Review data from all countries for internal purposes. NOT FOR CIRCULATION.

(last updated: 2021-10-19 07:03:38)

  • This reviews latest indicator estimate data in each country (ie., purple tab) - as is.
  • THREE Stata data files are created by Chelsea and saved in the sharepoint: “/BANICA, Sorin - HSA unit/3 Country implementation & learning/1 HFAs for COVID-19/HFA database/Renamed data/”
    – c19_all.dta
    – cehs_all.dta
    – community_all.dta
  • This analysis uses the Stata data files (changed from CSV files created in R, as of 8/31/2021), and analysis code is saved in the sharepoint: : “/BANICA, Sorin - HSA unit/3 Country implementation & learning/1 HFAs for COVID-19/HFA database/”
  • See 1.1 for the date of purple tab production in each survey
  • See below for date of the pulled dataset creation [FOR NOW DOWNLOAD DATE UNTIL SYNCING PROBLEM IS RESOLVED]
### C19CM
file.mtime(paste0(path,"c19_all.dta"))

[1] “2021-10-19 10:59:00 EST”

### CEHS
file.mtime(paste0(path,"cehs_all.dta"))

[1] “2021-10-19 10:59:00 EST”

### COMMUNITY 
file.mtime(paste0(path,"community_all.dta"))

[1] “2021-10-19 10:59:00 EST”

1. Implementation results

1.1 Overall

See the number of facilities/respondent in each country. Determine what dis-aggregation is possible or not.

Disaggregation by region/county has been excluded (for CMR and KEN).

NOTE: Latest file names manually updated on 9/22/2021, according to Chelsea’s Stata “rename” do files in the shrepoint

1.1.1 C19CM

C19CM: available data by country
Country Round Year Month Number of sentinel facilities Date of latest update for chartbook’s purple tab File name
Cameroon 1 2021 4 60 21Jul2021 CMR_WHO_COVID19HospitalReadiness_Chartbook_30July2021.xlsx
Ghana 1 2021 6 35 23Aug2021 Ghana_COVID19HospitalReadiness_Chartbook.xlsx
Kenya 1 2020 12 74 summary_COVID19HospitalReadiness_Kenya_R1.dta
Kenya 2 2021 4 77 KEN_Hospital_Chartbook_R2_26_05_2021_JK_(Jamlick).xlsx
Namibia 1 2021 8 43 15Sep2021 Namibia_COVID19HospitalReadiness_Chartbook_ADAPTED219.xlsx
Zambia 1 2021 7 53 19Aug2021 Zambia_WHO_COVID19HospitalReadiness_Chartbook_20082021.xlsx

1.1.2. CEHS

CEHS: available data by country
Country Round Year Month Number of sentinel facilities Date of latest update for chartbook’s purple tab File name
Cameroon 1 2021 4 186 19Jul2021 CMR_CEHS_Chartbook_30July2021.xlsx
Ghana 1 2021 6 143 23Aug2021 Ghana_CEHS_Chartbook.xlsx
Kenya 1 2020 12 91 summary_CEHS_Kenya_R1.dta
Kenya 2 2021 4 106 KEN_CEHS_Chartbook_R2_JK_01062021 (Jamlick).xlsx
Namibia 1 2021 8 116 21Sep2021 Namibia_CEHS_chartbook_ADAPTED-16_db.xlsx
Ukraine 1 2021 4 250 WHO_CEHS_chartbook_UKRAINE_v7_with_updated_navy_tab.xlsx
Zambia 1 2021 7 242 18Aug2021 WHO_CEHS_Zambia_Chartbook_Final_20082021.xlsx

1.1.3. COMMUNITY

Community: available data by country
Country Round Year Month Number of sentinel facilities Date of latest update for chartbook’s purple tab File name
Cameroon 1 2021 4 34 2Jun2021 CMR_Community_Chartbook30July2021.xlsx
GHANA 1 2021 6 216 23Aug2021 GH_Community_Chartbook.xlsx
Kenya 1 2020 12 51 summary_Community_Kenya_R1.dta

1.2 Disaggregated

See the number of facilities/respondent in each country. Determine what disaggregation is possible or not.

Disaggregation by region/county has been excluded (for CMR and KEN).

1.2.1. C19CM

C19CM: available data by country and analysis domain
Country Round Year Round Analysis.domain Domain.categories Number of sentinel facilities
Cameroon 1 2021 4 Sector Non-public 4
Cameroon 1 2021 4 Sector Public 56
Ghana 1 2021 6 Level District Hospital 27
Ghana 1 2021 6 Level Regional Hospital 8
Ghana 1 2021 6 Location Rural 7
Ghana 1 2021 6 Location Urban 28
Ghana 1 2021 6 Sector Government 26
Ghana 1 2021 6 Sector Non-Government 9
Kenya 1 2020 12 Level Level 2-4 47
Kenya 1 2020 12 Level Level 5-6 27
Kenya 1 2020 12 Location Rural 28
Kenya 1 2020 12 Location Urban 46
Kenya 1 2020 12 Sector Non-public 16
Kenya 1 2020 12 Sector Public 58
Kenya 2 2021 4 Level Level 4 58
Kenya 2 2021 4 Level Level 5 15
Kenya 2 2021 4 Level Level 6 4
Kenya 2 2021 4 Location Rural 30
Kenya 2 2021 4 Location Urban 47
Kenya 2 2021 4 Sector Non-public 15
Kenya 2 2021 4 Sector Public 62
Namibia 1 2021 8 Level Primary/Secondary 7
Namibia 1 2021 8 Level Tertiary 36
Namibia 1 2021 8 Location Rural 6
Namibia 1 2021 8 Location Urban 37
Namibia 1 2021 8 Sector Non-public 12
Namibia 1 2021 8 Sector Public 31
Zambia 1 2021 7 Level Primary/Secondary 2
Zambia 1 2021 7 Level Tertiary 51
Zambia 1 2021 7 Location Rural 15
Zambia 1 2021 7 Location Urban 38
Zambia 1 2021 7 Sector Non-public 17
Zambia 1 2021 7 Sector Public 36

