A Brief Overview of A Brief Overview of Lot Quality Assurance Lot Quality Assurance

Sampling (LQAS) Sampling (LQAS) and its application in the and its application in the

Health SectorHealth Sector

Joseph Valadez, PhD, ScD, MPHJoseph Valadez, PhD, ScD, MPH

Liverpool School of Tropical MedicineLiverpool School of Tropical Medicine

January 2010January 2010

A

B

C

DE

F G

Good

Below Averageor EstablishedBenchmark

Good

Below Average or Established Benchmark

Identify the reasons for program problems

Develop targeted solutions

Maintain the program at the current level

Identify Supervisors and Health Workers that can help other HealthWorkers improve their performance

What is LQAS?What is LQAS?An analysis method that can be used locally toAn analysis method that can be used locally to– identify health administrative units that identify health administrative units that fail to reach fail to reach an an

established established performance benchmark performance benchmark for an indicatorfor an indicator– support local management decision making support local management decision making by sharing by sharing

information across different health administrative units.information across different health administrative units.

Estimate Estimate coverage at an aggregate levelcoverage at an aggregate level (e.g., district or state or nation) Catchment Area (e.g., district or state or nation) Catchment Area– Suitable for Reporting PurposesSuitable for Reporting Purposes

LQAS uses LQAS uses small samplessmall samples– Most frequently used size = <20 per one admin unitMost frequently used size = <20 per one admin unit

Examples of countries using LQAS Examples of countries using LQAS M&E DataM&E Data

NigeriaNigeria

Eritrea Eritrea

Kenya Kenya

UgandaUganda

Advantages of LQAS for Local Program Advantages of LQAS for Local Program ManagementManagement

Can be used at a local level as it requires only Can be used at a local level as it requires only modest supervisionmodest supervision

Identifies where the successes and challenges Identifies where the successes and challenges are located using rigorous sampling theoryare located using rigorous sampling theory

Produces information that can be rapidly Produces information that can be rapidly interpreted by local managersinterpreted by local managers

Paper/pencil analyses rather than requiring Paper/pencil analyses rather than requiring computer analyses computer analyses

Data can be used for local management as well Data can be used for local management as well as for national reportingas for national reporting

Quality

Benchmark :

At least 65% (10 out of 19) Infants

sampled must have slept under

an ITN in the night preceding survey in each

health administration

unit

Children 0-11 Months Slept Under ITN Last Night

Anseba, Eritrea 2004Area Yes No Total1 9 10 192 13 6 193 18 1 194 3 16 195 11 8 196 12 7 197 18 1 198 12 7 19

Total 96   152

Insecticide TreatedBednets

Distribution of Project States by estimated coverage for ITN use by children and IPT by Pregnant Women

The small sample and pen & paper analysis make LQAS accessible to local public health practitioners: NGOs and public sector

1212

Afghanistan: Tracking ProgressAfghanistan: Tracking Progress

Recap:•LQAS is a M&E tool based on robust sampling.•Generally simple to administer once sampling frame is available and tools are standardized.•Can help to identify local health administrative units failing to reach pre-determined performance benchmarks and learning from those which achieved the benchmarks•Pooled data from different units can also be used to estimate coverage levels at sub national and national levels