Estimation of indices of health service readiness with a principal component analysis of the Tanzania Service Provision Assessment Survey

Elizabeth F. Jackson, Ayesha Siddiqui, Hialy Gutierrez, Almamy Malick Kante, Judy Austin, James F. Phillips

Research output: Contribution to journalArticle

Abstract

Background: Service Provision Assessment (SPA) surveys have been conducted to gauge primary health care and family planning clinical readiness throughout East and South Asia as well as sub-Saharan Africa. Intended to provide useful descriptive information on health system functioning to supplement the Demographic and Health Survey data, each SPA produces a plethora of discrete indicators that are so numerous as to be impossible to analyze in conjunction with population and health survey data or to rate the relative readiness of individual health facilities. Moreover, sequential SPA surveys have yet to be analyzed in ways that provide systematic evidence that service readiness is improving or deteriorating over time. Methods: This paper presents an illustrative analysis of the 2006 Tanzania SPA with the goal of demonstrating a practical solution to SPA data utilization challenges using a subset of variables selected to represent the six building blocks of health system strength identified by the World Health Organization (WHO) with a focus on system readiness to provide service. Principal Components Analytical (PCA) models extract indices representing common variance of readiness indicators. Possible uses of results include the application of PCA loadings to checklist data, either for the comparison of current circumstances in a locality with a national standard, for the ranking of the relative strength of operation of clinics, or for the estimation of trends in clinic service quality improvement or deterioration over time. Results: Among hospitals and health centers in Tanzania, indices representing two components explain 32 % of the common variance of 141 SPA indicators. For dispensaries, a single principal component explains 26 % of the common variance of 86 SPA indicators. For hospitals/HCs, the principal component is characterized by preventive measures and indicators of basic primary health care capabilities. For dispensaries, the principal component is characterized by very basic newborn care as well as preparedness for delivery. Conclusions: PCA of complex facility survey data generates composite scale coefficients that can be used to reduce indicators to indices for application in comparative analyses of clinical readiness, or for multi-level analysis of the impact of clinical capability on health outcomes or on survival.

Original languageEnglish (US)
Article number536
JournalBMC Health Services Research
Volume15
Issue number1
DOIs
StatePublished - Dec 3 2015
Externally publishedYes

Fingerprint

Tanzania
Principal Component Analysis
Health Services
Primary Health Care
Health
Health Information Systems
Health Planning
Far East
Africa South of the Sahara
Health Facilities
Family Planning Services
Quality Improvement
Health Surveys
Checklist
Demography
Population
Surveys and Questionnaires

Keywords

  • Health system
  • Principal component analysis
  • Readiness
  • Service provision assessment
  • Service provision assessment survey
  • Situation analysis
  • Tanzania

ASJC Scopus subject areas

  • Health Policy

Cite this

Estimation of indices of health service readiness with a principal component analysis of the Tanzania Service Provision Assessment Survey. / Jackson, Elizabeth F.; Siddiqui, Ayesha; Gutierrez, Hialy; Kante, Almamy Malick; Austin, Judy; Phillips, James F.

In: BMC Health Services Research, Vol. 15, No. 1, 536, 03.12.2015.

Research output: Contribution to journalArticle

Jackson, Elizabeth F. ; Siddiqui, Ayesha ; Gutierrez, Hialy ; Kante, Almamy Malick ; Austin, Judy ; Phillips, James F. / Estimation of indices of health service readiness with a principal component analysis of the Tanzania Service Provision Assessment Survey. In: BMC Health Services Research. 2015 ; Vol. 15, No. 1.
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