1.2.2. CEHS

CEHS: available data by country and analysis domain
Country Round Year Round Analysis.domain Domain.categories Number of sentinel facilities
Cameroon 1 2021 4 Sector 3.1 Publique 100
Cameroon 1 2021 4 Sector 3.2 Privé laic 58
Cameroon 1 2021 4 Sector 3.3 Privé confessionnel 27
Ghana 1 2021 6 Level CHPS/Clinic/Health Centre 108
Ghana 1 2021 6 Level Hospitals 35
Ghana 1 2021 6 Location Rural 80
Ghana 1 2021 6 Location Urban 63
Ghana 1 2021 6 Sector Government 123
Ghana 1 2021 6 Sector Non-Government 20
Kenya 1 2020 12 Level Level 2-3 44
Kenya 1 2020 12 Level Level 4-6 47
Kenya 1 2020 12 Location Rural 58
Kenya 1 2020 12 Location Urban 33
Kenya 1 2020 12 Sector Non-public 24
Kenya 1 2020 12 Sector Public 67
Kenya 2 2021 4 Level Level 2-3 48
Kenya 2 2021 4 Level Level 4 58
Kenya 2 2021 4 Location Rural 68
Kenya 2 2021 4 Location Urban 38
Kenya 2 2021 4 Sector Non-public 24
Kenya 2 2021 4 Sector Public 82
Namibia 1 2021 8 Level Primary 106
Namibia 1 2021 8 Level Secondary 10
Namibia 1 2021 8 Location Rural 63
Namibia 1 2021 8 Location Urban 53
Namibia 1 2021 8 Sector Non-public 19
Namibia 1 2021 8 Sector Public 97
Ukraine 1 2021 4 Level Hospitals 36
Ukraine 1 2021 4 Level Primary 214
Ukraine 1 2021 4 Location Rural 17
Ukraine 1 2021 4 Location Urban 233
Ukraine 1 2021 4 Sector Non-public 25
Ukraine 1 2021 4 Sector Public 225
Zambia 1 2021 7 Level Primary 212
Zambia 1 2021 7 Level Secondary 30
Zambia 1 2021 7 Location Rural 104
Zambia 1 2021 7 Location Urban 138
Zambia 1 2021 7 Sector Non-public 29
Zambia 1 2021 7 Sector Public 213

1.2.3. COMMUNITY

Community: available data by country and analysis domain
Country Round Year Round Analysis.domain Domain.categories Number of key informants
Cameroon 1 2021 4 2.Occupation 2.1 ASCs 18
Cameroon 1 2021 4 2.Occupation 2.2 non ASCs 16
GHANA 1 2021 6 Location 1.1 Rural 58
GHANA 1 2021 6 Location 1.2 Urban 158
Kenya 1 2020 12 Location 1.1 Rural 25
Kenya 1 2020 12 Location 1.2 Urban 26
Kenya 1 2020 12 Occupation 2.1 non CHWs 4
Kenya 1 2020 12 Occupation 2.2 CHWs 47

2. Quality check

2.1 Sanity check

2.1.1 C19CM

A. Clear errors (or very odd cases)
A.1. _100 vs. _50

Results: surveys that have one or more red flags in overall or disaggregated estimates

Results: details

A.2. More restrictive vs. less restrictive
* xtraining_score vs. xtrainingsupport_score
* xppe_allsome_score vs. xppe_all_score
* xequip_all vs. zequip_any

Results: surveys that have one or more red flags in overall or disaggregated estimates
survey redflag_xtraining
GHA_R1 1
NAM_R1 1

A.3. Other
* Data entry for the number of beds

Results: surveys that have one or more red flags in overall or disaggregated estimates
survey redflag_bed1
CMR_R1 1
KEN_R2 1
ZMB_R1 4

Results: details

B. Likely errors, based on pattern that we observe
* ybed_cap_isolation vs. ybed_cap_covid_severe/critical
* clinical staff infections vs. non-clinical staff infection

Results: surveys that have one or more red flags in overall or disaggregated estimates
survey redflag_bed1 redflag_staffcovid1
CMR_R1 1 0
GHA_R1 0 2
KEN_R2 1 1
NAM_R1 0 2
ZMB_R1 6 1

Results: details

2.1.2 CEHS

A. Clear errors (or very odd cases)
A.1. _100 vs. _50

Results: surveys that have one or more red flags in overall or disaggregated estimates

A.2. More restrictive vs. less restrictive
* xtraining_score vs. xtrainingsupport_score
* xppe_allsome_score vs. xppe_all_score
* xdiagbasic_score vs. xdiag_score
* xcvd_ref vs. xcvd_reftrans

Results: surveys that have one or more red flags in overall or disaggregated estimates

Results: details

B. Likely errors, based on pattern that we observe

2.2. Rough plausibility check (FOR GROUP DISCUSSION)

  • Is a pattern in a country “very” different from that in other countries?
  • If the denominator is large enough, is a pattern within a country plausible (based on the “typical” gradient by residential areas, facility level, etc.)?

