Service availability and readiness assessment (SARA)

Introduction

The Service Availability and Readiness Assessment (SARA) is a health facility assessment tool designed to assess and monitor the service availability and readiness of the health sector and to generate evidence to support the planning and managing of a health system. SARA is designed as a systematic survey to generate a set of tracer indicators of service availability and readiness. The survey objective is to generate reliable and regular information on service delivery (such as the availability of key human and infrastructure resources), on the availability of basic equipment, basic amenities, essential medicines, and diagnostic capacities, and on the readiness of health facilities to provide basic health-care interventions relating to family planning, child health services, basic and comprehensive emergency obstetric care, HIV, TB, malaria, and non-communicable diseases.

Sound information on the supply and quality of health services is necessary for health systems management, monitoring, and evaluation. The efforts to scale up interventions for HIV/AIDS, malaria, safe motherhood, child health, and to achieve the Millennium Development Goals (MDGs) through global health partnerships have drawn attention to the need for strong country monitoring of health services, covering the public, private-for profit, and the private not-for-profit sectors, and their readiness to deliver key interventions. With the increased demand for accountability and the need to demonstrate results at country and global levels, information is needed to track how health systems respond to increased inputs and improved processes over time and the impact such inputs and processes have on improved health outcomes and better health status.

The service availability and readiness assessment (SARA) methodology was developed through a joint World Health Organization (WHO) – United States Agency for International Development (USAID) collaboration to fill critical gaps is measuring and tracking progress in health systems strengthening. The SARA methodology builds upon previous and current approaches designed to assess service delivery including the service availability mapping (SAM) tool developed by WHO, and the service provision assessment (SPA) tool developed by ICF International under the USAID-funded MEASURE DHS project (monitoring and evaluation to assess and use results, demographic and health surveys) project, among others. It draws on best practices and lessons learned from the many countries that have implemented health facility assessments as well as guidelines and standards developed by WHO technical programmes and the work of the International Health Facility Assessment Network (IHFAN).

Overview presentation of SARA

SARA Reference manual 

Available in English and French
Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2
1 July 2015

Service Availability and Readiness Assessment (SARA) | Reference Manual, Version 2.2

SARA relies on a rapid data collection and analysis methodology, and can be combined with a record review to assess data quality of the facility reporting...

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Methodology

The SARA survey requires health facility visits with data collected based on key informant interviews and observation of key items. The survey can either be carried out as a sample or a census; the choice between these methodologies will depend on a number of elements including the county's resources, the objectives of the survey, and the availability of a Master Facility List (MFL).

Service Availability

A census is the recommended design methodology for forming the baseline of service availability and readiness data and is a requirement for calculating service availability indicators. The recommended data source for information on service availability is a national master facility list of all public and private facilities. A facility census is usually required to establish and maintain a national master facility list. A facility census aims to cover ALL public and private health facilities in a country. The census is designed to form the basis for a national and sub-national monitoring system of service delivery.

Service Readiness

The recommended design methodology for collecting information on service readiness is a sample survey. Sampling is done in a systematic way to ensure that the findings are representative of the country and region/district in which the survey is being conducted. Drawing a random sample of health facilities will be much more complicated if the country does not have a comprehensive and up-to-date master facility list. Therefore, it is highly recommended to invest in establishing a master facility list that includes all public and private facilities.

Indicators

The SARA survey is designed to generate a set of core indicators on key inputs and outputs of the health system, which can be used to measure progress in health system strengthening over time. Tracer indicators aim to provide objective information about whether or not a facility meets the required conditions to support provision of basic or specific services with a consistent level of quality and quantity. Summary or composite indicators, also called indices, can be used to summarize and communicate information about multiple indicators and domains of indicators. Indices can be used for general and service specific availability and readiness.

Service Availability refers to the physical presence of the delivery of services, encompassing health infrastructure, core health personnel, and service utilization. This does not include more complex dimensions such as geographic barriers, travel time, and user behavior, which require more complex input data. Service availability is described by an index using the three areas of tracer indicators. This is made possible by expressing the indicators as a percentage score compared with a target or benchmark, then taking the mean of the area scores.

General Service Readiness refers to the overall capacity of health facilities to provide general health services. Readiness is defined as the availability of components required to provide services such as basic amenities, basic equipment, standard precautions, laboratory tests, and medicines and commodities. General service readiness is described by an index using the five general service readiness domains. A score is generated per domain based on the number of domain elements present, then an overall general readiness score is calculated based on the mean of the five domains.

Service Specific Readiness refers to the ability of health facilities to offer a specific service and the capacity to provide that service measured through selected tracer items that include trained staff, guidelines, equipment, diagnostic capacity, and medicines and commodities.

Download SARA indicators index

Questionnaire

The SARA approach is to collect data that are comparable both across countries and within countries (i.e., across regions and/or districts). To achieve this, a standard core questionnaire has been developed. Typically, a country adopts the core questionnaire with adaptations to certain country-specific elements. The tool does not attempt to measure the quality of services or resources, but it can be used in conjunction with additional modules such as management assessment, quality of care, etc.

Download SARA core questionnaire