Harmonized Health Facility Assessment (HHFA) Kenya 2018-2019
Kenya, 2018
Reference ID
KEN-MOH-HHFA-2018-2019-vFINAL
Producer(s)
Ministry of Health
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Apr 14, 2022
Last modified
May 23, 2022
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Identification
Survey ID Number
KEN-MOH-HHFA-2018-2019-vFINAL
Title
Harmonized Health Facility Assessment (HHFA) Kenya 2018-2019
Country
| Name | Country code |
|---|---|
| Kenya | KEN |
Study type
Harmonized Health Facility Assessments[hfa/sara]
Abstract
The Ministry of Health in collaboration with World Health Organization (WHO) implemented Kenya Harmonized Health Facility Assessment (HHFA) in 2018. The purpose of the Kenya HHFA survey was to provide external validation of service availability and readiness information gaps critical for delivery of Universal Health Coverage (UHC) agenda for health; and to provide necessary information for strategic planning, health sector priority investment areas and areas of acceleration to achieve 100% UHC by 2022.
The objectives of KHFA 2018 were to:
(i) provide essential information at national and county levels to facilitate decision making on investments needed to deliver the essential health package towards UHC;
(ii) generate the evidence to support the ongoing national and county UHC roadmap, strategic plan development, annual health reviews to guide more effective county/country and partner investments;
(iii) provide a baseline of health infrastructure situation which will assist in development of health infrastructure and maintenance of master plans for all planning entities in the health sector;
(iv) improve access to healthcare; and
(v) fill critical data gaps in health service availability and readiness required for assessing and monitoring progress in health system strengthening, UHC roadmap, within the broader context of monitoring and evaluation (M&E) of county and national health strategies; support county and national planners in planning and managing health systems.
The HHFA survey covered 2,980 health facilities in 47 counties across Kenya. Additionally, the survey covered 94 community units, 2 in each county.
The following modules were included in the assessment: service availability, service readiness, management and finance, quality of care, and community.
The objectives of KHFA 2018 were to:
(i) provide essential information at national and county levels to facilitate decision making on investments needed to deliver the essential health package towards UHC;
(ii) generate the evidence to support the ongoing national and county UHC roadmap, strategic plan development, annual health reviews to guide more effective county/country and partner investments;
(iii) provide a baseline of health infrastructure situation which will assist in development of health infrastructure and maintenance of master plans for all planning entities in the health sector;
(iv) improve access to healthcare; and
(v) fill critical data gaps in health service availability and readiness required for assessing and monitoring progress in health system strengthening, UHC roadmap, within the broader context of monitoring and evaluation (M&E) of county and national health strategies; support county and national planners in planning and managing health systems.
The HHFA survey covered 2,980 health facilities in 47 counties across Kenya. Additionally, the survey covered 94 community units, 2 in each county.
