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Ressource	WHO Service Availability Readiness Assessments (SARA)
Objectif	(a) To assess and monitor the service availability and readiness and to generate evidence to support the planning and managing of a health system. (b) To generate reliable and regular information on service delivery such as the availability of key human and infrastructure resources, basic equipment, essential medicines, and diagnostic capacities, and on the readiness of health facilities to provide basic health-care interventions.
Contenu	A Reference manual which includes an overview of the survey process, tools, and indicators. An Implementation guide which provides a step-by-step instruction for a SARA survey. SARA is a health facility assessment tool designed to generate a set of tracer indicators of service availability (physical presence of services) and readiness (capacity to deliver services) and measurement methods to detect change and monitor progress in HSS. It builds on experiences of SAM, SPA, working with USAID and partners to scale up SARA in countries. The SARA survey generates a set of tracer indicators of service availability and readiness that can be used to: detect change and measure progress in health system strengthening over time; plan and monitor the scale-up of interventions that are key to achieving the SDGs; generate the evidence base to feed into country annual health reviews; support national planners in planning and managing health systems In a sample report, the following information on immunization can be found: Percentage of health facilities offering child immunization services (measured through DTP+Hib+HepB, Polio, BCG) either in the facility or as outreach, according to level of service, managing authority, ownership and residence. Among health facilities offering child immunization services, the percentage with trained staff, guidelines, equipment, and medicines, according to level of service, managing authority, ownership and residence. Among health facilities offering child immunization services, the percentage of staff and training, equipment, medicines and commodities, readiness to provide child immunization services, total number of facilities offering child immunization services. The number of countries that have conducted this assessment is limited, and data can be accessed at national level.
Résultats attendus	Generates a set of core indicators on key inputs and outputs of the health system used to measure progress in health system strengthening over time. Tracer indicators provide objective information about whether a facility meets the required conditions to support provision of basic or specific services with a consistent level of quality and quantity.
Utilisation	To be used if report available at the country level. •Does not require user input. This is an assessment that would have been conducted before. It shouldn't be conducted just for the purposes of informing a criterion for decision-making (e.g. criterion for CAPACITI decision-making tool), as it is resource intensive. Make note of when it was published.
Forces	Provides objective information whether a facility meet a defined standard. Findings can be summarised using composite indicators or "indices."
Contraintes/Limitations	(a) Service availability refers to the physical presence of the delivery of services and encompasses health infrastructure, core health personnel and aspects of service utilization. This does not include more complex dimensions such as geographical barriers, travel time and user behaviour, which require more complex input data. (b) For SARA, composite indices are useful to compare districts or regions or to look at change over time. However, composite indices also have limitations. It can be difficult to understand the individual factors contributing to an index score, and thus it is important to have information on individual indicator items in addition to composite index scores. All categories of facilities are assessed and indices calculated together which may not be consistent with immunization programme priorities. (c) The general survey template is comparable across countries and years, but it can be adapted to the country context limiting this comparability.
Pourquoi l'utiliser	(a) For monitoring of facilities and their readiness to deliver services. It is a way of monitoring performance by tracking how health systems respond to increased inputs in terms of improved outputs and outcomes. (b) Identifies system strengths and weaknesses that will enable scaling up of interventions. (c) The use of composite and tracer indicators to assess performance will enable health system / program managers to identify service availability gaps. (d) Zero dose and under immunised – Identifies supply side health system gaps to service delivery that impede availability and reach of services
Qui devrait l'utiliser	Can be applied nationally, sub nationally or at facility level to set a baseline assessment for health system readiness.
Exemples de critères que cette ressource pourrait traiter	Information can be extracted to understand the service provision, disaggregated by background characteristics such as level of service, managing authority, ownership, residence. This is useful to determine supply side gaps to service delivery that impede availability and reach of services.
Si disponible, notes sur le processus de développement	Developed by the country. Although there are development guidelines, the quality will be context specific.
Liens supplémentaires	https://www.who.int/healthinfo/systems/sara_reference_manual/en/
Lien d'accès à la ressource	/fr/ressources/orientations/who-service-availability-readiness-assessments-sara