Assessing readiness to provide services in health facilities: Examples of different methods providing different results

In the context of health systems where there is not universal accreditation or certification for health facilities, health facility assessments (HFA) are increasingly being used to assess programs and to evaluate readiness to provide health services. Unlike household surveys, however, consensus on “best practices” in methodology for conducting HFA does not exist. Differences in methods include a) using differing methods of data collection—some by interviewing a senior person and others validating responses by observation, b) using one response to represent the situation within a total facility c) assessing different service areas independently, and d) using different definitions for the same indicator. Finally, within the public sector, there is usually a theoretical criteria for classifying facilities (hospital, health center (or lower level)), while private sector facilities may be classified using no discernable criteria. The lack of clarity in facility clarification in the private sector, and differences between the theoretical criteria and reality in the public sector, result in facilities that differ hugely in magnitude of size and services being lumped together during analysis.

Data relevant to infection control, from nationally representative Service Provision Assessments (SPAs) conducted with ICF Macro technical support in Tanzania, Uganda, and Kenya will be used to demonstrate how the picture of readiness to provide services within facilities and the profile of facility conditions differs depending on where and how data are collected, and how facilities are classified for analysis. Infection control indicators will be the primary focus.