Figure 1
Sample selection of the health facilities: Afghanistan, Bangladesh, and Nepal, SPA surveys.
Table 1
Percentage distribution of surveyed facilities according to background characteristics: Service Provision Assessment Survey, Afghanistan Bangladesh, and Nepal.
| VARIABLES | AFGHANISTAN | BANGLADESH | NEPAL |
|---|---|---|---|
| % | % | % | |
| Facility location | |||
| Rural | na | 27.1 | 46.5 |
| Urban | 72.9 | 53.6 | |
| Managing authority | |||
| Private | 89.0 | 62.0 | 7.9 |
| Public | 11.0 | 38.0 | 92.1 |
| Facility types1 | |||
| Private hospitals/clinics | 87.8 | ||
| Special hospitals | 7.7 | na | na |
| National/Provincial hospitals | 4.4 | ||
| Facility types2 | |||
| Non-government organization | na | 30.0 | |
| clinics/hospitals | na | ||
| Private clinics/hospitals | 37.8 | ||
| Urban health centers | 27.9 | ||
| District hospitals | 4.3 | ||
| Facility types3 | |||
| Community health units | na | na | 7.9 |
| Urban health centers | 8.5 | ||
| Health posts | 68.9 | ||
| Primary health care centers | 3.6 | ||
| Private hospitals | 7.9 | ||
| Local-level hospitals | 1.2 | ||
| Federal/provisional hospitals | 1.9 | ||
| External sources of revenue | |||
| None | 28.2 | 3.9 | 12.1 |
| Other than govt. | 17.7 | 61.5 | 76.9 |
| Govt. | 54.1 | 34.6 | 11.1 |
| Routine quality assurance activities | |||
| No | 73.6 | 75.3 | 75.9 |
| Yes | 26.4 | 24.7 | 24.1 |
| Routine management meetings | |||
| Not performed | 15.5 | na | 19.2 |
| Performed | 84.5 | 80.8 | |
| External supervision | |||
| No | 12.3 | 28.2 | 4.6 |
| Yes | 87.7 | 71.8 | 95.4 |
| User fees | |||
| None | 8.3 | 8.1 | 73.1 |
| Separate fees | 79.3 | 84.9 | 23.5 |
| Fixed for all services | 12.4 | 7.0 | 3.3 |
| Presence of health provider, 24 h | |||
| No | 30.8 | 22.3 | 58.2 |
| Yes | 69.2 | 77.7 | 41.8 |
| Clients’ opinions | |||
| Not reviewed | 60.1 | 84.3 | 84.7 |
| Reviewed | 39.9 | 15.7 | 15.3 |
| Ability to perform | |||
| Only diagnosis | 3.6 | 26.1 | 26.1 |
| Only treat | 4.9 | 3.2 | 12.0 |
| Both | 91.5 | 70.7 | 61.9 |
| No. of CVD care providers | 3.0 | 3.1 | 1.8 |
[i] Note: na = data are not available; 1facility type was measured for Afghanistan; 2facility type was measured for Bangladesh: 3facility type was measured for Nepal.
Table 2
Percentage distribution of surveyed facilities according to availability of guidelines, equipment, and medicines: Service Provision Assessment Survey, Afghanistan Bangladesh, and Nepal.
| VARIABLES | AFGHANISTAN | BANGLADESH | NEPAL |
|---|---|---|---|
| % (95% CI) | % (95% CI) | % (95% CI) | |
| Staff and guideline | |||
| Presence of guidelines | 20.9 (13.3–29.0) | 22.4 (15.5–30.9) | 11.3 (9.1–13.8) |
| Availability of trained staff | 21.5 (11.2–37.5) | 15.3 (70.5–83.5) | 12.9 (10.5–15.7) |
| Equipment and supplies | |||
| BP apparatus | 93.4 (78.0–98.3) | 97.1 (93.5–98.7) | 97.4 (95.7–98.5) |
| Adult scale | 70.5 (58.4–80.2) | 84.0 (78.4–88.4) | 95.1 (93.2–96.5) |
| Stethoscope | 93.8 (77.8–98.5) | 97.6 (93.7–99.1) | 98.4 (96.9–99.2) |
| Medicines and commodities | |||
| Aspirin | 83.9 (68.9–92.4) | 33.1 (26.5–40.4) | 17.7 (15.3–20.4) |
| Thiazide | 35.7 (23.7–49.8) | 16.4 (11.5–22.9) | 6.7 (5.5–8.3) |
| Beta blockers (atenolol) | 84.1 (69.1–92.6) | 36.6 (29.9–43.7) | 32.4 (28.9–36.1) |
| Calcium channel blockers | 89.0 (76.5–95.2) | 47.3 (40.2–54.6) | 61.5 (57.7–65.4) |
| (amlodipine/nifedipine) | |||
| Oxygen | 77.0 (67.7–84.3) | 55.3 (48.1–62.3) | 27.6 (24.4–31.1) |
| Fully ready | 0.5 (0.07–4.0) | 0.03 (0.01–0.08) | 0.09 (0.04–0.24) |
| Readiness score | 6.7 (6.2–7.2) | 5.6 (5.3–5.9) | 4.6 (4.51–4.71) |
[i] Note: CI = Confidence interval.
