The SPA core questionnaires have been revised to meet the needs of national and international public health specialists. Before being used in a country, the SPA core questionnaires are adapted to the information and health needs of that country by local technical experts in each service area.
The revised SPA core questionnaires are:
The Inventory Questionnaire assesses structural quality, primarily physical resources like availability of guidelines, equipment, diagnostics, commodities, and medicines in assessed health facilities. Interviewers verify the existence and functionality of certain items.
The Inventory Questionnaire includes three modules designed to measure availability of services as well structural quality indicators. The first module collects information on overall availability of different services in health facilities; module 2 collects information on general physical and human resources - staff coverage, infrastructure, communication, sources of water, electricity, facility infrastructure, health care waste management, processing of equipment for reuse, pharmaceuticals, and laboratory diagnostic capacity; module 3 collects information on service-specific physical and human resources.
The Health Worker Interview Questionnaire collects information from providers about the human resources aspects of structural quality – professional qualifications, the services they provide and recent in-service training, and their work environment.
Some or all of the health providers working at facilities are interviewed with the Health Worker Interview Questionnaire. In the revised SPA, the Health Worker Interview has been expanded to measure providers’ experience of verbal and physical abuse in the workplace, direct and proxy work satisfaction, and management of other staff, among other things.
Some or all health providers involved in labor and delivery and newborn care are assessed on their skills in newborn resuscitation using a Newborn Resuscitation Simulation Questionnaire, new in the revised SPA. Newborns needing resuscitation is rare, so assessing provider skill through simulation allows for better estimates of general levels of provider skill than observation. The newborn resuscitation simulation tool was adapted from materials from the Helping Babies Breathe Project.
Interviewers observe client-provider consultations for three priority services using Observation Protocols: antenatal care (ANC), family planning (FP), and curative care for sick children. This is to assess how often consultations follow generally accepted standards of care, including integrated management of child illnesses (IMCI). The number of consultations observed depends on the number of providers and clients in the facility that day. The new observation protocols have been revised to follow updated clinical guidance.
Interviewers also talk to clients who were observed for ANC, FP, and sick child services when they are leaving the facility with the Client Exit Interview Questionnaires to assess the client’s experience of the care they received. In the revised SPA, all or a sample of postpartum women who delivered at the facility are selected for the early postnatal care exit interview. The newly revised exit interviews focus on the client’s experience of care and include questions on client-provider communication and respectful treatment, among other topics. Questions in the antenatal and postnatal care exit interviews can be used to calculate validated person-centered antenatal care and maternity care scales. Questions in the family planning exit interview can be used to calculate a validated family planning quality of care scale. In addition to items from these scales, all exit interviews include a set of common experience of care questions.