Service Provision Assessments (SPA) are surveys conducted in health facilities and communities to obtain information about the health and family planning services available in a country. The objective of the SPA is to provide information about the characteristics of health services including their quality, infrastructure, utilization, and availability. Findings from the SPA can supplement household-based information on health status and service utilization collected by Demographic and Health Surveys (DHS).

Click here to view a list of SPA Surveys

The SPA survey offers a comprehensive assessment of a country’s health care services, including:

• Costs
• Availability of services
• Infrastructure
• Quality of care
• Components of care
• Data for Improvement

HIV/AIDS SPA

The standard SPA survey includes some questions on HIV/AIDS. MEASURE DHS developed a special HIV/AIDS SPA in 2004 to meet the needs of the President’s Emergency Plan for AIDS Relief. The HIV/AIDS SPA focuses on the delivery of preventive care and support services. It provides data on all indicators in the President’s Emergency Plan, including voluntary counseling and testing, prevention of maternal-to-child transmission of HIV/AIDS, and antiretroviral therapy.

Survey Tools

The SPA focuses on five key services: child health, maternal health, family planning, sexually transmitted infections, and HIV prevention, care, and support. Indicators include:

• Facility infrastructure: water, electricity, latrines, infection control
• Equipment and supplies: exam tables, lab tests, pharmaceutical commodities, sterilization and disinfection
• Support systems: training, supervision, quality assurance, equipment maintenance, guidelines, visual aids
• Management systems: adequate MIS for clients, logistics systems, equipment maintenance
• Providers’ adherence to standards: patient history, risk assessment, health education, relevant examinations, infection control procedures

The SPA also measures the quality of specific services and whether all required elements are present to provide routine care, for example, immunization and diarrhea treatments for child health services. Exit interviews are conducted with family planning clients to identify problems and gauge client satisfaction with the services provided.

A Local Perspective

The SPA core questionnaire reflects generally accepted standards for health care services, including UNICEF immunization guidelines and standards set by the Safe Motherhood Initiative. However, local working groups and experts in each service area adapt the SPA questionnaire to the information and health needs of each country. For example, the Kenya SPA included a review of childbirth records to collect information on specific delivery practices.

Survey Design

Each SPA survey includes a nationally representative sample of over 400 facilities and covers all types of health services sites from hospitals to health posts. Public, private, and faith-based institutions are all represented. Data collection teams fill out facility checklists, observe providers at work, and interview providers and clients at each facility. A SPA generally includes observations of about 4,000 provider-client interactions and interviews with at least 1,000 health care providers.

Using SPA data: An example from Ghana

Family planning methods are widely available in Ghana’s health care facilities. Temporary methods can be found in almost 90 percent of facilities, and permanent methods in 76 percent. Over 90 percent of facilities surveyed provide family planning services five days a week. Along with these very positive results, the SPA found areas needing improvement. Almost 60 percent of family planning services lacked a regular supply of clean water and disinfectant solution, for example.

Ghanaian public health officials are using the SPA to evaluate national interventions to improve family planning services. To help this effort, ORC Macro prepared a trend analysis, comparing the 2002 data with earlier surveys in 1993 and 1996.