data quality comments are in blue box

3. Results interpretation (FOR GROUP DISCUSSION)

3.1. C19CM

C19CM: Summary score - safety/IPC

  • xtraining_score: Average score for training based on the tracer items (range: 0-100), among all facilities
  • xtrainingsupport_score: Average score for training AND supportive supervision based on the tracer items (range: 0-100), among all facilities
  • xsafe_score: Average score for safety measures based on the tracer items (range: 0-100), among all facilities
  • xppe_allsome_score: Average PPE items for all or some staff score (range: 0-100), among all facilities
  • xppe_all_score: Average PPE items for all staff score (range: 0-100), among all facilities
  • xguideline_score: Average score for IPC guidelines based on the tracer items (range: 0-100), among all facilities
  • xipcitem_score: Average IPC items score (range: 0-100), among all facilities

C19CM: Summary score - case diagnosis and management

  • xspcmitem_score: Average specimen collection items score (range: 0-100), among all facilities

  • xrdt_capacity: Average current testing load out of maximum capacity (%), Among those that conduct RDT tests onsite

  • xpcr_capacity: Average current testing load out of maximum capacity (%), among those that conduct PCR tests onsite

  • xdiagcovid_score: Average COVID diagnosis score (range: 0-100), among all facilities

  • xdrug_score: Average medicines score (range: 0-100), among all facilities

  • xsupp_score: Average supplies score (range: 0-100), among all facilities

  • xequip_anyfunction_score: Average equipment score, any quantity functioning (range: 0-100), among all facilities

  • xequip_allfunction_score: Average equipment score, all quantity functioning (range: 0-100), among all facilities

C19CM: IMST

  • ximst: % of facilities that have IMST
  • ximst_fun: % of facilities that have IMST, activated

Note: Do further analysis of “scores” by IMST status. If no difference, consider dropping the questioins.

C19CM: Bed capacity

  • ybed: Total pooled number of inpatient beds

  • ybed_cap_covid: Total pooled number of inpatient beds that can be used for any COVID-19 patients

  • ybed_cap_covid_severe: Total pooled number of inpatient beds that can be used for severe COVID-19 patients (not requiring intensive care)

  • ybed_cap_covid_critical: Total pooled number of inpatient beds that can be used for critical COVID-19 patients (requiring intensive care)

  • ybed_cap_noncovid: ybed - ybed_cap_covid

  • ybed_cap_respiso: Total pooled number of inpatient beds that can be used for respiratory isolation

  • ybed_covid_night: Total pooled number of inpatient beds currently occupied by confirmed/suspected COVID-19 patients (Average over two days)

  • ybed_convert_respiso: Total pooled number of inpatient beds that can be converted for respiratory isolation, if needed

  • ybed_convert_icu: Total pooled number of inpatient beds that can be converted for ICU, if needed

Note: Cameroon: ybed_cap_covid >> ybed_cap_respiso. French Q tanslation issue or health systems difference? “ybed_cap_respiso” is an add/unclear indicator.

A good example that interpretation requires COVID-19 transmission context.
- Kenya R2 & Zambia R1 were conducted in the middle of an outbreak - post-peak, when hospitalizations would have peaked….
- Ghana R1 was done during the low phase, right before an outbreak/peak.

C19CM: Staff: COVID-19 infection and vaccination

  • staff_pct_covid_clinical: percent of clinical staff who’ve been diagnosed with COVID, pooled across facilities
  • staff_pct_covid_nonclinical: percent of non-clinical staff who’ve been diagnosed with COVID, pooled across facilities
  • staff_pct_covid_all: percent of all staff who’ve been diagnosed with COVID, pooled across facilities
  • staff_pct_covaxany: % of staff who received any dose of COVID vaccine
  • staff_pct_covaxfull: % of staff who received full dose of COVID vaccine

C19CM: PPE

  • xppe: % of facilities that provide PPE to staff

  • xppe_allsome_100: % of facilities that have each of all 6 tracer PPE items currently available for all or some staff

  • xppe_allsome_50: % of facilities that have 50% or more of the tracer items

  • xppe_all_100: % of facilities that have each of all 6 tracer PPE items currently available for all staff

  • xppe_all_50: % of facilities that have 50% or more of the tracer items

  • xppedispose: % of facilities that dispose used PPE safely according to the IPC guidelines

Self reported PPE dispose is universally high - DROP (from round 2)

  • **xppe_all__gown**: % of facilities that have PPE tracer item currently available for all staff: Gown, protective
  • **xppe_all__gloves**: % of facilities that have PPE tracer item currently available for all staff: Gloves, examination
  • **xppe_all__goggles**: % of facilities that have PPE tracer item currently available for all staff: Goggles, protective
  • **xppe_all__faceshield**: % of facilities that have PPE tracer item currently available for all staff: Face shield
  • **xppe_all__respirator**: % of facilities that have PPE tracer item currently available for all staff: Respirator masks (N95 or FFP2)*
  • **xppe_all__mask**: % of facilities that have PPE tracer item currently available for all staff: Mask, medical/surgical
  • Reported PPE dispose is universally high. Consider to drop..
  • Availability of respirator masks is lowest among all items in all countries.
  • Availability of gloves and medical mask is universally high.

C19CM: IPC

  • **xipcitem__soap**: % of facilities that have: liquid soap
  • **xipcitem__sanitizer**: % of facilities that have: hand sanitizer
  • **xipcitem__biobag**: % of facilities that have: bio-hazardous bag
  • **xipcitem__boxes**: % of facilities that have: safety boxes
  • **xipcitem__bodybags**: % of facilities that have: body bags
  • xipcitem_100: % of facilities with all tracer IPC items
  • xipcitem_50: % of facilities that have 50% or more of the tracer items
  • Most IPC items (except bodybags) are reported to be near universally available.
  • Body bags are typically least available - except in Ghana.
  • Note: "xipcitem__handwash" is/would be an example of detailed indicator that will show up in the dashboard, if it is added in a specific country.

