Table 1 Simple description of tools used and purpose of each tool

Facility inventory checklists. Data based on the observation of the survey team leader and, where necessary, the response of senior administrators or department heads.

To record availability of water/electricity.

To document staff numbers and department allocations.

To record the presence/absence of key items of equipment, essential drugs, essential consumables, and availability of laboratory tests. For equipment or laboratory tests, the item had to be functional as well as present.

To record aspects of the organization of services – for example whether or not triage was operational in clinic areas providing walk-in services for sick newborns and children.

Medical record data abstraction tool

To record what was documented for newborns and children about the admission clinical assessment, diagnosis, and treatment, key aspects of inpatient care and outcome. Aim: 400 randomly selected case records per site from the six months prior to the survey.

Caretaker interview (used after gaining informed consent)

Structured interview questionnaire including specific data collected at patient discharge on caretaker's knowledge of the patient's diagnosis and post-discharge treatment. Aim: 50 consecutive, prospectively identified admissions during the survey period.

Major events/changes structured interview

For post-baseline surveys a short structured interview with senior hospital staff was performed to identify major new initiatives affecting the hospital or major staff movements.