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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