Monitoring the ability to deliver care in low- and middle-income countries: a systematic review of health facility assessment tools

Abstract

Introduction Health facilities assessments are an essential instrument for health system strengthening in low- and middle-income countries. These assessments are used to conduct health facility censuses to assess the capacity of the health system to deliver health care and to identify gaps in the coverage of health services. Despite the valuable role of these assessments, there are currently no minimum standards or frameworks for these tools.Methods We used a structured keyword search of the MEDLINE, EMBASE and HealthStar databases and searched the websites of the World Health Organization, the World Bank and the International Health Facilities Assessment Network to locate all available health facilities assessment tools intended for use in low- and middle-income countries. We parsed the various assessment tools to identify similarities between them, which we catalogued into a framework comprising 41 assessment domains.Results We identified 10 health facility assessment tools meeting our inclusion criteria, all of which were included in our analysis. We found substantial variation in the comprehensiveness of the included tools, with the assessments containing indicators in 13 to 33 (median: 25.5) of the 41 assessment domains included in our framework. None of the tools collected data on all 41 of the assessment domains we identified.Conclusions Not only do a large number of health facility assessment tools exist, but the data they collect and methods they employ are very different. This certainly limits the comparability of the data between different countries’ health systems and probably creates blind spots that impede efforts to strengthen those systems. Agreement is needed on the essential elements of health facility assessments to guide the development of specific indicators and for refining existing instruments.

Content of Care in 15,000 Sick Child Consultations in Nine Lower‐Income Countries

“…Much of the data on quality in low‐ and middle‐income countries have focused on structure (e.g., medicines, equipment, staff, provider knowledge; Nickerson et al. ). Here, we examine a process measure of quality: the content of clinical care.…”

“…Donabedian proposed that quality of care be assessed through structure, processes, and outcomes (Donabedian 1988). Much of the data on quality in low-and middle-income countries have focused on structure (e.g., medicines, equipment, staff, provider knowledge; Nickerson et al 2015). Here, we examine a process measure of quality: the content of clinical care.…”

Quality of care: measuring a neglected driver of improved health

“…A recent comprehensive review of health-facility assessment tools in low- and middle-income countries found that among the 10 tools that met the study´s inclusion criteria there was substantial variation in their content and comprehensiveness. Of the 41 domains for comprehensive health system measurement identified by the authors, the actual number of domains covered by each of the assessment tools ranged from 13 to 33, with a median of 25.5 40 . For example, even when data on the health workforce were available, the indicators on staff presence and availability of emergency staff were mostly missing, as were any assessments of the clinical training the staff had received 40 .…”

“…Of the 41 domains for comprehensive health system measurement identified by the authors, the actual number of domains covered by each of the assessment tools ranged from 13 to 33, with a median of 25.5 40 . For example, even when data on the health workforce were available, the indicators on staff presence and availability of emergency staff were mostly missing, as were any assessments of the clinical training the staff had received 40 . The review raised two concerns; first, the data being collected at the health facility level are inconsistent, incomplete and difficult to compare; and second, there is a preference towards the evaluation of primary-care services over those of secondary and tertiary care 40 .…”

“…For example, even when data on the health workforce were available, the indicators on staff presence and availability of emergency staff were mostly missing, as were any assessments of the clinical training the staff had received 40 . The review raised two concerns; first, the data being collected at the health facility level are inconsistent, incomplete and difficult to compare; and second, there is a preference towards the evaluation of primary-care services over those of secondary and tertiary care 40 . Finally, facility surveys offer an incomplete picture of the state of health services.…”