Service Availability and Readiness Assessment (SARA)

Service Availability and Readiness Assessment (SARA)

Service Availability and Readiness Assessment (SARA)

The Service Availability and Readiness Assessment (SARA) is designed as a systematic survey to generate a set of core indicators of services, which can be used to measure progress in health system strengthening over time.  The SARA core indicators are incorporated into the inventory component of the Service Provision Assessment (SPA) survey as well.  The SARA focuses on service availability, general service readiness, and service-specific readiness.

Service availability refers to the physical presence of the delivery of services, encompassing the health infrastructure, core health personnel, and service utilization. This does not include more complex dimensions such as geographic barriers, travel time, and user behavior, which require more complex input data.

General service readiness is the overall capacity of health facilities to provide general health services. Readiness is defined as the availability of components required to provide services such as basic amenities, basic equipment, standard precautions, laboratory tests, and medicines and commodities.

Service-specific readiness is the ability of health facilities to offer a specific service and the capacity to provide that service measured through selected tracer items that include trained staff, guidelines, equipment, diagnostic capacity, and medicines and commodities.

The SARA core indicators are collected using an inventory format relying on key informant interviews and observation of items in a facility. These data are comparable both across countries and within countries (i.e, across regions and/or districts). To achieve this, a standard core questionnaire has been developed. Typically, a country adopts the core questionnaire with adaptations to certain country-specific elements.

Interviews with the person in charge of the facility, or most senior health worker who is present at the facility and observation of items in a facility.

SARA is a health facility assessment tool designed to assess and monitor the service availability and readiness of the health sector and to generate evidence to support the planning and managing of a health system. The SARA survey objective is to generate reliable and regular information on service delivery (such as the availability of key human and infrastructure resources), on the availability of basic equipment, basic amenities, essential medicines, and diagnostic capacities, and on the readiness of health facilities to provide basic health-care interventions relating to family planning, child health services, basic and comprehensive emergency obstetric care, HIV, TB, malaria, and non-communicable diseases.

Although the service availability information is collected through the SARA questionnaire, these indicators should not be calculated for a sample of facilities; data must be available for ALL facilities in an administrative unit in order to calculate service availability. All service availability measures require data that link the numerator (e.g. number of facilities) to the denominator (population size).  Thus, a sample survey would not allow computation of the service availability indicators, as it is not clear what the corresponding population size to be used as the denominator should be. The
information needed to calculate service availability can be gathered from
multiple sources in addition to the SARA, namely a country’s health management information system (HMIS) and other routine information systems, and should be collated for all facilities before calculating the service availability indicators. If the SARA is implemented as a census, then it can be used to calculate service availability.

The tool does not attempt to measure the quality of services or resources, but it can be used in conjunction with additional modules such as management assessment, quality of care, etc.