SPA Methodology

SPA surveys are sample surveys of formal sector health facilities.  Pharmacies and individual doctors’ offices are typically not included in SPA surveys.  Typically, SPA surveys collect data from 400-700 facilities, selected from a comprehensive list of health facilities in a country (sampling frame), categorized by facility type, managing authority (public and non-public), and by region.  The sample is selected to provide indicators at the national level for the different facility types and managing authority as well as aggregate indicators at the regional level.  SPA surveys can also be done in a census of facilities, depending on the total number of facilities in the country.

Usually, hospitals are oversampled as they exit in small numbers in a country.  Subsequently, the data are weighted during analysis in order to ensure that the data are proportionally representative when presented.  To do this, a multiplier (weight) is applied to the data to ensure that the contribution of facilities to the total is proportionate to their existence in the country.

SPA surveys are typically fielded by 10–15 teams; each comprised of 3-4 interviewers mostly health workers.  These interviewers collect data from the facility in-charge and the most knowledgeable person(s) available for each service using the inventory questionnaire. Specific sections of the inventory questionnaire assess laboratories and pharmacies in these health facilities.  A key feature of the inventory questionnaire is that interviewers verify the existence of items that are being assessed; for example, are the medicines and commodities available at the time of the visit?

Interviewers also observe client-provider consultations for three priority services using observation protocols:  antenatal care, family planning, and curative care for sick children.  The number of consultations observed depends on the number of providers and clients in the facility that day.  Interviewers also interview clients who were observed when leaving the facility with the client exit interview questionnaires.

Some or all of the health providers working at facilities are interviewed with the health worker interview questionnaire.