Introduction
Methods
Study design
Data collection on facility characteristics
Selection of facility characteristics for analysis
Inputs available | Definition | Number of facilities with inputs available | % of facilities with inputs available [95% CI] |
---|---|---|---|
Equipment & infrastructure | |||
Equipment | At least 15 out of the 18 key items available on the day of the survey | 158 | 62.0 [53.2-70.1] |
N=248 | [Any communication equipment (mobile phone, telephone or two-way radio); Any means of transport (bicycle, motorbike or own vehicle); Labour bed/ couch; BP machine; Stethoscope; Thermometer; Adult weighing scale; Baby weighing scale; Sharps box; Decontamination solution; Steriliser (cooker or stove); Disposable gloves; Dressing material (gauze and tape); Waste receptacle with lid and plastic liner; Hand washing soap; Supplies to mix ORS, cups and spoons; Refrigerator; Fridge thermometer] | ||
Electricity | Any electricity supply available | 120 | 37.5 [22.1-56.0] |
N=247 | |||
Water | Any water supply available | 222 | 87.2 [76.9- 93.3] |
N=248 | [Running piped, non-running piped, stored] | ||
Commodities | |||
Drugs | All drugs on tracer list in stock on the day of the survey | 48 | 19.2 [12.9-27.6] |
N=248 | [Paracetamol tablets; Albendazole tablets; Amoxicillin Capsules; Amoxicillin Syrup; Co-trimoxazole tablets; Chlorphenamine (Piriton) tablets; Artemether-lumefantrine tablets; Hydrocortisone injection; Tetracycline eye ointment; Metronidazole (Flagyl) tablets; Clotrimazole cream; Injection Benzyl penicillin; Injection Gentamycin; ORS 500ml sachets] | ||
Family planning commodities | All essential family planning commodities in stock on the day of the survey | 180 | 76.6 [68.7-83.0] |
N=247 | [Contraceptive pills; Emergency contraceptive pills; Depo-Provera injections; Male condoms] | ||
Vaccine commodities | All essential vaccines in stock on the day of the survey | 199 | 77.5 [66.6-85.6] |
N=247 | [Tetanus toxoid; BCG; Measles; OPV; Pentavalent (DPT/ HepB/ Hib] | ||
Staff | |||
Qualified staff | At least 4 staff with medically related qualifications available | 141 | 46.6 [37.4-56.1] |
N=248 | [e.g. clinical officer, registered nurse, enrolled nurse, pharmaceutical technician, lab technologist, lab technician, public health technician, public health officer, social worker, VCT counsellor, health education officer] | ||
Support staff | At least 2 support staff available | 168 | 63.2 [55.3-70.6] |
N=248 | [e.g. cleaner, watchman, data clerk, clinical support staff, mixed category, administrative support, cashier, cook, and others] |
Services available | Definition | Number of facilities with services available | % of facilities with services available |
