Level of Agreement of the Service Level Index (SLI) Tool with a Standard Service Provision Assessment Tool for Measurement of Antenatal Care Service Provision

Abstract

The generation of health service delivery data in middle- and low-income countries typically relies on health facility surveys and routine health monitoring data. Previous studies on antenatal care (ANC) service delivery have not employed measurement parameters that accurately and cost-effectively encompass various aspects of ANC service availability, content, and organization. This study aimed to assess the agreement level between the Service Level Index (SLI) tool, which measures ANC service provision, and a standard Service Provision Assessment tool. The SLI tool integrates pertinent sub-domains relevant to ANC service provision processes at the health facility level, employing selected key elements from these sub-domains as proxy measures. This approach minimizes the complexities associated with the time and effort required for assessing service delivery comprehensively. The study examined the agreement between the Service Level Index tool and the ANC module of the MEASURE/DHS Service Provision Assessment tool. To accomplish this, the results obtained from the service level index measurement for each health facility were compared with the outcomes derived from the MEASURE/DHS Service Provision Assessment tool. Statistical analysis using the Bland-Altman method was employed to ascertain the significance of differences between measurements obtained from the Service Level Index tool and the Service Provision Assessment tool. The estimated mean difference (d) and standard deviation (sd) were 0.1 and 0.507, respectively. The agreement level between the two tools (-1.19 to 1.46) indicated that, for 95% of observations, the scoring of ANC service provision conducted using the SLI tool deviated between 1.19% lower and 1.46% higher than the scores generated by the reference tool. The results revealed that the Service Level Index tool has the potential to serve as an alternative to the ANC module of the standard Service Provision Assessment tool for evaluating ANC services at the micro-level.