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Table 2 Availability of items in selected health-facility assessment instruments, reviewed April 2015, and operationalization in Zambia

From: Signal functions for measuring the ability of health facilities to provide abortion services: an illustrative analysis using a health facility census in Zambia

 

AMDD

SPA

SARA

FASQ

HFC

Operationalization in Zambia HFC

Medication abortion (mifepristone & misoprostol, or misoprostol alone)

(yes) 1,6

(yes) 6

(yes)a

no

no

Not asked; measured via ability to remove retained products of conception

Vacuum aspiration

(yes) 1,b

(yes) 3

(yes) 1,3

(yes) 1

(yes) 1

Measured only in facilities providing delivery care; for facilities without delivery services, question on PAC provision used instead

Dilation & Curettage (D&C) – no longer recommended but may still be used as a substitute for vacuum aspiration or misoprostol

(yes) 1,9

(yes) 3

(yes) 3,4

(yes) 1

no

Not asked; measured via ability to remove retained products of conception

Intravenous fluids

(yes) 5

(yes) 5,6

yes

no

(no) c

Not measured

Removal of retained products

(yes) 1

(yes) 2

(yes) 1

(yes) 1

(yes) 1

Measured only in facilities providing delivery care; for facilities without delivery services, question on PAC provision used instead

Parenteral antibiotics

(yes) 1

(yes) 1

(yes) 1

yes

(yes) 1

Uterotonics

(yes) 1

(yes) 1

(yes) 1

(yes) 5

(yes) 1

″

Blood transfusion

(yes) 1

yes

yes

yes

(yes) 1

″

Surgical/laparotomy capability

(yes) 1,7

(yes) 7

yes

(yes) 1,7

(yes) 1,7

Measured via caesarean section capability in facilities providing delivery care

Contraceptives (condom + pill + injectable)

(yes) 1,8

yes

yes

yes

yes

Measured

Long-acting reversible contraceptives (LARCs): implant or IUD

(yes) 1,8

yes

yes

yes

yes

Measured

Sterilization

(yes) 1

yes

yes

yes

yes

Measured

Family planning at least once per week

no

yes

no

yes

yes

Measured

Family planning 7 days a week

no

yes

no

yes

yes

Measured

Service provision 24 h per day, 7 days a week (24/7)

(yes) 1

yes

(yes) d

yes

(yes) 1

Measured only in facilities providing delivery care via question on 24/7 availability of a health professional with midwifery skill. For facilities without delivery services, question on PAC provision used instead

1+ health professionals on duty

(yes) 1

(yes) 1

no

(yes) 1

yes

Measured

3+ health professionals registered (needed for 24/7 PAC service)

yes

yes

yes

yes

yes

Measured

1+ medical doctors on duty

(yes) 1

no

no

(yes) 1

yes

Measured

3+ medical doctors registered (needed for 24/7 PAC service)

yes

yes

yes

yes

yes

Measured

Communication means

yes

yes

yes

yes

yes

Measured

Referral capability

yes

yes

yes

(yes) 6

yes

Measured

  1. Bracketed responses, e.g. (yes), signify there are caveats to the response, as indicated in the footnotes
  2. Zambia measured capability to provide different services as described in the text, mainly by interviewing key informants in facilities, checking inventories, and reviewing records
  3. 1 only asked if facility does: deliveries (AMDD or HFC); deliveries or newborn care (SPA); maternal health services (FASC); normal delivery or BEmOC or CEmOC or newborn care services (SARA)
  4. 2 only asked if facility does normal delivery, asks if removal of retained products performed after delivery
  5. 3 only asked if facility does delivery, asks availability of vacuum aspirator equipment or D&C kit
  6. 4 only asked if facility is hospital that offers surgical services (including minor surgery such as suturing, circumcision, wound debridement, etc.) or caesarean section
  7. 5 only asked if can treat haemorrhage, not specifically give uterotonics; availability of uterotonic stocks assessed
  8. 6 only asked if uses misoprostol to remove retained products
  9. 7 caesarean (FASC, HFC); caesarean & minor procedures (SPA); obstetric surgery e.g. caesarean (also asks about operating theatre even if no deliveries) (AMDD)
  10. 8 asked if provide temporary FP methods (pills, condoms, injectables, implants, & IUDs) all merged in one response
  11. 9 asked if provides D&E to remove retained products
  12. aasked for availability of misoprostol tablets, and of emergency contraceptive methods (e.g. levonorgestrel, ulipristal acetate, mifepristone) (merged together); if has FP services, asks if it provided emergency contraceptive services (e.g. levonorgestrel, ulipristal acetate, mifepristone)
  13. bonly asked if uses vacuum aspiration to remove retained products
  14. conly asked about case management for severe pneumonia and severe dehydration for children
  15. dasked hours not days open unless facility does caesarean (when 24/7 opening is assessed)
  16. AMDD averting maternal death and disability needs assessment toolkit. Available at: https://www.mailman.columbia.edu/research/averting-maternal-death-and-disability-amdd/toolkit. Accessed: 2015-04-18
  17. SPA MEASURE DHS Service Provision Assessment (SPA). Updated June 2012. Available at: http://www.measuredhs.com/What-We-Do/Survey-Types/SPA.cfm. Accessed: 2015-04-10
  18. SARA World Health Organization Service availability and readiness assessment. Version 2.2 December 2014. Available at: http://www.who.int/healthinfo/systems/sara_reference_manual/en/Accessed: 2015-04-18
  19. FASQ MEASURE Evaluation’s Facility Audit of Service Quality. Version 1. 25 Nov 2008. Available at MEASURE Evaluation IHFAN (International Health Facility Assessment Network): http://ihfan.org. DDI TEMP FASQ 2008 v01. Accessed: 2015-04-26
  20. HFC Japan International Cooperation Agency Health Facility Census. Available at MEASURE Evaluation IHFAN (International Health Facility Assessment Network): http://ihfan.org. Zambia 2008 HFC TEMP 2008-v02. Accessed: 2015-04-26
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BMC Pregnancy and Childbirth

ISSN: 1471-2393

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