C19CM: Equipment

  • **xequip_anyfunction__xray**: % of facilities that have any available quantity functioning X-ray machines
  • **xequip_anyfunction__oximeters**: % of facilities that have any available quantity functioning pulse oximeters
  • **xequip_anyfunction__vent_icu**: % of facilities that have any available quantity functioning ventilators for ICU
  • **xequip_anyfunction__vent_noninvasive**: % of facilities that have any available quantity functioning non-invasive ventilators
  • xequip_anyfunction_100: % of facilities that have all tracer items, any quantity functioning
  • xequip_anyfunction_50: % of facilities that have 50% or more of the tracer items, any quantity functioning

Note, programmatic: availability of any functioning ventilators (invasive and non-invasive) is sub-optimal. Even if they exist and functional, we do not know if the number of ventilators can address an outbreak.

  • **xequip_allfunction__xray**: % of facilities that have all available quantity functioning X-ray machines
  • **xequip_allfunction__oximeters**: % of facilities that have all available quantity functioning pulse oximeters
  • **xequip_allfunction__vent_icu**: % of facilities that have all available quantity functioning ventilators for ICU
  • **xequip_allfunction__vent_noninvasive**: % of facilities that have all available quantity functioning non-invasive ventilators
  • xequip_allfunction_100: % of facilities that have all tracer items, all quantity functioning
  • xequip_allfunction_50: % of facilities that have 50% or more of the tracer items, all quantity functioning

C19CM: Oxygen

  • xoxygen_concentrator: % of facilities that have: oxygen concentrator
  • xoxygen_bulk: % of facilities that have: external supply bulk
  • xoxygen_cylinder: % of facilities that have: external supply oxygen cylinders
  • xoxygen_plant: % of facilities that have: oxygen generator plant
  • xoxygensource: % of facilities that have: any of the FOUR sources
  • xoxygen_dist: of facilities that have piped oxygen distribution to terminal bedside wall units
  • xoxygen_portcylinder: % of facilities that have a portable medical gas cylinder for oxygen, which is fitted with a valve, a pressure and flow regulator?

Note: internally consistent - generally.
But, what is the difference between xoxygen_cylinder vs. xoxygen_portcylinder? The relationship is different in Kenya R2. Data error/different interpretation or actual difference?

oxygen availability is universally good, though distribution is low (no immediate intervention possible for this).

3.2. CEHS

CEHS: Staff: COVID-19 infection and vaccination

  • staff_pct_covid_clinical: percent of clinical staff who’ve been diagnosed with COVID, pooled across facilities
  • staff_pct_covid_nonclinical: percent of non-clinical staff who’ve been diagnosed with COVID, pooled across facilities
  • staff_pct_covid_all: percent of all staff who’ve been diagnosed with COVID, pooled across facilities
  • staff_pct_covaxany: % of staff who received any dose of COVID vaccine
  • staff_pct_covaxfull: % of staff who received full dose of COVID vaccine

CEHS: Staff absence

  • xabsence: % of facilities that have had staff leave or absence in the past 3 months
  • xabsence_medical: % of facilities that have had staff leave or absence due to COVID-19 sickness or need to care for family members in the past 3 months
  • xabsence_structure: % of facilities that have had staff leave or absence due to COVID-19 related structural reasons (i.e., gov policy on health providers; limited transportation due to lockdown; lack of personal protective equipment) in the past 3 months
  • xabsence_social: % of facilities that have had staff leave or absence due to COVID-19 related social reasons (i.e., fear related to COVID-19; or fear related to violence targeting health workers) in the past 3 months

Note, programmatic:
* staff absence is common (expected?), but they are not necessarily for COVID related reasons (as reported by respondents/manager).
* See increase/shift in reasons in Kenya, reflecting burn out as the pandemic prolongs?.

CEHS: Changes in HR mangement

  • xhr: % of facilities that have changed HR management in the past 3 months due to COVID-19
  • xhr_shift: % of facilities that have changed staff assignment in the past 3 months due to COVID-19
  • xhr_increase: % of facilities that have had increased staff FTE in the past 3 months due to COVID-19
  • xhr_increase_exp: % of facilities that have had increased staff FTE in the past 3 months due to COVID-19, expanding hours for existing staff
  • xhr_increase_new: % of facilities that have had increased staff FTE in the past 3 months due to COVID-19, recruiting new staff
  • xhr_secondment: % of facilities that have seconded staff in the past 3 months due to COVID-19
  • xhr_decrease: % of facilities that have had decreased staff FTE in the past 3 months due to COVID-19

CEHS: Changes in service delivey volume - IPC/safety strategies

  • **xsafe__entrance_screening**: % of facilities that have implemented: Screening of all patients and visitors at a dedicated entrance
  • **xsafe__staff_entrance**: % of facilities that have implemented: Designated staff entrance for screening
  • **xsafe__sep_room**: % of facilities that have implemented: COVID-19 suspected patient consultation takes place in a separate room
  • **xsafe__triage_c19**: % of facilities that have implemented: Triage system that isolates COVID-19 suspects and confirmed cases
  • **xsafe__isolatareas**: % of facilities that have implemented: COVID-19 isolation areas clearly identified and divided from non-COVID-19 areas
  • **xsafe__triage_guidelines**: % of facilities that have implemented: Screening and triage of patients for suspected COVID-19 using an up-to-date guidelines
  • **xsafe__distancing**: % of facilities that have implemented: Distancing of at least 1 metre among patients and visitors in waiting rooms and wards
  • **xsafe__hygiene_instructions**: % of facilities that have implemented: Displaying instructions on hand and respiratory hygiene practices for patient and visitors
  • **xsafe__hygiene_stations**: % of facilities that have implemented: Hand hygiene stations for staff and patients at all points of care
  • **xsafe__ppe**: % of facilities that have implemented: Use of personal protective equipment for staff
  • **xsafe__cleaning**: % of facilities that have implemented: Environment cleaning and disinfection
  • First of all, see this diversity!!!
  • Changes that require structural conditions are low - makes sense. e.g., staff entrance, isolate area.

