Health Facility Survey for Delivering Services Related to the Diagnosis and Management of HIV/AIDS and Sexually Transmitted Infections 2009
Bhutan, 2009
Identification
BTN_2009_STI_v02_M
Health Facility Survey for Delivering Services Related to the Diagnosis and Management of HIV/AIDS and Sexually Transmitted Infections 2009
| Name | Country code |
|---|---|
| Bhutan | BTN |
Health Facility Survey
Prevention of HIV/ STIs as well as care and support for those living with HIV/ STIs has received considerable attention in Bhutan. The Ninth Five Year Plan provided a multi-sectoral strategy to prevent and control HIV/ AIDS. It also identified this as one of the country's most important programme in promoting healthy outcomes for women and children. Services related to prevention, treatment and care are provided at health facilities at different levels. The services include provision of Voluntary Counselling and Testing (VCT) for HIV, Syndromic Management for STIs, along with some laboratory diagnosis which ranges from simple tests in the district hospitals to a wider and comprehensive range of tests at regional and national referral hospitals. To further facilitate delivery of services, several manuals and guidelines on the Syndromic Management of STIs and VCT have been provided at health care facilities and also personnel have been trained to provide these services.
To assess the health faculties' functionality and utilization of theses services for prevention and control of STIs and HIV in the country the Research and Epidemiology Unit of the Ministry of Health carried out Health Facility Survey (HSF 2009), with financial support from the World Bank, which is representative of the health facilities in the country. The findings are very useful in planning and future programme interventions to improve these services for the population of Bhutan.
Sample survey data [ssd]
-health facility
Version
Version 2.0:For External Use
2009-12-01
Scope
BHU, District Hospitals, Regional and National Referral Hospitals: Facility Management, Facility setup and services(Infrastructure,Equipment), Universal Precautions, Procedure for STI case management, Record keeping (Infrastructure, Equipment, Personnel and experience of the centre/clinic in maintaining records and confidentiality), Monitoring quality of services
VCT Centers (HISC): Infrastructure/ Physical features of the facility, , Service delivery - nature of services, Personnel, Staff Roles and Responsibilities, Availability and adherence to Protocols, Record Keeping Systems, Availability of Health Education Material and Condoms, Test Kits and medical consumables (if tests are done at the facility, if not please note and skip this section), Confidentiality, Monitoring quality of services.
NATIONAL REFERRAL HOSPITAL, PUBLIC HEALTH LABORATORY and REGIONAL HOSPITAL LABORATORIES: LABORATORY TESTS CONDUCTED, CARRYING OUT HIV/STI TESTS (Infrastructure, Equipment, Laboratory Supplies, Personnel and experience of the laboratory in conducting HIV/STI tests, reporting results and maintaining confidentiality, Universal Precautions and waste disposal), ABILITY TO STORE SAMPLES APPROPRIATELY, ABILITY TO MAINTAIN RECORDS AND CONFIDENTIALITY, QUALITY CONTROL (QC) SYSTEMS, CONFIDENTIALITY.
DISTRICT HOSPITAL LABORATORIES AND BHUs: Laboratory tests conducted, CARRYING OUT HIV/STI TESTS (Infrastructure, Equipment, Laboratory Supplies, Personnel and experience of the laboratory in conducting HIV/STI tests, reporting results and maintaining confidentiality, Universal Precautions and waste disposal), ABILITY TO STORE SAMPLES APPROPRIATELY, ABILITY TO MAINTAIN RECORDS AND CONFIDENTIALITY, QUALITY CONTROL (QC) SYSTEMS, CONFIDENTIALITY.
| Topic | Vocabulary |
|---|---|
| Health Facility | Ministry of Health (MoH)/ World Health Organization (WHO) |
| Sexually Transmitted Infections (STIs) | MoH/ WHO |
| HIV/AIDS | World Bank |
Coverage
National
Dzongkhag (Districts)
Regions: Eastern Bhutan, Central Bhutan, and Western Bhutan
All health facilities providing STI/HIV services in Bhutan.
The health facilities providing STI/HIV services in Bhutan assessed in this survey were grouped into five categories based on the services they provided and their capacities:
1.The OPD of the JDW National Referral Hospital, at Thimphu, and two Regional Referral Hospitals, at Mongar and Gelephu, which provide services for STIs and HIV as part of an integrated health system.