Table 3
Models of negative binomial regression for variables associated with health facility readiness to manage CVDs: Service Provision Assessment Survey, Afghanistan Bangladesh, and Nepal.
| VARIABLES | AFGHANISTAN | BANGLADESH | NEPAL |
|---|---|---|---|
| IRR (95% CI) | IRR (95% CI) | IRR (95% CI) | |
| Facility location | |||
| Rural | na | 1.00 | 1.00 |
| Urban | 1.05 (0.97–1.13) | 0.98 (0.93–1.03) | |
| Managing authority | |||
| Private | 1.00 | 1.00 | 1.00 |
| Public | 0.59 (0.46–0.76)a | 1.05 (0.91–1.21) | 0.73 (0.66–0.81)a |
| Facility types1 | |||
| Private hospitals/clinics | 1.00 | na | na |
| Special hospitals | 1.42 (1.17–1.72)b | ||
| National/Provincial hospitals | 1.65 (1.16–2.34)b | ||
| Facility types2 | |||
| Non-government organization | na | 1.00 | na |
| clinics/hospitals | |||
| Private clinics/hospitals | 0.91 (0.80–1.04) | ||
| Urban health centers | 0.62 (0.46–0.85)b | ||
| District hospitals | 0.89 (0.51–0.93) | ||
| Facility types3 | |||
| Community health units | na | na | 1.00 |
| Urban health centers | 1.02 (0.97–1.09) | ||
| Health posts | 1.04 0.95–1.19) | ||
| Primary health centers | 1.31 (1.21–1.42)a | ||
| Private hospitals | – | ||
| Local-level hospitals | 1.42 (1.28–1.57)a | ||
| Federal/provisional hospitals | 1.33 (1.20–1.48)a | ||
| External sources of revenue | |||
| Government | 1.00 | 1.00 | 1.00 |
| Other than government | 1.01 (0.90–1.13) | 1.05 (0.68–1.93) | 1.03 (0.97–1.11) |
| None | 0.77 (0.64–0.92)b | 0.79 (0.68–0.97)c | 1.08 (0.99–1.19) |
| Routine quality assurance activities | |||
| No | 1.00 | 1.00 | 1.00 |
| Yes | 0.99 (0.92–1.06) | 1.05 (0.95–1.16) | 1.06 (1.01–1.11)c |
| Routine management meetings | |||
| Not performed | 1.00 | na | 1.00 |
| Performed | 0.97 (0.83–1.13) | 1.01 (0.96–1.06) | |
| External supervision | |||
| No | 1.00 | 1.00 | 1.00 |
| Yes | 1.47 (0.96–2.26) | 0.98 (0.86–1.11) | 1.03 (0.95–1.14) |
| User fees | |||
| None | 1.00 | 1.00 | 1.00 |
| Separate fees | 0.80 (0.59–1.10) | 1.02 (0.92–1.14) | 1.10 (1.04–1.18)b |
| Fixed for all services | 1.01 (0.72–1.41) | 0.97 (0.84–1.13) | 1.04 (0.95–1.14) |
| Presence of health provider, 24 h | |||
| No | 1.00 | 1.00 | 1.00 |
| Yes | 1.16 (1.06–1.28)b | 1.19 (1.08–1.33)b | 1.02 (0.97–1.07) |
| Clients’ opinions | |||
| Not reviewed | 1.00 | 1.00 | 1.00 |
| Reviewed | 1.09 (1.01–1.17)c | 1.09 (1.02–1.19)c | 1.04 (0.99–1.09) |
| Ability to perform | |||
| Only diagnosis | 1.00 | 1.00 | 1.00 |
| Only treat | 1.16 (0.97–1.38) | 1.00 (0.91–1.17) | 1.16 (1.08–1.26)a |
| Both | 1.27 (1.05–1.53)c | 1.09 (1.01–1.17)c | 1.17 (1.09–1.25)a |
| No. of CVD care providers | 1.02 (1.01–1.04)b | 1.02 (1.01–1.04)b | 1.02 (1.01–1.04)a |
[i] Note: CI = confidence interval; IRR = incidence risk ratio; na = data were not available; 1facility type was measured for Afghanistan; 2facility type was measured for Bangladesh; 3facility type was measured for Nepal. Here a, b, and c indicate p < 0.001, p < 0.01 and p < 0.05.