Background
Methods
Study design
Definitions | Parameters/Indicators | |
---|---|---|
General service availability | Physical presence of the delivery of services and encompasses health infrastructure, core health personnel and aspects of service utilization | |
Compared to target or benchmark: (i) Health infrastructure | - Number of health facilities per 10,000 population - Number of inpatient beds per 10,000 population | |
(ii) Health workforce | - Number of health workers per 10,000 population - Nurse to doctor ratio | |
(iii) Service utilization | - Hospital discharges per 100 population per year - Outpatient visits per capita per year | |
General service readiness | Overall capacity of health facility to provide general health services at minimum standards. Defined as availability of components required to provide services, such as basic amenities, basic equipment, standard precautions for infection prevention, diagnostic capacity and essential medicines. | |
Mean of average scores in five domains: (i) Facility | Mean availability of 7 items (%): power source, water source, sanitation, rooms with auditory and visual privacy, communication equipment, access to internet, and emergency transport. | |
(ii) Basic equipment | Mean availability of 6 items (%): adult scale, child and infant scale, thermometer, stethoscope, blood pressure apparatus, and light source | |
(iii) Infection prevention | Mean availability of 11 items (%): guidelines for infection prevention, eye protection, gowns, masks, latex gloves, disposable syringes, disinfectant and alcohol-based hand rub, appropriate storage of infectious waste, appropriate storage of sharp waste, safe disposal of sharps, sterilization equipment | |
(iv) Diagnostics | Mean availability of 10 items (%): hemoglobin, blood glucose, urine protein, urine glucose, alanine-aminotransferase and creatinine, HIV, syphilis, pregnancy test, TB microscopy, general microscopy | |
(v) Essential medicines | Mean availability of 13 items (%): diazepam 5 mg, amitriptyline 25 mg, paracetamol suspension 250 mg/5 ml, omeprazole 20 mg, glibenclamide 5 mg, captopril 25 mg, simvastatin 20 mg, atenolol 50 mg, salbutamol 0.1 mg, co-trimoxazole 8 + 40 mg/ml, amoxicillin 50 mg, ciprofloxacin 500 mg, ceftriaxone 1 g injection. | |
Service-specific readiness | Ability of health facility to offer a specific service and the capacity to provide that service. Measured through consideration of tracer items, including trained staff, guidelines, equipment, diagnostic capacity and medicines and commodities. | |
(i) Family planning (ii) Antenatal care (iii) Routine immunization (iv) Preventive and curative care for children under-five years old (v) Adolescent health services (vi) Tuberculosis services (vii) HIV and STI services (viii) Diagnostic and management of NCDs (ix) Basic obstetric and newborn care (x) Basic surgical services (xi) Blood transfusion | For each services the readiness score is computed as the mean availability of service-specific items in four domains: (i) Trained staff and up-do-date standards, (ii) Functioning equipment, (iii) Diagnostics capacity (iv) Availability of medicines and commodities. |
Sample size and sampling units
Data collection
Data analyses
Results
General availability and readiness of health services
Characteristics | CHD | KHD | Total | International benchmark a |
