SPA Methodology

In the context of the SPA, a facility may be any service location outside of the home. The type of facility assessed in any SPA survey depends on the interest within a country, and on the ability to develop a sampling frame from which to draw a sample. The facilities that have been assessed include all types of general service facilities managed by governments, some specialized government facilities, and facilities managed by the non-governmental private-for-profit and non-profit sector. Except in rare situations where there was an available list of private-for-profit providers, this has excluded most pharmacies that provide services and individual providers’ offices.

Survey Instruments

There are four main types of questionnaires:

• Facility Audit Questionnaires collect information on the facility infrastructure, equipment, drugs, pharmacy and laboratory services, record-keeping, management, and counseling.
• Observation Protocols are completed for sick child, antenatal care, family planning, and STI consultations. Interviewers observe these client-provider interactions to assess how well service providers adhere to national and international standards of care.
• Exit Interview Questionnaires are administered to clients observed with providers and cover client’s understanding and recall of provider instructions and other information, and the client’s perception of the service delivery environment.
• The Health Worker/Provider Interview collects information from providers on pre-service and in-service training, supervision, and attitudes about their work environment.

Sample Design

Each SPA survey includes a nationally representative sample of over 400 facilities from hospitals to health posts. SPAs generally include observations of about 4,000 provider-client interactions and interviews with at least 1,000 health care providers.

The SPA aims to provide information that is representative at the national and regional level, of the types of facilities that are present. A sample of facilities is used to keep the cost and logistics of the survey reasonable.  In order to have a sufficient sample for services that are not widely available, the sample often includes the facilities that provide the service of interest in a higher proportion than they actually exist in the country (referred to as oversampling).  In order to ensure that the data are proportionally representative when presented, a multiplier (or weight) is used to ensure that the contribution of facilities to the total is proportionate to their presence.