Service Delivery Indicators

2018: The SDI Health survey team visited a sample of 3,094 health facilities across Kenya between March and July 2018. The 2018 Kenya SDI was the largest to date. The sample was composed of 1,781 public facilities and 1,313 private facilities. The survey team observed 13,026 workers for absenteeism and assessed 4,430 health workers for competence using patient case simulation. The data collected were representative of the 47 counties, of facility location (i.e. urban/rural areas), facility ownership (i.e. public/private), and level of facility (i.e. first level hospital/health center/dispensary and clinic). The health workers were broken down into three categories: (i) doctors (specialist and general medical doctors), (ii) clinical officers, and (iii) nurses. This survey represents the second SDI in Kenya’s health sector.

2012: The results of Kenya’s first Service Delivery Indicators survey were released in Nairobi on 12 July 2013. Survey implementation was preceded by extensive consultation with Government and key stakeholders on survey design, sampling, and adaptation of survey instruments. Pre‐testing of the survey instruments, enumerator training and fieldwork took place in the second half of 2012. The surveys were implemented by the Kenya Institute of Public Policy Research and Analysis (KIPPRA) and Kimterica with support by the World Bank and the USAID‐funded Health Policy Project. Information was collected from 294 public and non-profit private health facilities and 1,859 health providers. The results provide a representative snapshot of the quality of service delivery and the physical environment within which services are delivered in public and private (nonprofit) health facilities at the three levels: dispensaries (health posts), health centers and first-level hospitals.

Report 2018

Data 2018

Report 2012

Highlights 2012

Data 2012

The 2018–2019 Malawi Harmonised Health Facility Assessment (HHFA) is the second large-scale, systematic, and detailed look at the status of health facilities in Malawi after the 2013 Malawi Service Provision Assessment. The 2018–2019 HHFA was designed to provide national and subnational information on the availability, readiness, and quality of services from all functioning health facilities in the country. These facilities included hospitals, health centers, dispensaries, clinics, and health posts. Additionally, the managing authorities of these facilities included the Government, Christian Health Association of Malawi, nongovernment organizations, private, and faith-based organizations. The data reported are stratified by type of health facility, managing authority, and region.

The Malawi HHFA survey instrument was comprised of the Service Availability and Readiness Assessment (SARA) and the Service Delivery Indicators (SDI) survey instruments harmonized into a single tool. Data collection activities occurred between November 2018 and March 2019. Data from a total of 1,106 health facilities was collected. A total of 12,773 health care workers were observed for absenteeism, 1,433 health workers were assessed with clinical vignettes, and 4,118 patients were interviewed.

Datasets for these surveys have not yet made available to the public.

HHFA Full Report 2019

HHFA Short Report 2019

HHFA District Profiles 2019

Policy brief – Harnessing Momentum

Policy brief – Closing the Gap

Policy brief – Enhancing Human Capital

Data – Not available

The health facility survey in Mozambique covered 204 facilities across all three sub-regions of the country (north, central, and south). The survey also included 1,116 health providers assessed for absence and 658 providers assessed for clinical knowledge. The results provide a representative picture of the quality of service delivery in the country, as well as the physical environment within which services are delivered. The survey covers three dimensions of service delivery: (i) two measures of provider effort; (iii) three measures of provider knowledge/ability; and (ii) five measures of the availability of key inputs, such as drugs, equipment, and infrastructure.

Report 2014

Data 2014

This report presents the findings from the implementation of the first round of SDI surveys for the health sector in Niger. From October to November 2015, surveys were conducted in 256 health facilities, which included district hospitals, health centers, and health posts. Information was gathered from 1,355 health providers who were representative of facilities across different settings of care, ranging from public and private facilities, and facilities located in rural and urban settings.

Report 2015

Report 2015 (French)

Highlights 2015

Data 2015

The SDI methodology was used in Nigeria to provide insights on challenges facing frontline service provision in the country. Nigeria was the fifth country in Africa (after Kenya in 2012 and Uganda in 2013; as well as pilots in Tanzania and Senegal in 2010) to use this methodology to assess the quality of service delivery. The survey implementation was preceded by consultations with stakeholders in Nigeria to adapt instruments to the country context while maintaining comparability across countries. The implementation was done with close collaboration with the Federal Ministry of Health and the National Primary Health Care Development Agency, and in close coordination with the relevant state authorities (i.e. State Ministries of Health, and the State Primary Health Care Development Agencies where they existed). The SDI surveys collected data from health facilities in six states (Anambra, Bauchi, Ekiti, Niger, Cross River, and Kebbi) using personal interviews and provider assessments. The health survey covered 1,038 randomly selected primary health facilities and all secondary hospitals (i.e. 134 in total) in the six states, assessing over 2,734 and 6,040 health professionals for knowledge and effort respectively. The sample was selected to make the survey representative at the State level, allowing for disaggregation by provider type (level of care in health) and location (rural/urban).

