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Building country capacity to undertake harmonised health facility assessments: Part of the solution or only creating more complexity?

By Juliet Nabyonga-Orem
on February 7, 2020

From 28 September-4 October 2019, the WHO Regional Office for Africa (WHO Afro) organized a training of trainers’ workshop in Kampala, Uganda, to orient facility data managers, ministry of health (MoH) statisticians and other stakeholders on the use of a new harmonised health facility assessment tool. The training sought to provide guidance on how parallel facility-based assessment tools can be phased out for the adoption of a harmonized tool, obtain feedback on the tool and inform country teams on the new modules. In this blog, we explore whether the HHFA tool indeed offers a possible solution to persistent problems faced in monitoring and reporting.

As countries embark on their universal health coverage (UHC) journey, phrases you often hear are “it is a tailored path”; “progressive realisation will be needed” etc. Underpinning these sentiments is the need to “stay the course” which requires strong monitoring and reporting.  To this effect, many member-states have expressed the need for more streamlined tools for data collection and analysis including for facility-based assessments. Beyond the siloed, service specific tools that exist today (mainly for HIV, TB and Malaria), countries need to consider more unified and disease-agnostic approaches to data collection and analysis, as they aim to strengthen their monitoring systems for the attainment of UHC. The introduction of the harmonised health facility assessment tool  (HHFA) therefore comes at an opportune moment and addresses this gap, by providing an all-encompassing facility-based methodology that will offer countries with a more comprehensive approach to leveraging facility-based data for decision making in the health sector.

End of September 2019, over 30 participants gathered in Kampala, Uganda, to be trained on the HHFA tool and learn from the lessons of Kenya- the pioneer country in the WHO African Region to utilize the tool on a national scale. Colleagues from Kenya emphasized the comparative advantage of the HHFA tool including the standardization of indicators, measurement methods and analyses, for assessing service delivery, the opportunity to reduce the time spent by health workers responding to multiple surveys and the opportunity for donors to collectively invest in system strengthening initiatives that are country-led.

Top among the concerns shared by member states during discussions was the length of the tool, consisting of 5 modules that exceed 100 questions each. This density, they noted, has multiple consequences including the need for substantial human capital for implementation, high costs for roll-out and capacity gaps particularly at facilities in rural areas.

Is overcoming these obstacles feasible? Or is the implementation of such a tool across the region a pipe dream?

Adoption of this tool and its implementation will certainly be more demanding than was the case for its predecessors (WHO-SARA, World Bank-SDI and USAID SPA). However, with the right level of political commitment, drive for resource mobilization and the alignment of stakeholders- both governmental and external ones, the HHFA could unlock large amounts of information that will enrich the national health planning process in countries and push countries closer to their targets for 2030.

Areas for further exploration were noted such as the need for a guide on utilizing data obtained from the HHFA as a precursor to the facility accreditation process, the improvement of data quality in health facilities, the development of the patient perspective module and the establishment of health data coordination platforms at the country level, mirroring the global health data collaborative (HDC).  The need for well-established master facility lists to avoid inclusion of closed/non-existing facilities, misclassified facility, and non-response in the assessment were also emphasized and member states requested for WHO to facilitate cross-country technical assistance when they start to implement.

The integration of the HHFA tool as a core tool in national health information systems addresses some of the data challenges that countries face as they strive for progress towards the 2030 agenda. However, realising the dream requires extra human and financial resources and time to implement a tool of 5 modules with 100 questions each. Pooling all available resources as countries minimise fragmentation is crucial. Much more lies ahead for our national health information systems, but the adoption of the HHFA is certainly a step in the right direction!

About Juliet Nabyonga-Orem

Health Systems and Services Cluster; World Health Organization, Inter-Country Support Team for Eastern & Southern Africa; P.O Box CY 348; Causeway, Harare, Zimbabwe

About Regina Titi-Ofei

Information Analytics Officer, Health Systems and Services (HSS) Cluster; World Health Organization, Regional Office for Africa
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