CEHS: PPE

  • xppe: % of facilities that provide PPE to staff

  • xppe_allsome_100: % of facilities that have each of all 6 tracer PPE items currently available for all or some staff

  • xppe_allsome_50: % of facilities that have 50% or more of the tracer items

  • xppe_all_100: % of facilities that have each of all 6 tracer PPE items currently available for all staff

  • xppe_all_50: % of facilities that have 50% or more of the tracer items

  • xppedispose: % of facilities that dispose used PPE safely according to the IPC guidelines

  • **xppe_all__gown**: % of facilities that have PPE tracer item currently available for all staff: Gown, protective
  • **xppe_all__gloves**: % of facilities that have PPE tracer item currently available for all staff: Gloves, examination
  • **xppe_all__goggles**: % of facilities that have PPE tracer item currently available for all staff: Goggles, protective
  • **xppe_all__faceshield**: % of facilities that have PPE tracer item currently available for all staff: Face shield
  • **xppe_all__respirator**: % of facilities that have PPE tracer item currently available for all staff: Respirator masks (N95 or FFP2)*
  • **xppe_all__mask**: % of facilities that have PPE tracer item currently available for all staff: Mask, medical/surgical
  • Individual items’ pattern is very similar to what we saw in C19CM.
  • Availability of respirator masks is lowest among all items in all countries. availability of gloves and medical mask is universally high.

CEHS: referral of COVID-19 patients

  • **xcvd_ref: % of facilities that have designated facilities for the referral of patients with suspected or confirmed COVID-19
  • **xcvd_reftrans: % of facilities that have designated facilities for the referral of patients with suspected or confirmed COVID-19 AND have access to safe and isolated transportation to transfer the patients

What do we do/act with this data? Does every facility need to have a referral facility??? what does that mean, if/when patient volume surges?
Note: check Kenya R1.

CEHS: Management of COVID-19 patients at primary-level facilities

  • xcvd_team: % of primary-level facilities that have a focal point or team responsible for COVID-19 service coordination
  • xcvd_sop: % of primary-level facilities that have a focal point or team AND standard operation procedures
  • xcvd_guide_casemanage: % of primary-level facilities that have received up-to-date guidelines to manage asymptomatic or mild COVID-19 cases, including for referral
  • GHA and CMR show much lower general “readiness”
  • In Ghana, probably because of health systems/coordination. See very low xcvd_pt.
  • In CMR, not clear…
  • xcvd_spcm: % of primary-level facilities that collect specimens from patients to diagnose COVID-19
  • xcvd_test: % of primary-level facilities that collect specimens AND conduct PCR tests or RDT to diagnose COVID‑19 on site
  • xcvd_test_pcr: % of primary-level facilities that collect specimens AND conduct PCR tests to diagnose COVID‑19 on site
  • xcvd_test_rdt: % of primary-level facilities that collect specimens AND conduct RDT to diagnose COVID‑19 on site
  • xcvd_spcmtrans: % of primary-level facilities that collect specimens, do not conduct tests to diagnose COVID‑19 on site, BUT have a functioning specimen transport system for forwarding specimens from the facility to a referral laboratory
  • Other than Ukraine, specimen collection is done only in about a half of the EHS facilities.
  • If testing is done on site, it’s mostly RDT. Makes sense.
  • See testing availability increase in Kenya from 7% in R1 to 26% in R2 - mainly because of expanded RDT.

CEHS: Management of COVID-19 patients at primary-level facilities (in the past three months

  • xcvd_pt: % of primary-level facilities that have seen patients with suspected COVID-19 in the past 3 months

  • xcvd_pt_sep_room: Among primary-level facilities that had COVID-19 patients in the past 3 months, % of primary-level facilities that performed: Patient consultation takes place in a separate room

  • xcvd_pt_c19_check: Among primary-level facilities that had COVID-19 patients in the past 3 months, % of primary-level facilities that performed: Checked for COVID-19 symptoms

  • xcvd_pt_o2_measure: Among primary-level facilities that had COVID-19 patients in the past 3 months, % of primary-level facilities that performed: Measured O2 saturation with pulse oximeter

  • xcvd_pt_refer: Among primary-level facilities that had COVID-19 patients in the past 3 months, % of primary-level facilities that performed: Referred the patient to specialized care

  • xcvd_pt_diagtest: Among primary-level facilities that had COVID-19 patients in the past 3 months, % of primary-level facilities that performed: Performed diagnostic test

  • xcvd_pt_home_isolate: Among primary-level facilities that had COVID-19 patients in the past 3 months, % of primary-level facilities that performed: Instructed patients with mild symptoms to self-isolate at home

  • xcvd_pt_tele: Among primary-level facilities that had COVID-19 patients in the past 3 months, % of primary-level facilities that performed: Provided teleconsultation to answer patient’s questions before facility visit

  • xcvd_pt_score: Average score for COVID-19 patients management based on the tracer items (range: 0-100), among primary-level facilities that had COVID-19 patients in the past 3 months

  • xcvd_pt_100: Among primary-level facilities that had COVID-19 patients in the past 3 months, % of facilities that have performed all seven tracer items for management of COVID-19 patients

  • xcvd_pt_50: Among primary-level facilities that had COVID-19 patients in the past 3 months, % of facilities that have performed 50% of tracer items for management of COVID-19 patients

Note: Ghana should drop these xcvd_pt questions. Too small denominator.