2.The laboratories of the Public Health Laboratory and the JDW National Referral Hospital, both at Thimphu, are more developed and provide a wider range of diagnostic tests for STIs and HIV.
3.Thirty District Hospitals in 20 districts (with some districts having more than one hospital) - these provide services for STIs and HIV as part of an integrated system. A basic laboratory is available in each of these hospitals designed to diagnose syphilis, gonorrhoea (by gram staining) and HIV (a single rapid test). VCT is also provided as part of the package of services.
4.172 BHUs, which provide syndromic management for STIs.
5.Two standalone VCT Centers (Health Information Service Center or HISC) at Thimphu and Phuntsholing where comprehensive VCT is provided and laboratory facilities are available for three rapid tests for HIV diagnosis. Outreach services to reach the more vulnerable populations with HIV prevention information is also provided through these Centers.
Producers and sponsors
| Name | Affiliation |
|---|---|
| Ministry of Health | Royal Government of Bhutan |
| Name | Affiliation | Role |
|---|---|---|
| Dr Lungten Z Wangchuk | Ministry of Health | Analysis and report writing, Principal Investigator |
| Dr. Gampo Dorji | Ministry of Health | Analysis and report writing |
| Mr. Masud Reza | ICDDR-Bangladesh | Analysis and report writing |
| Ms. Choden and Ms. Kinley Wangmo | Ministry of Health | Data entry for the survey |
| International Center for Diarrhoeal Disease Research | Bangladesh | Protocol development |
| Sonam Chophel, Dollay, Kinga, Rahal Singh Das, Samten and Namgay Tenzin | Ministry of Health | Data collection |
| Mr. Mongal Singh Gurung | Ministry of Health | Report publication and dissemination |
| Mr. Sonam Phuntsho | Ministry of Health | Administrative support for the survey |
| Name | Role |
|---|---|
| World Bank | Financial |
| Royal Government of Bhutan | Technical |
| Name | Affiliation | Role |
|---|---|---|
| Research Ethics Board of Health | Ministry of Health | Review and approval of the survey |
| Dasho (Dr.) Gado Tshering | Ministry of Health | Guidance and support |
| Mr Mongal Singh Gurung | Ministry of Health | Report Publication and Dissemination |
Sampling
Following health facilities were sampled:
I. The National Referral Hospital in Thimphu, Public Health Laboratory in Thimphu, two Regional Referral Hospitals in Mongar and Gelephu and two stand-alone VCT Centers (HISC) in Thimphu and Phuntsholing.
II. A random selection of District Hospitals and BHUs in three regions of Bhutan (east, west and central). For the selection of these sites the sample size calculation was done based on a standard formula used for health facility surveys.
The formula provided a sample size of 13 for District Hospitals. For each region (east, west and central), the number of District Hospitals to be sampled was calculated as a proportion based on the number of District Hospitals available in the region.
The formula provided a sample size of 45 for BHUs. For each region (east, west and central), the number of BHUs to be sampled was calculated as a proportion based on the number of BHUs available in the region.
The first health facility at the district and BHU level was selected based on random number method. The subsequent facilities were selected systematically based on the sampling interval until the required sample size was met in each region.
Response rate for health facilities is 100%
NA
Survey instrument
Different sets of questionnaires were administered to service providers (prescribers) as shown below:
-
Survey of STI and HIV services (for BHU) - the questionnaire to assess the comprehensive, integrated services for STI and HIV.
-
Survey of STI and HIV services (for BHU Grade-I, District, Regional and JDW National Referral Hospitals) - the questionnaire to assess the comprehensive, integrated services for STI and HIV diagnosis, management and referral.
-
Survey of stand-alone VCT Centers (the HISC sites in Thimphu and Phuentsholing) - the questionnaire was specifically designed to assess the VCT services available at these two sites.
-
Survey of laboratories in the JDW National Referral Hospital, Public Health Laboratory and the two Regional Referral Hospitals - the questionnaires to assess the laboratory services available at these sites.
