Service Provision Assessment Survey 1999-2000

The BSPA was conducted in conjunction with the 1999-2000 Bangladesh Demographic and Health Survey (BDHS). The primary objective of the BSPA sampling plan was to obtain a representative sample of health and family planning facilities and providers offering reproductive and child health services to the population included in the BDHS household survey that would provide reliable information on the manner in which these services are being delivered to the Bangladeshi population. A secondary objective was to design the sample in such a way that the BSPA data could be linked to data from the 1999-2000 BDHS. As noted earlier, the BSPA covered all 341 clusters of the BDHS. There is strong justification for carrying out a health service provision assessment survey and population survey in the same geographical areas that goes beyond the statistical issue of linking the two data sets for analysis (Turner et al., 2001). On one hand, conducting the two surveys in tandem resulted in large cost savings. On the other hand, linking provides a description of the health services supply environment relevant for a representative sample of the country.

The health and family planning system in Bangladesh is hierarchical. Generally, hospitals are located in the district headquarters. At the Upazila level, Upazila health complexes, mother and child welfare centers (MCWCs), and NGO health facilities are working to provide health and family planning services. Union health and family welfare centers and rural dispensaries are located at the union level. Villages are covered by satellite clinics and fieldworkers. Nongovernmental organizations are playing a greater role in delivering health and family planning services in Bangladesh.

The BSPA sampling plan captures a nationally representative sample of facilities, providers, and fieldworkers in the health and family planning service environment. As noted earlier, the primary sampling unit (PSU) or index cluster is equivalent to a village in rural areas and a mahalla block in urban areas. The cluster or village may not contain any facility. Although the household and individual instruments were applied only in the index clusters (mouzas), facility instruments were applied to health facilities found in the index cluster and adjacent clusters/villages that form an administrative unit such as a union or Upazila.

In the BSPA, all the Upazila health complexes located in the Upazila headquarters of the index cluster were selected for facility interviews. Similarly all the UHFWCs and RDs from the union of the index cluster were selected for interview. All the NGO health facilities from the union where the index cluster was located were selected.

To select the providers and fieldworkers, a different strategy was applied. Family welfare visitors assigned generally to the UHFWC in the union-some FWVs also work in Upazila health complexes were selected for the interview, and subassistant community medical officers who provided services in UHFWCs and RDs were also selected for interview. In addition, NGO health personnel working in the NGO health facilities were selected. Government fieldworkers, such as family welfare assistants (FWAs) and health assistants (HAs), are supposed to make home visits for maternal and child health and family planning services. All the government fieldworkers, as well as all NGO fieldworkers, who were assigned to work in the village were selected for the interview.

Geographic positioning systems (GPS) were used in the BSPA to facilitate the linkage of the BDHS clusters and the location of facilities.

See a map showing the location of the Upazilas surveyed and a map showing the location of all facilities in Appendix A of the final report.