CEHS: Management of COVID-19 patients: Home-based self-isolation

  • xcvd_pthbsi: % of primary-level facilities that have instructed home isolation for mild COVID-19 patients

  • xcvd_pthbsi_tele: % of primary-level facilities that have instructed home isolation for mild COVID-19 patients AND: Provided remote consultation (phone or video call, text message)

  • xcvd_pthbsi_homevisit: % of primary-level facilities that have instructed home isolation for mild COVID-19 patients AND: Visited patients at home

  • xcvd_pthbsi_followup: % of primary-level facilities that have instructed home isolation for mild COVID-19 patients AND: Arranged follow-up visit to the facility (e.g. by asking the patient to report to a designated entrance at prearranged appointment time)

  • xcvd_pthbsi_safetyinstruct: % of primary-level facilities that have instructed home isolation for mild COVID-19 patients AND: Provided safety instructions for the members of the patient’s household

  • xcvd_pthbsi_complianceassess: % of primary-level facilities that have instructed home isolation for mild COVID-19 patients AND: Assessed compliance with self-isolation

  • xcvd_pthbsi_report: % of primary-level facilities that have instructed home isolation for mild COVID-19 patients AND: Reported the home-based self-isolation and care patients to relevant health authority

  • xcvd_guide_casemanage: % of primary-level facilities that have received up-to-date guidelines to manage asymptomatic or mild COVID-19 cases, including for referral

Note: Ghana should drop these xcvd_pthbsi questons. Too small denominator.

CEHS: Management of COVID-19 patients: Souce of information

  • xcvd_info: % of primary-level facilities that have received any other information to manage asymptomatic or mild COVID-19 cases
  • xcvd_info_moh: % of primary-level facilities that have received any other information to manage asymptomatic or mild COVID-19 cases from: MOH
  • xcvd_info_localgov: % of primary-level facilities that have received any other information to manage asymptomatic or mild COVID-19 cases from: local government authority
  • xcvd_info_who: % of primary-level facilities that have received any other information to manage asymptomatic or mild COVID-19 cases from: WHO
  • xcvd_info_prof: % of primary-level facilities that have received any other information to manage asymptomatic or mild COVID-19 cases from: professional associations
  • xcvd_info_other: % of primary-level facilities that have received any other information to manage asymptomatic or mild COVID-19 cases from: other

Note: in CMR, “other” is the major source. What are they?

CEHS: COVID-19 vaccination

  • xcovax: % of facilities that provide COVID-19 vaccine

  • **xcovax_offer__pfizer**: Among facilities that provide COVID-19 vaccine, % of facilities that offer vaccine 001

  • **xcovax_offerav__pfizer**: Among facilities that provide COVID-19 vaccine, % of facilities that offer and have vaccine 001

  • **xcovax_offer__moderna**: Among facilities that provide COVID-19 vaccine, % of facilities that offer vaccine 002

  • **xcovax_offerav__moderna**: Among facilities that provide COVID-19 vaccine, % of facilities that offer and have vaccine 002

  • **xcovax_offer__astra**: Among facilities that provide COVID-19 vaccine, % of facilities that offer vaccine 003

  • **xcovax_offerav__astra**: Among facilities that provide COVID-19 vaccine, % of facilities that offer and have vaccine 003

  • **xcovax_offer__jj**: Among facilities that provide COVID-19 vaccine, % of facilities that offer vaccine 004

  • **xcovax_offerav__jj**: Among facilities that provide COVID-19 vaccine, % of facilities that offer and have vaccine 004

See the gap between “offer” vs. “available” in GHA and ZMB.

  • xcovax_syr: Among facilities that provide COVID-19 vaccine, % of facilities that syringes

  • xcovax_sharp: Among facilities that provide COVID-19 vaccine, % of facilities that have sharps containers

  • xcovax_strtemp: Among facilities that provide COVID-19 vaccine, % of facilities that have cold storage for COVID-19 vaccine remaining in the recommended temperature range, currently

  • xcovax_strtemp_w: Among facilities that provide COVID-19 vaccine, % of facilities that have cold storage for COVID-19 vaccine remaining in the recommended temperature range, currently AND for the past week

  • xcovax_aefikit: Among facilities that provide COVID-19 vaccine, % of facilities that have AEFI kit

  • xcovax_aefireport: Among facilities that provide COVID-19 vaccine, % of facilities that have system to report AEFI to the central center

See cold chain issues in GHA.
Missing aefi data - why??

  • **xcovax_train__storage**: Among facilities that provide COVID-19 vaccine, % of facilities that have staff trained on: storage of vaccine
  • **xcovax_train__admin**: Among facilities that provide COVID-19 vaccine, % of facilities that have staff trained on: administration of vaccine
  • **xcovax_train__report_adverse**: Among facilities that provide COVID-19 vaccine, % of facilities that have staff trained on: management of adverse events
  • **xcovax_train__manage_adverse**: Among facilities that provide COVID-19 vaccine, % of facilities that have staff trained on: reporting adverse events

Reported training is universally high. Probably not reporting bias, since the vaccine is brand new.

  • xcovax_infrtrn: Among facilities that provide COVID-19 vaccine, % of facilities that inform when to return for the next vaccination
  • xcovax_infside: Among facilities that provide COVID-19 vaccine, % of facilities that inform side effect
  • xcovax_infaewhat: Among facilities that provide COVID-19 vaccine, % of facilities that inform what to do in case of adverse events
  • Reported practice is universally high. Consider dropping this.
  • But, what happened in Zambia. Most commonly offered vaccine is ASTRA Z, which requires two visits.

