This report has outlined the benefits that can be achieved by linking DHS and SPA survey data. Such linkage has the potential of generating answers to key programmatic and policy questions. However, many considerations have to be taken into account when linking these data, particularly geographic limitations. Framing the question of interest and appropriately operationalizing DHS and SPA variables are key steps in creating an appropriate linkage between the two survey datasets.
The Haiti case study presented in section 6 describes one approach taken to exploring the availability of delivery services in the service environment within which pregnant women live, and assessing women’s care-seeking or utilization of health facility delivery services. This is one piece in a larger analysis designed to assist decisionmakers in understanding the factors associated with women’s utilization health facilities for delivery. Other, non-facility-related factors likely influence a woman’s decision to deliver in a health facility including level of education and household wealth status. The appropriate linkage of the DHS and SPA data is one component in an analysis that may require other advanced statistical methods such as multivariate regression models. While clearly there are limitations to creating an appropriate link between the DHS and SPA datasets, the opportunity for linkage exists and allows for better understanding of the data.
Looking beyond DHS and SPA surveys, program managers and policymakers will probably want to link data from other program-specific surveys, facility and household or population-based surveys, or data from routine health information systems. The MEASURE Evaluation document “Using Geospatial analysis to inform decision making in targeting health facility-based programs: A Guidance Document” (Colston and Burgert 2014) describes ways to leverage various types of data to improve understanding of the dynamics between populations and facilities within a country. Alternatively, household and facility data collection methods specific to the researcher’s question of interest may be possible (time and funding permitting). If you are preparing a household or facility survey and anticipate linking them together, several alternative sampling methods may be considered that allow for expansion of the types of linkages possible; however, they may also limit the representativeness of the population survey, the facility survey, or both. Some descriptions of these methods and their pros and cons are presented in the conclusion of the Skiles et al. paper (2013).
This document has described the considerations to be made before linking the DHS and SPA data and methods for creating linkages between DHS and SPA datasets. It is important when interpreting the results of such analysis to be cognizant of limitations to the questions posed and the data used. These data and linked analyses may be a starting point for further investigation of care-seeking behaviors, access to health services, and issues of quality of services that require other and more advanced quantitative and qualitative studies.
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