Evidence and Information for Policy

ServiceService Availability Availability Mapping Mapping

Presentation to the MERG Geneva, Switzerland

October, 2004

Evidence and Information for Policy

The visionThe vision• SAM as a country owned monitoring tool meeting the needs of multiple

partners.

• At national level, SAM is used to track equity between districts and identify major gaps in service availability.

• At district level, SAM is used for monitoring service availability alongside supervisory visits.

• Disease-specific programmes use SAM, thus avoiding fragmentation and duplication.

• SAM results are widely disseminated and used by health sector and civil society, including other sectors.

• National planners are able to map all facilities and all services on a regular basis.

Evidence and Information for Policy

ApplicationApplication1. Data collected using PDAs by district health teams

2. PDA is synchronized with PC for data transfer

3. Data is analysed and maps produced using HealthMapper

Evidence and Information for Policy

District questionnaireDistrict questionnaireQuestionnaire overview:– Section 1: Availability of services and service

providers, by district– Section 2: Estimated coverage of specific

interventions, by district– Section 3: Availability of services, by facility

Evidence and Information for Policy

Facility questionnaireFacility questionnaireQuestionnaire overview:

- Section 1: General characteristics- Section 2: General purpose equipment- Section 3: Injection and sterilization equipment- Section 4: Human resources- Section 5: Trained staff - Section 6: Drugs and commodities - Section 7: Lab tests- Section 8: Information on interventions available in

the facility

Evidence and Information for Policy

SAM implementationSAM implementation

ImplementedUganda Zambia

PlannedBurkina FasoDR CongoCote d`IvoireMozambiqueSenegal South AfricaTanzaniaSri LankaLaosViet Nam

Cost~ USD300 per districts (in- country costs)

Time~ 4-8 weeks

Ongoing

Kenya

Evidence and Information for Policy

Infrastructure topicsInfrastructure topics

• In-patient, maternity, and delivery beds available in all facilities

• Blood transfusion services• Laboratory services• Communication and technology resources• Injection practices

Evidence and Information for Policy

Evidence and Information for Policy

Human resource topicsHuman resource topics

• Number of:– Doctors– Nurses– Clinical officers– Dentists– Laboratory technicians– HMIS personnel– Medical records personnel

Evidence and Information for Policy

Evidence and Information for Policy

Evidence and Information for Policy

Evidence and Information for Policy

Evidence and Information for Policy

Using SAM to look at inequities:Using SAM to look at inequities:Health staff by district: (ass.) doctors, nurses, and midwives per Health staff by district: (ass.) doctors, nurses, and midwives per

10,000 population, excluding Kampala and Jinja districts10,000 population, excluding Kampala and Jinja districts

0

2

4

6

8

0 1 2

Nurse and midwives per 10,000

(assistant) Doctorsper 10,000

Kabarole

Apac

Adjumani

Luwero

More doctors, more nursesFewer doctors, more nurses

Fewer doctors, fewer nurses

Bushenyi

Busia

Kalangala

Kotido

Arua

Yumbe

Masindi

Moroto

Kasese

Hoima

Masaka

Mbale

National average per 10,000 people1.1 (ass.) doctors 2.9 nurses & midwives

Nakapiripirit

Kanungu

Kumi

Nebbi

Kisoro

Moyo

Kaberamaido

Kitgum

Rukungiri

Tororo

Soroti

Bundibugyo

Kiboga

Nakasongola

Kiboga

RakaiMpigiMukono

KyenjojoMubende

KayungaNtungamo

Kapchorwa

KibaaleMbarara

Palissa

Bugiri

Lira

SironkoKatakwi

IgangaMayugeKamwenge

Kamuli

Evidence and Information for Policy

HIV/AIDSHIV/AIDS

• Availability of:– PMTCT– T&C– ART therapy– ART drug supply

Evidence and Information for Policy

Evidence and Information for Policy

Evidence and Information for Policy

Evidence and Information for Policy

Evidence and Information for Policy

Evidence and Information for Policy

Percent of districts with ART, PMTCT or HIV testing & Percent of districts with ART, PMTCT or HIV testing & counselling services, SAM Uganda, 2004counselling services, SAM Uganda, 2004

7254

20

21

24

10

722

70

0%

100%

ART PMTCT Testing &counseling

Perc

ent o

f dis

trict

s

Two or moreOne facilityNo facility

Evidence and Information for Policy

Percent of districts that have at least one laboratory Percent of districts that have at least one laboratory that can do specified tests, SAM Uganda 2004that can do specified tests, SAM Uganda 2004

96

83

7

7

0 20 40 60 80 100

Hemoglobin

Blood count

CD4+ cellcount

Liverfunctions

Evidence and Information for Policy

FindingsFindings• The SAM can provide a snapshot of service availability for HIV/AIDS,

health services and other services.

• HealthMapper and palm pilot are a useful way of collecting information that will be relevant for health planning and monitoring.

• A national monitoring system of the scale up of AIDS-related services needs to be put in place. This should depend on district reports, with special visits to the clinics providing the services. The SAM and HealthMapper can be used to track progress on a regular basis and can also monitor system wide effect on service availability.

• Goal is to take the SAM to the district level. The district should be enabled to plan and monitor service availability through mapping of facilities and services on a regular basis related to regular supervision and drug supplies.

Evidence and Information for Policy

THANK YOUTHANK YOU