3.2.A CEHS service provision

CEHS: Changes in service delivey strategies

  • xstrategy: of facilities that have modifications in service provision in the past 3 months
  • xstrategy_reduce: of facilities that have implemented measures to reduce service provision in the past 3 months
  • xstrategy_reduce_closure: of facilities that have implemented measures to reduce service provision in the past 3 months: closure
  • xstrategy_reduce_hrchange: of facilities that have implemented measures to reduce service provision in the past 3 months: service hour change
  • xstrategy_reduce_reduce: of facilities that have implemented measures to reduce service provision in the past 3 months: reduced/suspended service scope or volume
  • xstrategy_reduce_redirect: of facilities that have implemented measures to reduce service provision in the past 3 months: redirect
  • xstrategy_reduce_priority: of facilities that have implemented measures to reduce service provision in the past 3 months: priority
  • xstrategy_reduce_combine: of facilities that have implemented measures to reduce service provision in the past 3 months: Provided all care in a single visit for multiple morbidities
  • xstrategy_self: of facilities that have implemented measures to reduce service provision in the past 3 months: self-care
  • xstrategy_home: of facilities that have implemented measures to reduce service provision in the past 3 months: home based care
  • xstrategy_remote: of facilities that have implemented measures to reduce service provision in the past 3 months: telemedicine
  • xstrategy_prescription: of facilities that have implemented measures to reduce service provision in the past 3 months: new prescription appproaches

(Facilities can provide multiple strategies.)

Note: reflection of various context. no benchmark. requires context specific interpretation.
* Makes sense that Ukraine looks different from others. See remote and prescription.
* Very few closure. Mostly reduced hours. Scope reduction is not common. Meaning service availability did not change drastically - especially for priority patients.

CEHS: Changes in service delivery volume - Outpatient

  • xopt_increase: % of facilities that have had increased outpatient attendance in the past 3 months in one or more of the 18 services listed

  • xopt_increase_reason_covidnow: % of facilities that have had increased outpatient attendance in the past 3 months AND cited reasons reflecting current outbreak

  • xopt_increase_reason_covidafter: % of facilities that have had increased outpatient attendance in the past 3 months AND cited reasons reflecting impact of past outbreak

  • xopt_increase_reason_gbv: % of facilities that have had increased outpatient attendance in the past 3 months AND cited reasons reflecting GBV

  • xopt_decrease: % of facilities that have had decreased outpatient attendance in the past 3 months in one or more of the 18 services listed

  • xopt_decrease_reason_comdemand: % of facilities that have had decreased outpatient attendance in the past 3 months AND cited reasons reflecting community demand changes

  • xopt_decrease_reason_enviro: % of facilities that have had decreased outpatient attendance in the past 3 months AND cited reasons reflecting barriers in care seeking

  • xopt_decrease_reason_intention: % of facilities that have had decreased outpatient attendance in the past 3 months AND cited reasons reflecting changes in service provision strategies

  • xopt_decrease_reason_disruption: % of facilities that have had decreased outpatient attendance in the past 3 months AND cited reasons reflecting disruption at the facility level

(Facilities can provide multiple reasons.)

  • Again, this is more to explain HMIS trend AND depends on timing of data collection in the course of the pandemic.
  • Also, different service use behave differently. So, xopt_increase and xopt_decrease would be yes in most facilities, unless they are specialized in particular services (which should not be part of the EHS sample anyway, in theory)
  • this data in particular should be laid over the outbreak trend data.
  • For example, it makes sense that GHA reported “covidafter” reasons for increase, cause the survey was done in between waves.
  • Kenya R1 had high service readiness disruption and also high external environmental reasons (which was strongly imposed in most of 2020?).
  • Namibia, GBV??? 53% of sentinel facilities reported GBV is a reason behind increased services - though this one doesn’t pin point which services See what services increased in Namibia. Only 20% of facilities reported increased violence related services.
  • But, the most common reason for the decrease is (reduced) community demand. will be interesting to see if this changes over time.
  • See individual services…
  • really tricky….

CEHS: Reasons for decreased OPT volume: disruption

  • **xdisrupt__hr**: % of facilities that reported outpatient volume decreased in some services AND quiet a lot/great deal is due to: HR
  • **xdisrupt__finance**: % of facilities that reported outpatient volume decreased in some services AND quiet a lot/great deal is due to: finance
  • **xdisrupt__ipc**: % of facilities that reported outpatient volume decreased in some services AND quiet a lot/great deal is due to: IPC
  • **xdisrupt__medsupp**: % of facilities that reported outpatient volume decreased in some services AND quiet a lot/great deal is due to: medicines/supplies

Similar indicators:
* In section 7, __xdisrupt_supply**: % of facilities that reported service disruption due to supply stock out (potentially leading question)
* In section 4, __xopt_decrease_reason_disruption**: % of facilities that have had decreased outpatient attendance in the past 3 months AND cited reasons reflecting disruption at the facility level

CEHS: Changes in service delivery volume - ER

  • xer: % of facilities providing emergency unit services

  • xer_increase: Among facilities with emergency unit, % of facilities that have had overall increased emergency unit visits in the past 3 months compared to the same months last year

  • xer_decrease: Among facilities with emergency unit, % of facilities that have had overall decreased emergency unit visits in the past 3 months compared to the same months last year

  • xer_nochange: Among facilities with emergency unit, % of facilities that have had overall no changes in emergency unit visits in the past 3 months compared to the same months last year

  • **xer_increase__002**: Among facilities with emergency unit. % of facilities that have had increased emergency unit visits for injuries in the past 3 months

  • **xer_increase__003**: Among facilities with emergency unit. % of facilities that have had increased emergency unit visits for emergency surgeries in the past 3 months

  • **xer_increase__004**: Among facilities with emergency unit. % of facilities that have had increased emergency unit visits for NCD related conditions in the past 3 months

  • **xer_increase__005**: Among facilities with emergency unit. % of facilities that have had increased emergency unit visits for emergency blood transfusion services in the past 3 months

  • **xer_decrease__002**: Among facilities with emergency unit. % of facilities that have had decreased emergency unit visits for injuries in the past 3 months

