SPA Overview

The Service Provision Assessment (SPA) survey is a health facility assessment that provides a comprehensive overview of a country’s health service delivery.  SPA surveys fill an urgent need for monitoring health system strengthening in developing countries.  They collect information on the overall availability of different facility-based health services in a country and their readiness to provide those services.  The SPA questionnaires have been updated in 2012 in collaboration with international agencies to make them easier to use and to include additional information.  The inventory questionnaire collects information for the calculation of USAID and WHO’s service readiness indicators.

SPA surveys answer 4 broad groups of questions:

  • What is the availability of different health services in a country?  Specifically, what proportions of the different facility types offer specific health services?
  • To what extent are facilities prepared to provide health services?  Do facilities have the necessary infrastructure, resources and support systems available?  For example, what proportions of facilities have regular electricity?  What proportions have regular water supply?
  • To what extent does the service delivery process follow generally accepted standards of care?  Does the process followed in service delivery meet standards of acceptable quality and content?
  • Are clients and service providers satisfied with the service delivery environment?

The key services and topics assessed in a SPA survey are:

  • Infrastructure, Resources, and Systems: water, electricity, latrines, infection control, management systems, storage and stock monitoring for vaccines, contraceptives, and medicines, infection control
  • Child Health: availability of vaccines, medicines, and Vitamin A, availability of curative care services and the availability of equipment and supplies for outpatient care, adherence to guidelines for sick child care
  • Maternal and Newborn Health: availability and appropriate assessment of clients for antenatal care, delivery services, newborn care, emergency obstetric care
  • Family Planning: availability of contraceptives and supplies, user fees, counseling and client assessment, provision of STI treatment for family planning clients
  • HIV/AIDS: availability HIV testing services, HIV/AIDS care and support services, antiretroviral treatment, prevention of mother-to-child-transmission, post-exposure prophylaxis
  • Sexually Transmitted Infections (STIs)
  • Malaria: availability of malaria diagnostic and treatment services, guidelines, antimalarial, laboratory diagnostic capacity
  • Tuberculosis: availability of TB diagnostic services, availability of first line medicines for treating TB
  • Basic surgery 
  • Non-communicable diseases:  diabetes, cardiovascular diseases and chronic respiratory diseases


SPA Resources