---|---|---|---|---|
Population | 158,014 | 159,465 | 317,479 | |
Number of health facilities in sample | 80 | 66 | 146 | |
Facilities by ownership and managing authority | ||||
Private, % | 78.75 | 71.21 | 75.34 | |
Private management, % | 18.75 | 24.24 | 21.23 | |
Public, % | 2.50 | 4.55 | 3.42 | |
Facilities by level of service | ||||
Primary level, % | 18.8 | 24.2 | 21.2 | |
Secondary b, % | 68.8 | 60.6 | 65.1 | |
Health service density: | ||||
No. of facilities per 10,000 population | 5.1 | 4.1 | 4.6 | 2 |
Inpatient beds per 10,000 population | 14.4 | 28.8 | 21.6 | 25 |
Hospital discharges per 100 population | 6.6 | 14.1 | 10.4 | 10 |
Outpatient visits per person per year | 5.9 | 6.0 | 5.9 | 5 |
No. of core health personnel per 10,000 | 50.6 | 73.8 | 61.2 | 23 |
Nurse to doctor ratio | 1.3:1 | 1.5:1 | 1.4:1 | 4:1 |
CHD | KHD | Total | P value | By facility level | |||||
---|---|---|---|---|---|---|---|---|---|
FHCs | Clinics | Sanatoriums | Hospitals | P value | |||||
Number of facilities | |||||||||
80 | 66 | 146 | 31 | 88 | 20 | 7 | |||
Basic amenities, 7 items (% [95% CI]) | |||||||||
68.1 [56.6–76.7] | 70.4 [57.8–79.4] | 69.1 [61.3–76.1] | 0.080 | 77.4 [60.2–88.6] | 64.3 [54.4–73.9] | 73.6 [53.8–88.8] | 78.6 [48.7–97.4] | < 0.001 | |
Basic equipment, 6 items (% [95% CI]) | |||||||||
40.4 [29.9–50.9] | 58.4 [47.1–70.1] | 47.2 [40.7–56.7] | 0.030 | 88.5 [71.1–94.8] | 27.1 [19.1–37.4] | 34.3 [18.1–56.7] | 80.0 [48.7–97.5] | < 0.001 | |
Standard precautions, 11 items (% [95% CI]) | |||||||||
73.2 [63.2–82.1] | 75.0 [64.2–84.5] | 76.0 [66.3–80.4] | 0.329 | 81.5 [63.7–90.8] | 73.3 [63.8–81.9] | 80.0 [58.4–91.9] | 78.8 [48.7–97.6] | 0.025 | |
Diagnostics, 10 items (% [95% CI]) | |||||||||
11.1 [6.0–20.0] | 16.8 [9.6–27.4] | 13.9 [9.1–20.2] | 0.179 | 38.4 [23.7–56.2] | 3.5 [1.2–9.5] | 0.5 [0.0–0.2] | 66.7 [35.9–91.8] | < 0.001 | |
Medicines, 13 items (% [95% CI]) | |||||||||
11.4 [6.6–19.1] | 18.4 [10.7–29.1] | 14.5 [9.6–20.1] | 0.442 | 21.8 [11.4–39.8] | 13.1 [7.9–22.3] | 13.1 [5.2–36.1] | 7.7 [2.6–51.3] | 0.130 | |
General service readiness index [95% CI] | |||||||||
40.8 [31.1–52.2] | 47.8 [36.8–60.3] | 44.1 [36.1–51.9] | 0.021 | 61.5 [43.8–76.3] | 36.3 [27.1–46.8] | 40.3 [21.9–61.3] | 62.4 [25.1–84.2] | < 0.001 |
Availability of PHC
CHD | KHD | Total | P value | Density per 10,000 | By facility level | P value | ||||
---|---|---|---|---|---|---|---|---|---|---|
FHCs | Clinics | Sanatoriums | Hospitals | |||||||
Family planning services (%) | ||||||||||
30.0 | 31.8 | 30.8 | 0.813 | 1.4 | 100.0 | 12.5 | 0.0 | 50.0 | < 0.001 | |
Antenatal care services (%) | ||||||||||
22.5 | 28.8 | 25.3 | 0.385 | 1.2 | 100.0 | 3.4 | 0.0 | 60.0 | < 0.001 | |
Routine immunization services (%) | ||||||||||
20.0 | 27.3 | 23.3 | 0.301 | 1.1 | 100.0 | 0.0 | 0.0 | 50.0 | < 0.001 | |
Preventive and curative care for children under 5 years old (%) | ||||||||||
26.3 | 39.4 | 32.2 | 0.091 | 1.5 | 100.0 | 11.4 | 5.0 | 66.7 | < 0.001 | |
Adolescent health services (%) | ||||||||||
26.3 | 36.4 | 30.8 | 0.188 | 1.4 | 100.0 | 12.5 | 0.0 | 50.0 | < 0.001 | |
Tuberculosis services (%) | ||||||||||
21.3 | 25.8 | 23.3 | 0.521 | 1.1 | 96.8 | 1.1 | 0.0 | 33.3 | < 0.001 | |
HIV counselling and testing, and STI services (%) | ||||||||||
16.3 | 21.2 | 18.5 | 0.442 | 1.0 | 71.0 | 2.3 | 0.0 | 50.0 | < 0.001 | |
NCD diagnosis and/or management (%) | ||||||||||
