Harmonized health facility assessment (HHFA): Core questions

Overview

The harmonized health facility assessment (HHFA) represents a resource package for conducting standardized health facility surveys. The HHFA enables a comprehensive, external review of the availability of health facility services, the systems that facilities have in place to deliver services at required standards of quality, and the effectiveness of the services. Availability, quality and effectiveness of health services are integral to universal health coverage (UHC) and contribute to achieving the Sustainable Development Goals (SDGs). HHFA data can support health sector reviews, planning and policy-making, and enable evidence-based decision-making for strengthening country health services.

The HHFA builds upon the USAID/WHO Service Availability and Readiness Assessment (SARA) and incorporates components of other key global health facility surveys and indicator lists. It is based on global service standards and uses standardized indicators, questionnaires and data collection methodologies. Standardization of indicators and data collection promotes alignment of health facility survey approaches and enables comparability of results over time and across geographic areas.

The HHFA includes four modules:

• service availability

• service readiness

• quality and safety of care

• management and finance

The modular approach, with core and additional indicators, allows countries to adapt the HHFA to their needs. A module is defined as a set of questions (in questionnaire format) and aims to collect information for a defined set of indicators in a specific disease, programme or service management area. Any item of data collected through a health facility assessment should be indicator-driven, i.e. should provide data for the numerator or denominator of a clearly defined indicator and/or research question.

The HHFA questionnaires are provided in two formats: “stand-alone” and “combined”. Each of the four HHFA modules has a set of stand-alone questionnaires that may include “core”, “core+additional” and/or “supplementary” questionnaires. The “combined” questionnaire contains the questions from all four HHFA modules, integrated and organized by service site or respondent to facilitate data collection at facility level.