The Service Provision Assessment (SPA) is a crucial tool for evaluating healthcare systems. It focuses on service availability and Quality of Care (QoC) within a country’s health facilities, providing actionable data for improvement. The SPA utilizes a comprehensive approach, examining a broad range of services with a particular emphasis on key areas like antenatal care (ANC), family planning (FP), maternity care, and services for sick children. The assessment delves into two crucial dimensions of quality: structural quality, encompassing physical resources and staffing; and process quality, which evaluates the delivery and patient experience of care. This data-driven approach enables targeted interventions to enhance healthcare services.

The SPA underwent a significant redesign in 2022, incorporating input from global health experts, representatives from organizations like WHO and UNICEF, Ministries of Health, and other stakeholders. This collaborative effort resulted in a more indicator-driven SPA, with a sharpened focus on Quality of Care. The revised SPA provides a framework for comprehensive and actionable assessments, ultimately contributing to stronger health systems.

The SPA examines a wide spectrum of health services and related topics:

• Child Health: This component assesses the availability of essential resources such as childhood vaccines, necessary medications, and nutritional supplements. It also evaluates the presence of equipment and supplies vital for outpatient care, growth monitoring, and nutritional assessments. Adherence to established guidelines for managing sick children, protocols for assessing and treating acute malnutrition, and the overall client experience are also key aspects of this area.

• Antenatal Care: The availability of essential equipment, medications, and supplies for antenatal care is a critical focus. The assessment also evaluates the proper assessment of pregnant women seeking antenatal care and gauges their experience with the services provided.

• Delivery and Newborn Care: This section focuses on the availability of essential equipment, medications, and supplies for delivery and newborn care. It includes an assessment of newborn care practices, such as evaluating resuscitation skills through simulation exercises. Early postpartum counseling for both mother and newborn, as well as the client’s overall experience, are also critical components.

• Family Planning: This area evaluates access to contraceptives and necessary supplies, the quality of counseling and client assessments, the provision of STI treatment for family planning clients, and the overall client experience.

• Malaria: Availability of diagnostic and treatment resources for malaria, including equipment, medications, and supplies, are assessed. Laboratory diagnostic capabilities, rapid diagnostic testing procedures, adherence to guidelines for treating children with fever or malaria, and caretaker experiences are also evaluated.

• Nutrition: This component focuses on the availability of growth monitoring and nutritional screening services for children. It also examines the availability of nutrition-related equipment, medications, supplements, and supplies. The assessment evaluates the dissemination of appropriate nutritional messages, counseling provided during pregnancy, services related to the prevention of mother-to-child transmission (PMTCT), newborn services, and care for sick children.

• Health System Strengthening: This crucial area evaluates Health Management Information Systems (HMIS), the frequency and effectiveness of management meetings, mechanisms for gathering client feedback, quality management initiatives like audits and mortality reviews, external supervision practices, opportunities for professional development, and ongoing quality improvement efforts.

• Water, Sanitation, and Hygiene (WASH): This section assesses access to improved water sources, infection prevention and control (IPC) measures, waste management practices, and the availability of basic sanitation services, including specific types of toilets.

• Emergency Preparedness: This area focuses on the availability of 24/7 emergency services, the existence and quality of emergency plans, and the maintenance of essential medicine stockpiles for emergency situations.

• Gender-Based Violence: This component evaluates the availability of services specifically designed to address gender-based violence.

• HIV/AIDS: This section assesses the availability of HIV counseling and testing services, comprehensive HIV/AIDS care and treatment, access to antiretroviral treatment, programs for the prevention of mother-to-child transmission (PMTCT), post-exposure prophylaxis, voluntary medical male circumcision services, and nutrition assessment, counseling, and support (NACS).

• Non-Communicable Diseases: This area evaluates the availability of diagnostic and treatment services for non-communicable diseases such as diabetes, cardiovascular diseases, and chronic respiratory illnesses. It also assesses the availability of essential medications, treatment guidelines, basic supplies, and equipment.

• Post-Abortion Care: This component focuses on the availability of comprehensive post-abortion care services.

• Primary Health Care: This section assesses the availability of fundamental primary health care services, essential equipment, necessary drugs, and critical supplies.

• Reproductive Cancers: This area evaluates the availability of screening services for reproductive cancers, specifically breast cancer and cervical cancer.

• Sexually Transmitted Infections (STIs): This component focuses on the diagnosis and treatment of sexually transmitted infections (STIs) other than HIV. It also examines referral practices for HIV counseling and testing and the availability of STI treatment guidelines.

• Tuberculosis: This section assesses the availability of comprehensive TB diagnostic and treatment services. Areas covered include access to diagnostic tools, treatment regimens, and overall quality of care for tuberculosis patients.