---|---|---|---|
[95% CI] | |||
Laboratory | Laboratory services available | 115 | 38.1 |
N=246 | [25.1-53.0] | ||
Family planning | Family planning services offered | 237 | 97.4 |
N=247 | [93.3-99.0] | ||
Delivery | Delivery services offered | 143 | 49.0 |
N=247 | [37.9-60.2] | ||
VCT/PITC | VCT/PITC services offered | 216 | 85.2 |
N=247 | [77.3-90.7] | ||
PMTCT | PMTCT services offered | 219 | 88.1 |
N=240 | [76.6-94.4] | ||
ART | ART services offered | 93 | 26.6 |
N=247 | [18.2-37.0] | ||
ITNs | ITNs available for distribution | 194 | 84.4 |
N=247 | [71.8-92.0] | ||
Outreach | At least one outreach activity conducted in the past quarter (April – June 2010) | 123 | 44.8 |
N=247 | [32.1-58.1] | ||
All childhood immunizations every weekday | All childhood immunization services available Monday to Friday | 136 | 45.6 |
N=247 | [25.3-67.5] | ||
All antenatal care every weekday | All antenatal care services available Monday to Friday | 203 | 74.6 |
N=246 | [57.1-86.6] |
Measuring socioeconomic status (SES) of the local area for each facility
SES quintiles | Number of facilities1 | Percent of households above the poverty line cut-offs | |
---|---|---|---|
Range (min-max) | Mean | ||
Poorest 20% | 68 | 17.8-36.9 | 31.1 |
2nd quintile | 65 | 37.0-43.9 | 39.9 |
3rd quintile | 30 | 44.0-51.0 | 47.6 |
4th quintile | 38 | 51.1-61.0 | 56.4 |
Least poor 20% | 47 | 61.7-92.1 | 71.5 |
Data analysis
Remoteness categories | Number of facilities | Distance (km) from main town cut-offs | |
---|---|---|---|
Range (min-max) | Mean | ||
Near | 80 | 0-5.8 | 3.6 |
Average | 140 | 6-30.6 | 13.5 |
Far | 28 | 31-77.1 | 44.1 |
Results
Categories | Total | SES Quintiles2 | P-value3 | |||||
---|---|---|---|---|---|---|---|---|
Poorest 20% | 2nd quintile | 3rd quintile | 4th quintile | Least poor 20% | ||||
N=248 | n=68 | n=65 | n=30 | n=38 | n=47 | |||
% | % | % | % | % | % | |||
[95% CI] | [95% CI] | [95% CI] | [95% CI] | [95% CI] | ||||
All facilities % | 100 | 20.4 | 20.3 | 20.3 | 20.9 | 18.2 | ||
Facility type | Dispensaries | 100 | 21.0 | 17.8 | 21.9 | 20.5 | 18.9 | P = 0.16 |
n=165 | [11.1-36.2] | [10.8-27.8] | [12.8-34.8] | [9.9-37.8] | [10.8-30.8] | |||
Health centers | 100 | 17.2 | 33.0 | 12.0 | 23.0 | 14.9 | ||
n=83 | [8.3-32.2] | [15.1-57.6] | [6.1-22.4] | [6.7-55.3] | [7.5-27.2] | |||
Province | Central | 100 | 0 | 7.9 | 0 | 7.4 | 84.7 | P<0.01** |
n=33 | [1.0-41.1] | [1.3-31.8] | [42.0-97.7] | |||||
Coast | 100 | 48.2 | 15.3 | 12.6 | 19.9 | 4.1 | ||
n=28 | [13.2-85.1] | [6.4-32.0] | [3.1-39.6] | [3.0-66.5] | [0.5-27.5] | |||
Eastern | 100 | 37.4 | 17.9 | 21.5 | 10.4 | 12.7 | ||