Report 2013

Data 2013

The first Service Delivery Indicators Report for Senegal was released in April 2012. Senegal along with Tanzania was one of the two countries SDI was pilot-tested. The Service Delivery Indicators were piloted in Senegal in the spring and summer of 2010. The main objective of the pilot was to test the survey instruments in the field and to verify that robust indicators of service delivery quality could be collected with a single facility-level instrument in different settings. It was decided that the pilot should include a Francophone country with a structure different from Tanzania’s, the other pilot country. Fieldwork in education began in late April 2010 and was completed in about six weeks; while fieldwork in health started a month after and took five weeks to complete. Senior staff members from Centre de Recherche Economique et Sociale (CRES) and the Institut National D’Études de Santé et Développement (INEADE) coordinated and supervised the fieldwork. Data was collected from 151 health facilities, both rural and urban. 

Report 2010

Data - Not available

The SDI survey visited a sample of 547 health facilities across Sierra Leone between January and April 2018. The sample was composed of 501 public facilities and 46 private facilities. The survey team observed 1,700 workers for absenteeism and assessed 818 health workers for competence using patient case simulation. The data collected are representative of the fourteen districts of facility location (i.e. urban/rural areas), facility ownership (i.e. public/private), and level of facility (i.e. hospital/health center/health post). The health workers were broken down into three categories:

(i) doctors (specialist and general medical doctors)

(ii) community health officers and assistants

(iii) nurses/midwives.

Report – Not available

Data 2018

2016: The third SDI survey in Tanzania's health sector was implemented from August to October 2016 (previous surveys were conducted in 2010 and 2014). As with the previous SDI surveys implemented in this country, data collection activities were preceded by extensive consultation with the Government and key stakeholders on survey design, sampling, and adaptation of survey instruments. Information was collected from 383 health facilities, 498 healthcare providers (for skills assessment), and 2,119 healthcare providers (for absence rate) across Tanzania.

2014: The SDI survey interviewed 403 heath providers across Tanzania between May 2014 and July 2014. 2,093 workers were observed for absenteeism and 563 health workers were assessed with clinical cases. Public and private (for- and nonprofit) providers have been visited as well as providers at different levels of services such as health posts, health centers, and district or first-level hospitals. The data collected are also representative of the traditional strata that is Dar es Salaam, other urban areas, and rural areas.

2010: The Service Delivery Indicators were piloted in Tanzania and Senegal in the spring/summer of 2010. The main objective of the pilots was to test the survey instruments in the field and to verify that robust indicators of service delivery quality could be collected with a single facility‐level instrument in different settings. To this end, it was decided that the pilots should include an Anglophone and Francophonecountry with different budget systems. The selection of Senegal and Tanzania was also influenced by the presence of strong local research institutes from the AERC network: Centre de Recherche Economique et Sociale (CRES) in Senegal and the Research on Poverty Alleviation (REPOA) in Tanzania. Both research institutes have extensive facility survey experience and are also grantees of the Hewlett‐supported Think Tank Initiative. In both Senegal and Tanzania, the sample was designed to provide estimates for each of the key Indicators, broken down by urban and rural location. To achieve this purpose in a cost-effective manner, a stratified multi‐stage random sampling design was employed. Given the overall resource envelope, it was decided that roughly 150 facilities would be surveyed in each sector in Senegal, while approximately 180 units would be surveyed in both sectors in Tanzania (as Tanzania is a much larger country than Senegal in terms of area and population). The sample frames employed consisted of the most recent list of all public primary schools and public primary health facilities, including information on the size of the population they serve.

Data 2016

Report 2014

Highlights 2014

Data 2014

Report 2010

This report presents the findings from the implementation of the first round of SDI surveys for the health sector in Togo. From September to November 2013, surveys were conducted in 180 health facilities, which included district hospitals, health centers, and dispensaries. Information was gathered from 1,364 health providers who were representative of facilities across different settings of care, ranging from public and private (nonprofit) facilities, and facilities located in rural and urban settings.

Report - Not available

Data 2013

The Uganda SDI surveys were implemented by the Economic Policy and Research Center (EPRC), a leading African think tank. Before implementation, there was an extensive consultation process involving key stakeholders in education and health (technical officers in ministries, non-governmental organizations, and private sector) in Uganda to contextualize the SDI instruments and discuss the survey design. Data collection in the field took place between June and August 2013, with simultaneous data entry. The SDI is representative of Uganda’s four regions and Kampala, covering 400 health facilities across the country. Both public and private (for-profit and not-for-profit) providers were included. In addition to noting the presence/ absence of 1,507 health providers, 736 providers were administered seven vignettes (sometimes called ‘patient case simulations’). Of the vignettes, five were on common tracer conditions, and two on the management of maternal and neonatal complications.

Report 2013

Data 2013