21.3 | 31.8 | 26.0 | 0.148 | 1.2 | 96.8 | 2.3 | 0.0 | 83.3 | < 0.001 | |
Basic obstetric and newborn care (%) | ||||||||||
0.0 | 1.5 | 0.7 | n/a | 0.1 | 0.0 | 0.0 | 0.0 | 16.6 | n/a | |
Basic surgery (%) | ||||||||||
2.5 | 4.5 | 3.4 | 0.826 | 0.2 | 0.0 | 0.0 | 0.0 | 80.0 | < 0.001 | |
Blood transfusion (%) | ||||||||||
1.3 | 6.1 | 3.4 | 0.257 | 0.2 | 0.0 | 0.0 | 0.0 | 83.3 | < 0.001 | |
Specific service availability score (%) | ||||||||||
17.0 | 23.1 | 19.8 | 0.27 | 0.9 | 69.5 | 4.1 | 0.5 | 56.7 | < 0.001 |
Service-specific readiness
FHCs | Hospitals | Clinics | Sanatoriums | All facilities | ||||||
---|---|---|---|---|---|---|---|---|---|---|
SSAS | SSRS | SSAS | SSRS | SSAS | SSRS | SSAS | SSRS | SSAS | SSRS | |
Family planning services (% [95% CI]) | ||||||||||
100.0 [88.9–100.0] | 44.0 [29.2–62.2] | 50.0 [39.8–60.2] | 54.2 [44.5–63.6] | 12.5 [5.2–36.0] | 27.3 [11.2–46.9] | 0.0 [0.0–3.5] | 0.0 [0.0–3.5] | 30.8 [23.9–38.7] | 34.5 [27.0–42.3] | |
Antenatal care services (% [95% CI]) | ||||||||||
100.0 [88.9–100.0] | 56.5 [40.7–73.6] | 60.0 [49.8–69.8] | 95.8 [89.9–98.3] | 3.4 [0.8–23.6] | 79.2 [58.4–91.9] | 0.0 [0.0–3.5] | 0.0 [0.0–3.5] | 25.3 [18.9–32.9] | 40.2 [32.8–48.5] | |
Routine immunization services (% [95% CI]) | ||||||||||
100.0 [88.9–100.0] | 83.6 [67.4–92.9] | 50.0 [39.8–60.2] | 76.7 [67.5–83.9] | 0.0 [0.0–0.2] | 0.0 [0.0–1.1] | 0.0 [0.0–3.5] | 0.0 [0.0–3.5] | 23.3 [17.2–30.8] | 79.3 [72.2–85.2] | |
Preventive and curative care for children under 5 years old (% [95% CI]) | ||||||||||
100.0 [88.9–100.0] | 44.5 [29.2–62.2] | 66.7 [56.7–75.9] | 40.6 [31.5–50.4] | 11.4 [2.8–30.1] | 30.0 [14.5–51.9] | 5.0 [2.6–51.3] | 31.3 [23.1–40.9] | 32.2 [25.1–40.1] | 41.3 [33.4–49.2] | |
Adolescent health services (% [95% CI]) | ||||||||||
100.0 [88.9–100.0] | 74.2 [56.7–86.3] | 50.0 [39.8–60.2] | 88.9 [81.3–93.7] | 12.5 [5.2–36.0] | 29.2 [14.5–51.9] | 0.0 [0.0–3.5] | 0.0 [0.0–3.5] | 30.8 [23.9–38.7] | 64.1 [56.3–71.7] | |
Tuberculosis services (% [95% CI]) | ||||||||||
96.8 [83.8–99.4] | 53.4 [37.7–70.8] | 33.3 [24.0–43.3] | 100.0 [96.3–100.0] | 1.1 [0.8–23.6] | 91.7 [69.9–97.2] | 0.0 [0.0–3.5] | 0.0 [0.0–3.5] | 23.3 [17.2–30.8] | 56.8 [48.7–64.6] | |
HIV counselling and testing, and STI services (% [95% CI]) | ||||||||||
71.0 [53.4–83.9] | 52.2 [34.8–68.0] | 50.0 [39.8–60.2] | 75.0 [65.7–82.5] | 2.3 [0.8–23.9] | 56.8 [34.2–74.2] | 0.0 [0.0–3.5] | 0.0 [0.0–3.5] | 18.5 [13.0–25.6] | 52.5 [44.7–60.7] | |
NCD diagnosis and/or management (% [95% CI]) | ||||||||||
96.8 [83.8–99.4] | 51.7 [34.8–68.3] | 83.3 [73.7–89.4] | 41.8 [32.6–51.6] | 2.3 [0.8–23.9] | 25.9 [11.2–46.8] | 0.0 [0.0–3.5] | 0.0 [0.0–3.5] | 26.0 [19.6–33.7] | 39.1 [31.5–47.1] | |
Basic obstetric and newborn care (% [95% CI]) | ||||||||||
0.0 [0.0–1.1] | 0.0 [0.0–1.1] | 16.6 [10.6–26.2] | 100.0 [96.3–100.0] | 0.0 [0.0–1.6] | 0.0 [0.0–1.6] | 0.0 [0.0–3.5] | 0.0 [0.0–3.5] | 0.7 [0.1–3.7] | 100.0 [97.4–100.0] | |
Basic surgery (% [95% CI]) | ||||||||||
0.0 [0.0–1.1] | 0.0 [0.0–1.1] | 80.0 [70.0–86.6] | 91.8 [84.8–95.8] | 0.0 [0.0–1.6] | 0.0 [0.0–1.6] | 0.0 [0.0–3.5] | 0.0 [0.0–3.5] | 3.4 [1.5–7.8] | 91.8 [86.2–95.2] | |
Blood transfusion (% [95% CI]) | ||||||||||
0.0 [0.0–1.1] | 0.0 [0.0–1.1] | 83.3 [73.7–89.4] | 91.9 [84.9–95.8] | 0.0 [0.0–1.6] | 0.0 [0.0–1.6] | 0.0 [0.0–3.5] | 0.0 [0.0–3.5] | 3.4 [1.5–7.8] | 91.9 [84.2–95.2] |