n=33 | [10.5-75.2] | [13.0-24.1] | [10.7-38.5] | [4.4-22.8] | [2.7-43.1] | |||
North Eastern | 100 | 64.9 | 32.0 | 0 | 0 | 3.0 | ||
n=25 | [18.2-93.9] | [6.3-76.6] | [0.4-19.3] | |||||
Nyanza | 100 | 27.1 | 8.9 | 38.3 | 25.7 | 0 | ||
n=25 | [2.5-84.5] | [0.6-60.9] | [9.7-78.1] | [7.2-60.6] | ||||
Rift Valley | 100 | 1.3 | 20.9 | 27.9 | 35.4 | 14.6 | ||
n=32 | [0.1-12.7] | [5.6-54.0] | [14.3-47.1] | [12.0-68.7] | [5.6-33.1] | |||
Western | 100 | 33.9 | 51.6 | 8.4 | 6.2 | 0 | ||
n=33 | [14.7-60.3] | [18.4-83.4] | [1.7-33.0] | [1.2-26.9] | ||||
Municipal1 | 100 | 25.7 | 12.9 | 10.0 | 16.3 | 35.1 | ||
n=39 | [5.4-67.8] | [5.0-29.3] | [2.7-31.2] | [5.2-40.8] | [6.6-80.6] | |||
Remoteness | Near | 100 | 19.8 | 20.7 | 17.4 | 16.6 | 25.5 | P=0.50 |
n=80 | [7.6-42.7] | [11.8-33.8] | [7.1-36.6] | [7.5-32.6] | [16.4-37.3] | |||
Average | 100 | 24.3 | 18.6 | 17.7 | 25.5 | 13.8 | ||
n=140 | [13.9-38.9] | [7.0-41.3] | [10.6-28.0] | [7.1-60.4] | [6.1-28.6] | |||
Far | 100 | 7.9 | 25.0 | 32.9 | 11.9 | 22.3 | ||
n=28 | [1.9-28.0] | [11.4-46.2] | [14.1-59.4] | [0.8-68.7] | [8.6-46.7] |
Facility inputs
Outcome: Facility inputs | SES Quintiles | P- value (chi-squared test of association by SES quintiles) | Equity ratio | Concentration index1 | Indirectly standardized concentration index1 | ||||
---|---|---|---|---|---|---|---|---|---|
Poorest 20% | 2nd quintile | 3rd quintile | 4th quintile | Least poor 20% | |||||
n=68 | n=65 | n=30 | n=38 | n=47 | |||||
% | % | % | % | % | |||||
[95% CI] | [95% CI] | [95% CI] | [95% CI] | [95% CI] | |||||
Equipment & infrastructure | |||||||||
Equipment | 61.1 | 52.5 | 80.0 | 48.1 | 69.7 | P = 0.20 | 1.14 | 0.01 | −0.02 |
N=248 | [45.3-74.9] | [31.0-73.1] | [45.7-95.0] | [35.5-60.9] | [47.6-85.3] | P=0.76 | P=0.49 | ||
Electricity | 22.7 | 34.2 | 23.9 | 38.5 | 71.7 | P <0.01** | 3.16 | 0.09 | 0.07 |
N=247 | [11.3-40.5] | [21.9-49.0] | [6.5-58.6] | [13.9-70.9] | [45.1-88.6] | P<0.01** | P<0.01** | ||
Water | 85.5 | 82.1 | 91.8 | 92.3 | 83.8 | P = 0.70 | 0.98 | 0.01 | −0.01 |
N=248 | [72.1-93.0] | [39.1-97.0] | [75.7-97.5] | [58.2-99.1] | [41.3-97.5] | P-0.54 | P=0.55 | ||
Commodities | |||||||||
Drugs | 16.1 | 6.0 | 22.1 | 21.1 | 31.7 | P = 0.15 | 1.97 | 0.04 | 0.02 |
N=248 | [7.9-30.0] | [3.1-11.5] | [6.8-52.8] | [10.8-37.0] | [15.3-54.4] | P<0.01** | P=0.10 | ||
Family planning | 79.1 | 72.1 | 58.7 | 82.8 | 91.4 | P = 0.20 | 1.16 | 0.02 | 0.01 |
N=247 | [71.1-85.3] | [36.4-92.1] | [41.3-74.2] | [56.2-94.8] | [71.8-97.8] | P=0.48 | P=0.83 | ||
Vaccines | 70.3 | 72.9 | 76.6 | 84.7 | 83.2 | P = 0.64 | 1.18 | 0.02 | 0.03 |
N=247 | [53.2-83.2] | [45.1-89.8] | [32.5-95.7] | [48.4-97.0] | [61.5-93.9] | P=0.47 | P=0.52 | ||