  • **xer_decrease__003**: Among facilities with emergency unit. % of facilities that have had decreased emergency unit visits for emergency surgeries in the past 3 months

  • **xer_decrease__004**: Among facilities with emergency unit. % of facilities that have had decreased emergency unit visits for NCD related conditions in the past 3 months

  • **xer_decrease__005**: Among facilities with emergency unit. % of facilities that have had decreased emergency unit visits for emergency blood transfusion services in the past 3 months

CEHS: Changes in service delivery volume - inpatient

  • xipt: % of facilities providing IPT inpatient services
  • xipt_increase: Among facilities provide inpatient services, % of facilities that have had increased inpatient admissions in the previous 3 months compared to the same months last year
  • xipt_decrease: Among facilities provide inpatient services, % of facilities that have had decreased inpatient admissions in the previous 3 months compared to the same months last year
  • xipt_nochange: Among facilities provide inpatient services, % of facilities that have had no changes in inpatient admissions in the previous 3 months compared to the same months last year

CEHS: Changes in service delivery volume - pre ER

  • xpreer: % of facilities that provide pre-hospital emergency care services
  • xpreer_increase: Among facilities provide pre-hospital emergency care services, % of facilities that have had increased pre-hospital emergency care services
  • xpreer_decrease: Among facilities provide pre-hospital emergency care services, % of facilities that have had decreased pre-hospital emergency care services
  • xpreer_nochange: Among facilities provide pre-hospital emergency care services, % of facilities that have had no change in pre-hospital emergency care service volume

CEHS: Changes in service delivery volume - outreach

  • xout: % of facilities that provide community outreach or home-visit services

  • **xout_decrease__immun**: Among facilities providing community outreach or home-visit services, % of facilities that have reduced or suspended: Immunization outreach

  • **xout_decrease__malaria**: Among facilities providing community outreach or home-visit services, % of facilities that have reduced or suspended: Malaria prevention campaigns, including distribution of ITN

  • **xout_decrease__ntd**: Among facilities providing community outreach or home-visit services, % of facilities that have reduced or suspended: Neglected tropical disease outreach activities, including mass drug administration

  • **xout_decrease__cbc**: Among facilities providing community outreach or home-visit services, % of facilities that have reduced or suspended: Community-based mobile clinics

  • **xout_decrease__home**: Among facilities providing community outreach or home-visit services, % of facilities that have reduced or suspended: home visits

  • xout_decrease: Among facilities providing community outreach or home-visit services, % of facilities that have reduced or suspended one or more of the five services (see below) in the past three months

CEHS: Changes in service delivey volume - restoration

  • xresto: % of facilities that have developed plans to deliver services for patients who missed their routine appointments that are unrelated with COVID-19 in the previous 3 months AND registered them

  • xresto_imp_preg: Among facilities that provide ANC, % of facilities that have implemented plans for targeted catch up for pregnant women who missed appointments in the past three months

  • xresto_imp_immunization: Among facilities that provide child immunization, % of facilities that have implemented plans for targeted catch up for missed appointments for childhood immunization

  • xresto_imp_chronic: Among facilities that provide NCD, % of facilities that have implemented plans for targeted catch up for chronic non-communicable diseases patients who missed appointments in the past three months

  • xresto_imp_tb: Among facilities that provide TB, % of facilities that have implemented plans for targeted catch up for TB patients who missed appointments in the past three months

  • xresto_imp_hiv: Among facilities that provide HIV, % of facilities that have implemented plans for targeted catch up for HIV patients who missed appointments in the past three months

  • xresto_imppln_preg: Among facilities that provide ANC, % of facilities that have developed or implemented plans for targeted catch up for pregnant women who missed appointments in the past three months

  • xresto_imppln_immunization: Among facilities that provide child immunization, % of facilities that have developed or implemented plans for targeted catch up for missed appointments for childhood immunization

  • xresto_imppln_chronic: Among facilities that provide NCD, % of facilities that have developed or implemented plans for targeted catch up for chronic non-communicable diseases patients who missed appointments in the past three months

  • xresto_imppln_tb: Among facilities that provide TB, % of facilities that have developed or implemented plans for targeted catch up for TB patients who missed appointments in the past three months

  • xresto_imppln_hiv: Among facilities that provide HIV, % of facilities that have developed or implemented plans for targeted catch up for HIV patients who missed appointments in the past three months

3.3. COMMUNITY

COMMUNITY: Attitude towards COVID-19 vaccine

Percent of communities where most/some people are concerned about COVID-19 and where most people would receive COVID-19 vaccine

COMMUNITY: Reasons for vaccine hesitancy

  • Francophone Western Africa has more vaccine hesitancy in general even before the pandemic. But, general hesitancy in CMR is not substantially higher than that in KEN & GHA. Why?
  • Because, in CMR, these reasons are practically answered by all CHWs (about their communities - which is practically general population).
  • Whereas in KEN & GHA, these reasons are for about half of the CHWs who think not most people in their community would get the COVID vaccine - i.e., select communities. So, general vaccine hesitancy in those settings may appear higher than general vaccine hesitancy in CMR. Still rather puzzling…

Note, programmatic: the difference between COVID-19 vaccine specific concerns and general concerns about vaccine suggests potential target groups and interventions.

COMMUNITY: Unmet need

Missing data - why??

Met/unmet need distribution among people who have specific condition/need (Individual)

COMMUNITY: Barriers to access care

COMMUNITY: Sources of care

COMMUNITY: Marginalized people

COMMUNITY: Risk of COVID-19 infection among key informants

COMMUNITY: Stigma & support

COMMUNITY: Service volume change

COMMUNITY: Community initiatives, health

COMMUNITY: Community initiatives, social/economic