We do not normally produce estimates of healthcare workers per 100,000 population. To weight the numbers of health workers in the sampled facilities up to the population of all facilities, you would need to know the non-normalized sampling fraction for each facility. This may not be available. You would have to look at the sampling information in the SPA report. If the sampling fractions are not given explicitly in the report or in the data files, then they are not available. For SPA censuses, as in Malawi and Haiti, there is no problem. The total number of health workers would be divided by the total population and multiplied by 100,000. But in any case there may be health workers in some settings, such as private doctors' offices, who are not captured by a SPA.

We do not work with SARA data and we cannot answer questions about it.

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Thank you very much for your response on refrigeration and for sharing the report.

I have a follow up question regarding the number of health care workers per 10,000 population.

I found two points of guidance on this:

1. (The number of health workers at a given time in a given country or region / Total population for the same geographical area)

The ratio can be adjusted to per 10,000 population by multiplying the numerator and denominator by the same factor required for the denominator to equal 10,000.

and

2. For the SARA indicator: N per 10,000 population/23 * 100 (max.100)

So I think this means that the first indicator can only be calculated at the admin level seeing as in most cases we do not know the population that the health facility itself serves. Therefore if we were to map health facility provision, for individual facilities, it would make most sense to map the raw numbers of total health care workers per facility. But for aggregation to health zone level, we would sum the health care workers across facilities and divide by the population of the health zone. So e.g. if there were a total of 20 healthcare workers over a health zone of 20,000 we would do 20*.5/20,000*.5 ie. 0.001 HCW for 10,000 population. Is that correct?

What if we were to want to know the average number of health care workers (HCW) per health zone. For that would we add any facility weighting?

Then finally, for the SARA indicator, on the understanding that 23 is the metric for the minimum number of HCW per 10,000 population according to WHO standards, is it correct to say that the indicator is telling us the percentage of the target number of HCW per 10,000 population that the health zone/admin area is acheiving?

Thanks again for your response

Regards]]>

The weight for a specific facility in the data file is based on just the sample design. It is inversely proportional to the probability of selection. When the weights are used, you will get (for example) an unbiased estimate of the proportion of ALL facilities of that type that have a refrigerator. It is not (for example) an estimate of the proportion of the population that uses a facility that has a refrigerator. The latter would be good to know but I don't think we can estimate it. If you want to re-weight the data by some measure of size, you can certainly do that.

There is a growing literature on effective coverage, which combines SPA data with DHS survey data. DHS has produced several reports on that topic (e.g. Analytical Study 67, https://www.dhsprogram.com/pubs/pdf/AS67/AS67.pdf). It may provide a strategy for what you are thinking of.

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Thanks for the response. My question is: do the weights take into account the size AND the type of the facility? For example, if I look at the variable in Facility (FC) dataset, and I see the variable q1008 'refrigeration observed' in the facility (1/2 for 0/1 respectively), will the existence of refrigeration in a provincial hospital count for the same as the existence of refrigeration in a health clinic? If not, what will be the difference, and how is the weight therefore calculated? Is it weighted by the number of beds in the facility for example? Or the capacity of staff? If neither, how would DHS recommend to deal with this question when thinking about vaccine refrigeration capacity?

Looking forward to your response.]]>

The SPA files include a weight variable. For example, the facilities file has "facwt". You would use that weight for any outcome variable. For example, you could cross-tabulate region and "has refrigerator" , using iweight=facwt/1000000.]]>

My team is looking at several indicators for SPA and we have a question on how to aggregate data on facilities of different sizes up to province level. For example could you provide guidance on how to relatively weight the refrigeration capabilities of a clinic versus a hospital and then get to a province level estimate?

Looking forward to your response, -- also if I need to provide more detail do let me know.

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Here are the variables used in table 6.4 and logic in CsPro:

if (Q1422(1)=1 or Q1422(3)=1) or (Q210=1 & (Q906(3)=1 or Q906(4)=1)) then col605=1; xtab(t605,rwt); endif; {iron} if (Q1422(2)=1 or Q1422(3)=1) or (Q210=1 & (Q906(2)=1 or Q906(4)=1)) then col605=2; xtab(t605,rwt); endif; {folic acid} if (Q1422(3)=1 or (Q210=1 & Q906(4)=1)) then col605=3; xtab(t605,rwt); endif; {combined iron and folic acid} if col605 in 1:3 then col605=4; xtab(t605,rwt); endif; {if at least one of the above 3 is true: Column 4 of table 6.4}

