Service Availability and Readiness Assessment (SARA)
Indicators and questionnaire
The SARA survey is designed to generate a set of core indicators on key inputs and outputs of the health system, which can be used to measure progress in health system strengthening over time. Tracer indicators aim to provide objective information about whether or not a facility meets the required conditions to support provision of basic or specific services with a consistent level of quality and quantity. Summary or composite indicators, also called indices, can be used to summarize and communicate information about multiple indicators and domains of indicators. Indices can be used for general and service specific availability and readiness.
Service Availability refers to the physical presence of the delivery of services, encompassing health infrastructure, core health personnel, and service utilization. This does not include more complex dimensions such as geographic barriers, travel time, and user behavior, which require more complex input data. Service availability is described by an index using the three areas of tracer indicators. This is made possible by expressing the indicators as a percentage score compared with a target or benchmark, then taking the mean of the area scores.
General Service Readiness refers to the overall capacity of health facilities to provide general health services. Readiness is defined as the availability of components required to provide services such as basic amenities, basic equipment, standard precautions, laboratory tests, and medicines and commodities. General service readiness is described by an index using the five general service readiness domains. A score is generated per domain based on the number of domain elements present, then an overall general readiness score is calculated based on the mean of the five domains.
Service Specific Readiness refers to the ability of health facilities to offer a specific service and the capacity to provide that service measured through selected tracer items that include trained staff, guidelines, equipment, diagnostic capacity, and medicines and commodities.
The SARA approach is to collect data that are comparable both across countries and within countries (i.e, across regions and/or districts). To achieve this, a standard core questionnaire has been developed. Typically, a country adopts the core questionnaire with adaptations to certain country-specific elements. The tool does not attempt to measure the quality of services or resources, but it can be used in conjunction with additional modules such as management assessment, quality of care, etc.