title: Estimation of indices of health service readiness with a principal component analysis of the Tanzania Service Provision Assessment Survey.
abstract: BACKGROUND
  Service Provision Assessment (SPA) surveys have been conducted to gauge primary health care and family planning clinical readiness throughout East and South Asia as well as sub-Saharan Africa. Intended to provide useful descriptive information on health system functioning to supplement the Demographic and Health Survey data, each SPA produces a plethora of discrete indicators that are so numerous as to be impossible to analyze in conjunction with population and health survey data or to rate the relative readiness of individual health facilities. Moreover, sequential SPA surveys have yet to be analyzed in ways that provide systematic evidence that service readiness is improving or deteriorating over time.
  
  
  METHODS
  This paper presents an illustrative analysis of the 2006 Tanzania SPA with the goal of demonstrating a practical solution to SPA data utilization challenges using a subset of variables selected to represent the six building blocks of health system strength identified by the World Health Organization (WHO) with a focus on system readiness to provide service. Principal Components Analytical (PCA) models extract indices representing common variance of readiness indicators. Possible uses of results include the application of PCA loadings to checklist data, either for the comparison of current circumstances in a locality with a national standard, for the ranking of the relative strength of operation of clinics, or for the estimation of trends in clinic service quality improvement or deterioration over time.
  
  
  RESULTS
  Among hospitals and health centers in Tanzania, indices representing two components explain 32% of the common variance of 141 SPA indicators. For dispensaries, a single principal component explains 26% of the common variance of 86 SPA indicators. For hospitals/HCs, the principal component is characterized by preventive measures and indicators of basic primary health care capabilities. For dispensaries, the principal component is characterized by very basic newborn care as well as preparedness for delivery.
  
  
  CONCLUSIONS
  PCA of complex facility survey data generates composite scale coefficients that can be used to reduce indicators to indices for application in comparative analyses of clinical readiness, or for multi-level analysis of the impact of clinical capability on health outcomes or on survival.
authors.affiliation: Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave, Suite B-2, New York, NY, 10032, USA. ej2217@cumc.columbia.edu.
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Jackson
authors.affiliation: Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave, Suite B-2, New York, NY, 10032, USA. ayesha.siddiqui@mssm.edu.|Department of Family Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, USA. ayesha.siddiqui@mssm.edu.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Siddiqui
authors.affiliation: Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave, Suite B-2, New York, NY, 10032, USA. hialy.gutierrez@gmail.com.
authors.forename: Hialy
authors.initials: H
authors.lastname: Gutierrez
authors.affiliation: Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave, Suite B-2, New York, NY, 10032, USA. amk2213@cumc.columbia.edu.
authors.forename: Almamy Malick
authors.initials: AM
authors.lastname: Kanté
authors.affiliation: Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave, Suite B-2, New York, NY, 10032, USA. ja2026@cumc.columbia.edu.
authors.forename: Judy
authors.initials: J
authors.lastname: Austin
authors.affiliation: Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave, Suite B-2, New York, NY, 10032, USA. James.phillips@cumc.columbia.edu.
authors.forename: James F
authors.initials: JF
authors.lastname: Phillips
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D003695:Delivery of Health Care; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005193:Family Planning Services; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011320:Primary Health Care; D025341:Principal Component Analysis; D058996:Quality Improvement; D012044:Regression Analysis; D013636:Tanzania