Here are the variables used in table 6.6 and logic in CSPro

haveanc=(Q102(5)=1 & Q1401 in 1:31); if haveanc then cntanc=0; if Q1410=1 or Q1412=1 then col604a=1; col1=1; xtab(t604A,rwt); xtab(t604B,rwt); cntanc=cntanc+1; endif; {guideline} if PROVANCT1 then col604a=2; col2=1; xtab(t604A,rwt); xtab(t604B,rwt); cntanc=cntanc+1; endif; {ever training} if (Q1421A(1)=1 & Q1421B(1)=1) or (Q1421A(2)=1 & Q1421B(2)=1 & Q1421A(3)=1 & Q1421B(3)=1) then col604a=3; col3=1; xtab(t604A,rwt); xtab(t604B,rwt); cntanc=cntanc+1; endif; {BP} if HEMOGLOB then col604a=4; col4=1; xtab(t604A,rwt); xtab(t604B,rwt); cntanc=cntanc+1; endif; {Hemoglobin} if Q837B(1)=1 or Q1406(2)=1 or Q1420(4)=1 then col604a=5; col5=1; xtab(t604A,rwt); xtab(t604B,rwt); cntanc=cntanc+1; endif; {Urine protien} if ( (Q1422(1)=1 or Q1422(3)=1) or (Q210=1 & (Q906(3)=1 or Q906(4)=1)) or (Q1422(2)=1 or Q1422(3)=1) or (Q210=1 & (Q906(2)=1 or Q906(4)=1)) or (Q1422(3)=1 or (Q210=1 & Q906(4)=1)) ) then col604a=6; col6=1; xtab(t604A,rwt); xtab(t604B,rwt); cntanc=cntanc+1; endif; {combined iron + folic acid} if cntanc = 6 then col604a=8; xtab(t604A,rwt); xtab(t604B,rwt); endif; {all six items} endif;

I am trying to replicate table 6.4 of Bangladesh SPA 2017 report (page 106). I was able to match the percentage of combined iron and folic acid tablets but unable to match the percentage of iron tablet, folic acid tablet, and iron/folic acid tablet with the report. I have tried in the following way in STATA:

*iron tablet

gen iron=0

replace iron=1 if (Q1422_1==1 | (Q210==1 & Q906_03==1))

*folic acid tablet

gen folic=0

replace folic=1 if (Q1422_2==1 | (Q210==1 & Q906_02==1))

*iron or folic acid tablet

gen ir_fol=0

replace ir_fol=1 if (Q1422_1==1 | Q1422_2==2) | (Q210==1 & (Q906_02==1 | Q906_03==1))

Please also help me how can I prepare the the readiness score of table 6.6 (page 108) by combining 6 items.

Thanks for your attention.

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In 2017 BHFS, the TT vaccine information for maternal services can be found in Q1022 (01) and Q1027 (01) where the TT vaccine usually kept with other vaccines in a common vaccination area.

The specification used for the "Injectable glucose solution" variable is Q903(15)=GLUCOSE INJECTABLE SOLUTION should be matching with the report results. However, you used Q903(18)=INSULIN INJECTIONS [ANTI DIABETIC]. Please use Q903(15) instead of Q903(18).

The Specification used for variable "Injectable insulin" should be Q903 (18) as mentioned earlier; there were different variables (other than Q903 (18)) that were included in the definition of "Injectable insulin" in the report that lead to the difference; we are currently reviewing these variables but you can use only Q903 (18) for this indicator.

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I am working with Bangladesh Health Facility Survey (BHFS), 2017. I used variable Q1422(5) and Q906(08) for creating "tetanus toxoid vaccine" as a medicine for ANC service in Nepal Health Facility Survey, 2015 and Afghanistan SPA and the percentage was similar to the reports.

Variable Q1422(5) is not available in BHFS 2017, though Q906(08) is available. If I use only Q906(08) for the variable "tetanus vaccine" as a medicine for ANC service in BHFS 2017, would it be correct?

If not, please help in identifying the variable "tetanus toxoid vaccine" for ANC service using BHFS 2017.

Another issue:

I created variable "Injectable glucose solution" as a medicine for diabetes using Q903(15), the percentage (19.2) is similar to the report (page 152, table 8.2). Similarly, I created variable "Injectable insulin" using Q903(18), but the percentage was not similar to the report which is 29.2. Please help in creating the variable "Injectable insulin" in BHFS 2017.

Thanks for your attention.]]>