake-affected districts.
- Provide a baseline assessment for tracking future progress.
The 2015 NHFS provides representative results for Nepal, for different facility types (public hospitals, primary health care centers [PHCCs], health posts [HPs], urban health centers [UHCs], standalone HIV testing and counseling sites [HTCs], and private hospitals), for different managing authorities (government and private), for each of the three geo-ecological regions in the country, the survey was also designed for representative results for each of the 13 development-ecological zones and for the area affected by the 2015 earthquake (14 districts). Stratification was achieved by separating the health facilities by facility type within each of the 13 development-ecological zones. Private hospitals were further stratified by number of inpatient beds (more than 100 or less than 100).
Sample survey data [ssd]
Health institutions, hospitals, and health centers
Scope
The 2015 Nepal Health Facility Survey covered the following topics:
FACILITY INVENTORY
- Facility identification
- Information and service availability
o Service availability
o Impatient services - Filter questions
o Processing of instruments
o Storage of medicines - Service readiness
- Service specific readiness
HEALTH PROVIDER/WORKER
- Identification
- Education and experience
- General training, communicable, non-communicable diseases
- Child health services
- Family planning services
- Maternal health services
- Sexually transmitted infections, TB, HIV/AIDS
- Diagnostic services
- Working conditions in facility
OBSERVATION OF ANC CONSULTATION
- Facility identification, provider information, and information about observation
- Observation of Antenatal-Care consultation
ANC CLIENT EXIT INTERVIEW
- Facility identification and information about interview
- Information about the visit, Antenatal Care
- Client satisfaction
- Client personal characteristics
OBSERVATION OF FAMILY PLANNING CONSULTATION
- Facility identification, provider information and 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
FAMILY PLANNING (FP) CLIENT EXIT INTERVIEW
- Facility identification and information about interview
- Information about the visit, family planning
- Client satisfaction
- Client personal characteristics
OBSERVATION OF SICK CHILD CONSULTATION
- Facility identification, provider information and information about observation
- Observation of sick child consultation
- Provider interaction with caretaker and child
- Diagnosis
- Treatment
SICK CHILD CARETAKER EXIT INTERVIEW
- Facility identification and information about interview
- Information about the visit, caretaker of sick child
- Client satisfaction
- Client personal characteristics
EXIT INTERVIEW QUESTIONNAIRE FOR POSTPARTUM WOMEN
- Facility identification and information about interview
- Background
- Accessing care and decision making
- Delivery care
- Quality of care
HEALTH FACILITY OPERATION AND MANAGEMENT COMMITTEE (HFOMC) MEMBER
- General information and interviewer visits
- Background
- Composition, training and knowledge
- Participation
- Observation
Coverage
National coverage
Producers and sponsors
| Name | Affiliation |
|---|---|
| Ministry of Health (MoH) | Government of Nepal |
| Health Development Partners (HDPs) | Government of Nepal |
| Name | Role |
|---|---|
| ICF International | Provided technical assistance through the worldwide DHS Program |
| Name | Role |
|---|---|
| United States Agency for International Development | Funded the study |
| UK Department for International Development | Funded the study |
| World Health Organization | Funded the study |
| Government of Nepal | Funded the study |
Sampling
Sampling
A master list of 4,719 formal-sector health facilities in Nepal was obtained from the MoH and used as the sampling frame for the survey. The majority of the facilities in the sampling frame were health posts (80 percent). For private hospitals, only those having 15 beds or more were included in the master list.
Sample of Facilities
A total of 1,000 facilities were selected for the survey. By design, the sample included all nonspecialized government hospitals, all private hospitals with 100 or more inpatient beds, and all PHCCs. The remainder of the sample consisted of sampled health posts, private hospitals with at least 15 beds but fewer than 100 beds, stand-alone HTC sites, and UHCs. Eight sampled facilities turned out to be duplicates, resulting in an effective sample size of 992 facilities.
Survey instrument
The 2015 NHFS used five main types of data collection tools/ questionnaires:
- Facility Inventory Questionnaire.
- Health Provider Questionnaire.
- Observation protocols for antenatal care (ANC), family planning (FP), and services for sick children (SC).