Each questionnaire was accompanied by a guideline, which was aimed at providing an understanding of the questions and what the appropriate response should be for each question. In some cases, the questions were open-ended and the guideline was designed to help the interviewer score the response although this may often have been subjective. Each question was scored and based on the score each sub-section was graded. The guideline also provided the appropriate score for each response.
The questionnaires were administered to the most senior staff at the facility and to other relevant personnel as deemed necessary. Also, in several instances direct observation were made to assess the situation and/or to corroborate responses. In those cases, the instructions provided in the questionnaire as well as the guidelines were followed. Direct observations, where conducted took precedence over response by senior staff.
Two sets of exit interviews (or client satisfaction questionnaires) were administered to the patients attending the facilities for comprehensive, integrated services for STI and HIV and with clients attending the VCT Centers. Each of these exit interview questionnaires were also accompanied by guidelines.
Data collection
| Start | End |
|---|---|
| 2009-05-20 | 2009-07-31 |
| Name | Affiliation |
|---|---|
| Ministry of Health | Royal Government of Bhutan |
The staff from the Research and Epidemiology Unit monitored the survey at frequent intervals in all the regions.
Also, the survey teams in each region consisted of two interviewers. While in the field, one collected the data and other acted as a supervisor to check the consistency and the roles were reversed when one person was tired of one role.The scores were graded by the interviewer and checked by the supervisors before they left the Centers to ensure consistency.
All the interviewers and supervisors were trained for a period of 8 days (24th April till 1st May 2009) by facilitators from ICDDR, B and Research and Epidemiology Unit.
In-house mock testing of the questionnaires by the interviewers followed by the field-testing of the questionnaires in presence of the facilitators helped the trainees improve their skills and gain hands-on experience in administering the questionnaires.
Data processing
The entire field data and the scores were double checked on hard copies by the monitoring team before data entry. To ensure the accuracy and reliability of data, double entry of data was done using Epi Info. In addition, validity range of each response and consistency checks were incorporated in the data-entry screens. After completing double entry, data were compared using Epi Info and the entry errors were incorporated in the first entry. Further cleaning was done using Excel after which data files were converted into SPSS by using Stat transfer for analysis. Summary statistics (such as percentages, mean and median) were calculated.
Data appraisal
Quality assurance of the survey was addressed by taking into consideration two issues:
-
A major concern with this survey was that several questions in the questionnaires were open-ended and scoring may have required subjective judgement. For this it was necessary to ensure that inter-interviewer variation was minimised. For this purpose, a thorough field-testing of the questionnaires after training was conducted. Any ambiguity found during the pre-testing was corrected in the guideline and the interviewers were re-trained using the corrected version.
-
In order to reduce interviewer bias, the health workers were assigned to conduct interviews in facilities, which were not their work place.
Data Access
| Name | Affiliation | URL | |
|---|---|---|---|
| Head, Health Research and Epidemiology Unit | Ministry of Health | www.moh.gov.bt | research@health.gov.bt |
| Is signing of a confidentiality declaration required? | Confidentiality declaration text |
|---|---|
| yes | Data access is provided to organizations or individuals upon writing an official application of request. There is a form to be filled where the data user has to indicate the reason for the data request, sort of analysis they will perform. The data user is made to sign an undertaking wherein they agree not to share the data with un-authorized/organizations. It is also made clear that deviations on the agreed upon conditions will be referred to a court of law in the country. |
Public use files are accessible upon request and signing of an agreement form on the data usage.
Ministry of Health(MoH), Bhutan. Health Facility Survey for delivering services related to the diagnosis and management of HIV/AIDS and Sexually Transmitted Infections (STIs) 2009
,version 2.0 for External Use. Dataset downloaded from http://www.nsb.gov.bt/ndas.
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses
©Ministry of Health(MoH) , 2011
Contacts
| Name | Affiliation | URL | |
|---|---|---|---|
| Head, Health Research and Epidemiology Unit | Ministry of Health | research@health.gov.bt | www.health.gov.bt |
Metadata production
DDI-BTN-MOH-HFS-2009-v01
| Name | Affiliation | Role |
|---|---|---|
| Mongal Singh Gurung | Ministry of Health | DDI Documentation |
2011-08-22
Metadata version
Version 1.0 (August 2011)