Baseline Survey for Health Services Availability and Kyaik Hto Township (Survey protocol)
Golden Zaneka Public Company Ltd. is a multifunctional health care service company which was established in November 2013 with the aim of providing quality health care services with affordable price. Service currently delivered by the Company are: Managed Health Care (Social Business Model), Emergency Medicine Care, Home Health Care services, Call Center / Emergency Medical Dispatch Services, Human Resource Capacity and Competency Building, Development of Community Medical centers as a social business model, Trading and Manufacturing of Pharmaceuticals. All of these services are delivered to the individuals as well as interested organizations. The Company is led by nine founding members who have extensive working experience in both public and private health care services in Myanmar . They also graduated from prominent international universities and currently providing services to the public with their utmost capability and compassion. The Company aspires to be a national and international core for providing clinical and public health services and has developed dedicated staff who received proper training and qualification for the services. It also sets modern equipment and supplies to be able to provide the best services for the customers.
The Company is implementing a pilot project in Kyaik Hto Township for providing managed health care to the community, home health care and emergency medical care services. Technical and advisory services are also providing to the local doctors, nurses and paramedics to improve their capacity in providing services. A C-band satellite communication link was established and communicated between hospitals, clinics in Kyaik Hto with Parami Hospital in Yangon. All emergency medical care, telemedicine, call center services, training and research services can be carried out through this communication link. By using this communication link health workers can improve their technical knowledge and provide modern health care to the community. On the other hand, communities in the Kyaik Hto Township can also have access to modern medical services with the minimal cost. In the near future, this type of project will reproduce to other townships all over the country. In order to effectively implement the Kyaik Hto Project activities and explore the background information of communities, baseline survey for health services availability and utilization is carried out.
Specific objectives of the survey are:
(1) To measure the morbidity pattern of major illnesses among children, youth, women and men in the villages and wards
(2) To assess expenditure and health care utilization pattern of households including cost of care, their affordability, arrangement of payment and interest to prepayment
(3) To measure background characteristics of households and household members, their knowledge, attitude and practice related to seeking medical care
Survey design and sampling:
Baseline Survey for Health Services Availability and Utilization will collect data from households and will use two stage cluster sampling method. First stage will select clusters (villages or wards) by probability proportionate to estimated size (PPES) method. Second stage will select households by segmentation method.
Sample size determination: The following formula was used to estimate the required sample size for the indicators:
[(1.96)2(r) (1-r) (f) (1.1)]
n = ———————————–
- n is the required sample size, expressed as number of households
- 1.96 is s factor to achieve the 95% level of confidence
- r is the predicted or anticipated prevalence (coverage rate) of the indicator
- 1.1 is the factor necessary to raise the sample size by 10 percent for non-response
- f is the shortened symbol for the deff (design effect)
- 0.1r is the margin of error to be tolerated at the 95% level of confidence ,defined as 10% of r(relative sampling error of r)
- Nh is the average household size
For the calculation of sample size: r is utilization of health care at clinics or health centers or OPD of hospitals (.05 percent of total population); design effect is taken as 1.5; average household size was taken as 4.5 person per household. The resulting number of household from this calculation is 2675. This means minimum number of household to be visited for the survey is 2675 and it may be rounded into 3000 to obtain adequate sample size. The average cluster size estimated in the survey is 30 and total number of clusters to be visited is 100.
Selection of clusters: Updated list of villages and wards from Kyaik Hto Township was used as sampling frame for selection of clusters. In urban areas wards are defined as primary sampling units (PSUs) or clusters and in rural area villages tracts are taken as PSUs. A total of 100 clusters (PSUs) are selected from sampling frame by systematic sampling ( Probability proportional to estimated size) method. Within each village tract a village will be selected by random sampling method.
Selection of households: Within each cluster two segments of 15 households each will be selected randomly for data collection. For the purpose of household selection, survey teams visit each cluster one day ahead of field data collection and listed the occupied households. In order to do that, a village or ward map is obtained from local authorities or drawn a sketch map by the team and make detail list of households in the map . All households in the map are divided into segments of 15 households approximately and selected two segments randomly to make a cluster of 30 households.
Household questionnaire will include:
- Household listing and education of household members
- Household characteristics module
- Household expenditure module
- Disease morbidity and household medical care expenditure module
- Prepayment module
Field work for data collection:
Field interviewers will be selected from volunteers working in the NGOs or civil organizati-
ons such as MMCWA, Red Cross and youth associations etc. in the Township and trained for interviews using questionnaire. Survey coordinator and supervisors will take responsibility for supervision and monitoring of field activities. Survey training will take one week and field data collection will take three weeks.
Data entry and processing:
Data entry will be done by computer staff from Parami Hospital using CSpro software and analyzed by SPSS software. Survey report will be prepared after data analysis.