- Exit Interview Questionnaires for ANC and family planning clients and for caretakers of sick children whose consultations were observed. Also, postpartum clients were interviewed as they were discharged from facilities; these interviews took place only in facilities that offered delivery services. Unlike antenatal care, family planning, and curative care for sick children, the survey did not involve observations of delivery services.
- Health Facility Operation and Management Committee (HFOMC)/Hospital Development Committee (HDC) Member Questionnaire for the chairperson or other committee members in public facilities (except the committee secretary). Members were interviewed based on their availability in the facility on the day of the survey.
Data collection
| Start | End |
|---|---|
| 2015-04 | 2015-11 |
| Name | Affiliation |
|---|---|
| New ERA | Private research firm |
Main Training
The main interviewer training for the 2015 NHFS took place March 22 through April 17, 2015, in Godavari. New ERA staff conducted the training in Nepali, with DHS staff providing technical support. Eighty-nine interviewer candidates (68 women and 21 men) participated. Almost all of the female trainees were nursing graduates (bachelor of science in nursing or bachelor of nursing), while the male candidates were mainly public health graduates with experience as health assistants. The NHFS training included classroom lectures and discussions, practical demonstrations, mock interviews, role plays, and field practices. Video clips of mock interviews as well as actual family planning, ANC, and sick child consultations were prepared and used to train the trainees.
The first two weeks of training were dedicated exclusively to training interviewers on the use of paper questionnaires and to a two-day field practice session. The third and fourth weeks of training, interviewer trainees were introduced to tablet computers and how to use them for data collection (CAPI) and for data entry and editing (CAFE).
Data Collection
As a result of the earthquake that occurred on April 25, 2015, NHFS data were collected in two phases. Phase 1 took place April 20 through 25, 2015, with all 20 teams collecting data in the Sunsari, Jhapa, and Morang districts. Following the earthquake, fieldwork was halted for more than one month while the situation was assessed. After it was determined that it was feasible for the survey to continue, data collection resumed on June 4 and continued through November 5, 2015. As a result of staff turnover due to the earthquake, only 18 teams participated in the second data collection phase. The teams resumed work in the far western development region of Nepal, and data collection in the 14 districts most affected by the earthquake took place in October and November 2015.
Data processing
All of the paper questionnaires used for recording information from the observation protocols and the exit interviews were sent to the NHFS central office in Kathmandu via courier services. Once the paper questionnaires arrived at the central office, they were sorted to ensure that they were in the correct order and none were missing. The office editor then edited the questionnaires to eliminate any mistakes that would prevent the computer from accepting information during data entry. When there was a problem with the questionnaires from a facility, the data collection team was consulted so that the problem could be rectified. Once data editing was completed, two data operators under the supervision of a data entry supervisor entered the paper questionnaires, allowing 100 percent verification. A data entry program developed by ICF International using CSPro software was employed during the entry of the questionnaires. Data entry began on April 20, 2015, when fieldwork commenced, and ended in November 2015, two weeks after the completion of fieldwork.
Access policy
The DHS Program
The DHS Program
http://dhsprogram.com/data/available-datasets.cfm
Cost: None
Data Access
| Name | URL | |
|---|---|---|
| The DHS Program | http://www.DHSprogram.com | archive@dhsprogram.com |
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
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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.
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Dataset Terms of Use
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Disclaimer and copyrights
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.
Contacts
| Name | Affiliation | URL | |
|---|---|---|---|
| Information about The DHS Program | The DHS Program | reports@DHSprogram.com | http://www.DHSprogram.com |
| General Inquiries | The DHS Program | info@dhsprogram.com | http://www.DHSprogram.com |
| Data and Data Related Resources | The DHS Program | archive@dhsprogram.com | http://www.DHSprogram.com |
Metadata production
DDI_NPL_2015_SPA_v01_M_WB
| Name | Affiliation | Role |
|---|---|---|
| Development Data Group | The World Bank | Documentation of the DDI |
Metadata version
Version 01 (February 2017). Metadata is excerpted from "2015 Nepal Health Facility Survey" final report.