Adapting the World Health Organization’s Service Availability and Readiness Assessment Tool (SARA) for Management and Leadership Training Programs, Adamawa State, Nigeria Open Access

Ezeokoli, Nchedochukwu Jennifer (Summer 2019)

Permanent URL:


Management and leadership competency is necessary for efficient and effective primary healthcare (PHC). Nigeria has committed to improve PHC by focusing on managing authorities called Officers-In-Charge. The Management and Leadership Training Program (M&LTP) deployed in Sierra Leone is proposed to be piloted in Nigeria to assist PHC revitalization. As part of the M&LTP, the World Health Organization’s (WHO) Service Availability and Readiness Assessment tool (SARA) gauges areas of improvement and promotes use of quantitative data for decision-making. SARA assesses health services availability, delivery, and quality especially around essential healthcare packages, medicines, and services. The goals of this project were two-fold: 1) determine the context-specific factors required to adapt SARA for a cultural and context-appropriate assessment; and 2) develop collection instruments for data management, collection, and analyses to “digitize” SARA via a tablet or smartphone with data stored for centralized data management. Data from in-depth key informant interviews and stakeholder meetings were used to revise a previously condensed SARA, leading to a successfully adapted SARA for the Nigerian PHC context and a “digitized” version available through an online survey platform and server. Strong data management in healthcare can inform policies, data-based decision making, and strengthen the health information system. Development of the digitized, adapted SARA tool provided a system for data collection, validation, maintenance, and analyses. Further efforts should be made to pilot the survey within the context of the program for refinement to develop a long-term evaluation plan.

Table of Contents

Executive Summary. 4

Acknowledgements. 6

Acronyms and Important Terms. 9

Introduction. 10

Project Purpose and Objectives. 12

Literature Review. 13

Sustainable Development Goals. 13

Health systems strengthening and the current need for management and leadership in low-resource settings. 13

Management and Leadership Training Program. 15

Service Availability and Readiness Assessment (SARA) Tool. 17

Abridged CHO SARA. 19

Nigeria: Health System & Primary Health Care. 21

Minimum Standards for PHC. 23

PHC in Nigeria. 24

Earlier SARA Adaptations. 25

Health Information Management System. 26

Methods. 27

Adaption of SARA to Nigeria. 28

M&LTP SARA Revision Guide (Appendix A). 28

In-depth key informant interviews. 28

Key Stakeholder Revision Meetings. 29

Digitization of SARA. 30

Pilot Testing of SARA. 30

Results. 32

Discussion, Recommendations, and Conclusions. 35

Strengths. 35

Weaknesses. 36

Recommendations. 36

PHC and Data Management: Possible Implications. 37

References. 38

Appendices. 41

Appendix A: M&LTP SARA Revision Guide. 41

Appendix B: Final Nigeria M&LTP SARA Tool 52

Appendix C: Data storage/platform comparison chart 58

Appendix D: Digitization screenshots of ODK+ (both app and website) 59

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Last modified

Primary PDF

Supplemental Files