International Health Facility Assessment Network (IHFAN)
Update on IHFAN's activities to promote core indicators for health service readiness.

Update on IHFAN's activities to promote core indicators for health service readiness.

Friday, Jan/14/2011

WHO and USAID are collaborating to move an agenda forward for agreement on
a) Core indicators for readiness to provide health services
b) A methodology for measuring the core indicators
c) An index/indices to present summary measures for readiness to provide health services that uses the core indicators

To this end, WHO sponsored a meeting to further the agenda, building on the following:

  1. Background materials related to core indicators and indices for measuring service readiness: 

    a. IHFAN documents related to core indicators and indices for health services found here

    b. WHO documents related to core indicators found here

  2. Experience of ICF Macro and WHO/MOHs in conducting health facility assessments (Service Provision Assessment (SPA) and Service Availability Mapping (SAM)).

    Meeting Details:
    Title: Strengthening Monitoring of Health Service Readiness: Core Indicators & Indices, Tools and Methods
    Dates: Geneva, 22-23 September 2010
    Participating organizations: WHO, USAID, IHFAN, CDC, The Global Fund, ICF Macro, Measure, representatives from the MOH Zambia and National Institute for Medical Research, Tanzania

As a result of the meeting, the following decisions are in the process of being finalized:
(NOTE) The combined assessment of service availability and readiness is referred to as SARA.

1. Core SARA package: Development of a core tool to assess readiness that can be combined with information on service availability and implemented rapidly and at relatively low cost.

2. Objectives of SARA:

  • To measure trends in health systems strengthening. to assess service readiness by key domains.

  • To assess service availability by key components.

  • To enable cross country comparisons and sub-national comparisons.

  • To provide a tool to support national planners.

3.Core SARA components and indicators:

  • Service Availability (density of facilities, beds, core health workers and health care utilization)

  • General Service Readiness (basic infrastructure and amenities, basic equipment including small surgery, standard precautions, laboratory diagnostic capacity, medicines and commodities).

  • Specific service readiness focusing on tracer items for key services (family planning, maternal and newborn care, child health, HIV/AIDS, tuberculosis, malaria, chronic diseases).

4. Service readiness index: The proposed method for calculating the readiness index is to use the unweighted mean score (the mean presence of specific items in each domain; overall readiness index = mean score of all domains).

5. Supplemental modules: A set of additional specialized modules will be available to supplement the core module, according to specific programme needs and country priorities. Topics for supplemental modules to be developed include; management and health information, community outreach, and standard precautions for infection control among others.

6. Design methodology: design methodology varies slightly between the service availability and service readiness domains:

  • Ideally, service availability is measured through a census of facilities. However, based on country circumstances such as presence of an updated master facility list and time since the last facility census, these indicators may be estimated at the time of data collection for service readiness (i.e., through a sample of facilities rather than a facility census). Alternative methods of calculating availability components, including extrapolation from sample data or passive data collection efforts managed by the Ministry of Health, may be considered.

  • Service Readiness is measured from a nationally representative sample survey, provided that a good master facility list (with all public and private facilities) exists in the country. A common sampling methodology will be employed across countries. In the case of a country with a relatively small number of facilities, service readiness may be measured through a full enumeration of all facilities.

7. Periodicity: To be finalized

Over the next year, USAID plans to collect the core indicators and to calculate the indices in a number of countries identified as high priority for USAID. The logistics for encouraging collection of information and calculation of indices for other countries will be a focus for the future. IHFAN will share links to the relevant materials and reports on decisions as they are finalized. We urge all to familiarize themselves with this important innovation.