Step 1: Complete Desk Review

The desk review is an important part of the assessment — by collecting, organizing and synthesizing available information, the team gains an understanding of the country context, public health priorities and health care trends, and equally important, identifies gaps to address during the in-country field work. Desk review activities include scanning the literature, analyzing secondary data, and creating a reference list so that all documents are organized and easily accessible to all team members.

1.1 Scan the Literature

Scan journal articles, reports and other gray literature, and laws and regulations related to the health domains, gender, and technical areas of interest. It’s easy to get into the weeds, so keep focused on the scope of the assessment and the information you’ll need for the preliminary synthesis and to write the final report. More specifically:

  • Context such as basic health indicators selected according to the assessment’s priority. This is for the introduction and to set the stage for each of the technical areas. Examine sex-disaggregated data to detect any gendered patterns that may suggest differential treatment of women and men, girl children and boy children. Include basic indicators of gender equality, such as sex-disaggregated educational levels, the prevalence of gender-based violence, women’s control over income and resources, maternal mortality ratio, etc. (See the DHS, the World Bank’s database on gender, previous gender assessments.)
  • An overview of the health system and key players
  • Policy environment and active development partners
  • Health expenditures

Common information sources to inform a private health sector assessment include:

  • Population, Health, and Nutrition Data
  • Business Environment Data
  • Regional Resources
  • Private Sector Assessment Reports
  • National Health Plans and Policies
  • Health Expenditures

1.2 Analyze Secondary Data

Once teams have reviewed available information, the next step is to begin to analyze publicly available data, such as demographic and health information, household health expenditures, and other relevant data. Look for trends, gaps, and opportunities for the private sector to contribute to improving health outcomes such as:

  • Trends in the use of the private health sector by service type (family planning, HIV and AIDS, etc.) and by wealth quintile  through analysis of DHS data
  • Trends in public and private financing of health care through analysis of National Health Accounts [if available]

Most secondary sources are publicly available datasets, such as Demographic and Health Surveys. These provide important data on health-seeking behaviors—including gender-influenced behaviors—and can be used to gauge reliance on the private health sector for specific health services. Commonly used data sources are summarized below:

Demographic and Health Surveys and AIDS Indicator Surveys
USAID supports ongoing population-based surveys that provide data on health-seeking behavior for priority health areas, including maternal and child health, family planning, and HIV and AIDS. Demographic and Health Survey (DHS) data are available for a majority of developing countries, while AIDS Indicator Survey (AIS) data are limited to high-HIV prevalence countries. To access DHS and AIS data from the Demographic and Health Survey (DHS) Program website, select either the DHS or AIS filter. Further guidance on how to analyze these data for a private health sector assessment is available.

A valuable resource that uses DHS data is Private Sector Counts, which illuminates the contribution of the public and private sectors to sick child care and family planning service delivery.

Service Provision Assessments
SPA surveys provide information on service delivery at the health facility level. Information includes levels and types of health facilities and limited measures on quality of care. The extent to which private health facilities are included in an SPA is often based on the existence (and robustness) of a registry of such facilities. Look at the sex ratios of providers and supervisors at all levels. Are women and men well-represented at the management level? To access SPA data, click on the link above and choose the SPA filter option.

National Health Accounts
NHAs track health spending from the source to point of care, and, of particular interest for a private sector assessment, provide data on health spending disaggregated by sector. NHA data can be accessed through the Health Systems 20/20 database, a Web-based tool that compiles and analyzes country data from multiple sources, provides charting options, and generates automated country fact sheets, helping users to assess the performance of various countries’ health systems. See WHO NHA Methods for guidance on using and analyzing NHA data.

Living Standards Measurement Survey Finder
The World Bank’s LSMS Survey Finder provides data on household health expenditures. Select “Health & Fertility” and choose a country and survey year. Consider sex-disaggregated data on household decision-making, expenditures, etc.

1.3 Create a Reference List

The team coordinator should create an annotated, linked list of all resources, organized by technical area or health focus (e.g., service delivery or HIV and AIDS). Using Excel enables each technical area to have its own worksheet. An organized and annotated list, including links to resources if feasible, aids assessment team members in preparing for fieldwork.

TIP ► All content must be properly cited and verifiable—this will boost the credibility of findings and recommendations, as well as expedite the report-writing process.

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