Assessment of service availability and readiness (SAR)
DM, HF, pain, HT, activities).Details
HIV INFECTION, DISEASE, COMPLICATIONS
The modified SARA tool assessed five aspects of service delivery elements (listed below). A HF could obtain up to 10 points for each element, so that a maximum of 50 points could be achieved.Availability and functionality of essential equipment (e.g., blood pressure (BP) machine, weighing scale, stadiometer, glucometer/urine dipsticks, stethoscope, patient register book, HT/DM screening logbook, referral register book, health education record).Availability of drugs and other consumables (for the treatment of HT and DM and whether drugs were in line with guidelines and in sufficient stock).Quality of records on patients with NCDs (guidelines, essential demographic data, clinical observations, information on diagnosis, treatment, referral and follow up).Healthcare utilisation at facility by patients with NCDs (number of HT and DM patients, evidence for increase in utilisation over past year).Prevention of NCDs and their complications (evidence for and number of health education sessions given, evidence for active screening for HT or DM among those that presented with other conditions e.g., back pain evidence of outreach activities).Details of the adapted SARA tool used are available from Supplementary table Health worker knowledge was assessed by means of a supervised self-completed multi-choice questionnaire that was based on 3 clinical case scenarios on HT, DM, and HIV infection. For each scenario, the assessment also looked at five elements: 1) essential diagnostic steps (symptoms, signs, tests); 2) risk factors for each of these 3 disease; 3) complications; 4) treatment regimens; and 5) guidelines for referral. The HIV case scenario was included for comparison, as earlier knowledge tests had indicated that HWs in East Africa had generally good knowledge on HIV case management [The inspection score from the SARA tool and the scores from the health worker clinical knowledge assessment were combined into a single aggregate facility performance score (FPS). The score from the SARA tool was converted to a percentage and scaled to a maximum of 60 points (e.g., a facility that scored 40 on the SARA would have achieved 40/50 = 0.80*60 = 48 points). Similarly, HW knowledge scores for each facility were totalled and converted to a percentage, then scaled to a maximum of 40 points. For example, if there were 5 HWs who accumulated a total of 132 points out of 150 (5 × 30) possible points (equivalent to 88%), the facility received a total of (40*0.88) = 35 points (rounded to the nearest whole number) for the knowledge assessment. The SARA and knowledge assessments points were then combined into the FPS with a maximum score of 100. Using the above example, the FPS would then be 48 + 35 = 83 out of a possible maximum of 100 points.Additional details on health worker characteristics are available from Supplementary table 