Staff | |||||||||
Qualified staff | 29.9 | 54.5 | 49.1 | 44.3 | 56.6 | P = 0.32 | 1.89 | 0.03 | 0.03 |
N=248 | [16.5-47.9] | [36.7-71.1] | [23.7-75.1] | [28.8-60.9] | [38.2-73.4] | P=0.08 | P=0.04* | ||
Support staff | 64.1 | 68.4 | 57.2 | 50.2 | 78.3 | P = 0.41 | 1.22 | 0.01 | <−0.01 |
N=248 | [44.6-79.9] | [37.2-88.7] | [39.0-73.7] | [36.0-64.4] | [49.8-92.9] | P=0.72 | P=0.89 |
Services available
Outcome: Availability of services | SES Quintiles | P- value (chi-squared test of association by SES quintiles) | Equity ratio | Concentration index1 | INDIRECTLY standardized concentration index1 | ||||
---|---|---|---|---|---|---|---|---|---|
Poorest 20% | 2nd quintile | 3rd quintile | 4th quintile | Least poor 20% | |||||
n=68 | n=65 | n=30 | n=38 | n=47 | |||||
% | % | % | % | % | |||||
[95% CI] | [95% CI] | [95% CI] | [95% CI] | [95% CI] | |||||
Laboratory | 15.6 | 42.6 | 32.0 | 46.3 | 53.5 | P = 0.02* | 3.43 | 0.05 | 0.05 |
N=246 | [8.2-27.7] | [23.3-64.5] | [12.4-61.1] | [31.8-61.5] | [35.5-70.6] | P=0.01* | P=0.01* | ||
All childhood immunizations every weekday | 47.6 | 59.7 | 42.3 | 31.5 | 47.7 | P = 0.22 | 1.00 | −0.02 | −0.03 |
N=247 | [30.9-64.7] | [33.9-81.1] | [13.8-77.1] | [16.8-51.1] | [26.7-69.5] | P=0.15 | P=0.20 | ||
All antenatal care every weekday | 83.3 | 73.9 | 63.5 | 67.0 | 87.4 | P = 0.40 | 1.05 | <0.01 | <0.01 |
N=246 | [62.5-93.7] | [45.6-90.5] | [18.1-93.2] | [53.6-78.1] | [71.7-95.0] | P=0.89 | P=0.97 | ||
Family planning | 92.9 | 100 | 100 | 97.3 | 96.4 | P = 0.31 | 1.04 | <−0.01 | <−0.01 |
N=247 | [81.5-97.5] | [81.3-99.7] | [83.7-99.3] | P=0.81 | P=0.35 | ||||
Delivery | 60.5 | 57.5 | 36.6 | 48.3 | 42.1 | P = 0.57 | 0.70 | −0.37 | <−0.01 |
N=247 | [39.2-78.4] | [25.8-84.1] | [12.8-69.4] | [35.9-60.9] | [19.0-69.4] | P=0.28 | P=0.87 | ||
VCT/PITC | 88.1 | 66.7 | 87.0 | 97.3 | 86.9 | P=0.05 | 0.99 | 0.15 | 0.04 |
N=247 | [79.5-93.5] | [46.2-82.4] | [62.3-96.4] | [81.3-99.7] | [67.5-95.5] | P=0.42 | P=0.03* | ||
PMTCT | 91.7 | 83.4 | 85.2 | 90.1 | 90.7 | P = 0.76 | 0.99 | <0.01 | 0.01 |
N=240 | [80.2-96.8] | [37.4-97.7] | [43.2-97.7] | [66.9-97.6] | [73.8-97.1] | P=0.82 | P=0.74 | ||
ART | 23.1 | 34.0 | 29.2 | 25.6 | 20.3 | P = 0.62 | 0.88 | <−0.01 | <−0.01 |
N=247 | [12.4-38.9] | [20.9-50.1] | [10.5-59.2] | [15.6-39.0] | [12.8-30.7] | P=0.65 | P=0.99 | ||
ITN | 81.6 | 74.7 | 99.7 | 82.7 | 82.9 | P = 0.39 | 1.02 | <−0.01 | −0.02 |
N=247 | [68.5-90.0] | [37.0-93.7] | [98.4-99.9] | [35.3-97.7] | [48.5-96.1] | P=0.93 | P=0.60 | ||
Outreach | 35.9 | 45.5 | 56.5 | 46.5 | 38.8 | P = 0.56 | 1.08 | <−0.01 | 0.03 |
N=247 | [26.4-46.7] | [32.1-59.6] | [22.3-85.4] | [30.9-62.8] | [15.4-68.9] | P=0.91 | P=0.08 |