The following modules were included in the assessment: service availability, service readiness, management and finance, quality of care, and community.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
Health facilities
Version
Version Description
vFINAL: Final report (2019)
Version Date
2019-02-01
Scope
Notes
The scope of the HHFA survey includes modules on:
1. Service availability: information relating to physical presence of facilities, resources, and services (e.g., building and utilities infrastructure, staff, beds)
2. Service readiness: information on capacity of the facility to provide specific services (e.g. presence of trained and knowledgeable staff, guidelines, drugs, supplies, diagnostics, equipment), appropriate service site systems and infrastructure conditions to support quality
3. Management and finance: information on practices to support continuous service availability and quality (e.g. management practices and supervisory practices, finance and health worker perspective)
4. Quality and safety of healthcare: information on the receipt of appropriate, effective and timely care by patients under safe conditions
5. Community systems
6. Cross-cutting country performance
The following services were assessed for availability:
1. Maternal, neonatal, and child health services
- Family planning
- Antenatal care
- Basic emergency obstetric and newborn care
- Comprehensive emergency obstetric care
- Essential medicines for mothers
- Post-abortion care
- Postnatal care for mothers and newborns
- Child immunization
- Child health preventive and curative care services
- Essential medicines for children
- Adolescent health
2. Communicable disease services
- Malaria
- Tuberculosis
- HIV/AIDS care and support
- Neglected tropical diseases
3. Non-communicable disease services
- Diabetes
- Cardiovascular disease
- Chronic respiratory disease
- Cancer
- Palliative care
- Rehabilitation care
4. Surgical services
- Basic and comprehensive surgery
- Emergency care
- Voluntary medical male circumcision service
1. Service availability: information relating to physical presence of facilities, resources, and services (e.g., building and utilities infrastructure, staff, beds)
2. Service readiness: information on capacity of the facility to provide specific services (e.g. presence of trained and knowledgeable staff, guidelines, drugs, supplies, diagnostics, equipment), appropriate service site systems and infrastructure conditions to support quality
3. Management and finance: information on practices to support continuous service availability and quality (e.g. management practices and supervisory practices, finance and health worker perspective)
4. Quality and safety of healthcare: information on the receipt of appropriate, effective and timely care by patients under safe conditions
5. Community systems
6. Cross-cutting country performance
The following services were assessed for availability:
1. Maternal, neonatal, and child health services
- Family planning
- Antenatal care
- Basic emergency obstetric and newborn care
- Comprehensive emergency obstetric care
- Essential medicines for mothers
- Post-abortion care
- Postnatal care for mothers and newborns
- Child immunization
- Child health preventive and curative care services
- Essential medicines for children
- Adolescent health
2. Communicable disease services
- Malaria
- Tuberculosis
- HIV/AIDS care and support
- Neglected tropical diseases
3. Non-communicable disease services
- Diabetes
- Cardiovascular disease
- Chronic respiratory disease
- Cancer
- Palliative care
- Rehabilitation care
4. Surgical services
- Basic and comprehensive surgery
- Emergency care
- Voluntary medical male circumcision service
Coverage
Geographic Coverage
Nationally representative, as well as representative at county levels
Universe
The survey covered 2,980 health facilities in 47 counties across Kenya. Additionally,the survey covered 94 community units, 2 in each county.
Producers and sponsors
Primary investigators
| Name |
|---|
| Ministry of Health |
Producers
| Name | Role |
|---|---|
| World Health Organization | Technical guidance, analysis and financing report writing |
| The Global Fund | Collaborator |
| The World Bank | Collaborator |
| US Agency for International Development | Collaborator |
| The Global Alliance for Vaccines and Immunization | Collaborator |
| PEPFAR/CDC | Collaborator |
| United Nations Children's Fund | Collaborator |
| United Nations Population Fund | Collaborator |
| United Nations Millennium Development Goals | Collaborator |
Sampling
Sampling Procedure
2,980 health facilities and 94 community units were selected for the sample. For health facilities, the sample was randomly selected from Kenya Health Master Facility List (KMHFL) based on specified parameters. All secondary hospitals and all public primary hospitals were purposively included together with maternity and nursing homes. The community units were selected based on the following criteria: (i) community health units sampled were those linked to the health facilities where the facility assessment was being conducted and (ii) population density and distance to health facilities.
Data Collection
Dates of Data Collection
| Start | End |
|---|---|
| 2018-11-01 | 2018-12-31 |
Data Collection Mode
Face-to-face [f2f]
Data Collection Notes
A training for the survey team was held in two phases. The first phase of training was a trainer of trainers (TOT) workshop for national and county supervisors who were trained on all survey modules. The research assistants training followed thereafter. CSPro experts were also part of the trainings to provide technical support. An additional training was held for research assistants who participated in the qualitative data collection exercise (the community module). The team was also guided through the standard operating procedures (SOPs) of transcription and how to deal with the intricacies of direct and back translation from local languages to English and vice versa.
The survey team composition included one national survey coordinator, 12 survey coordinators, 4 CSPro experts/data managers, 47 national supervisors, 47 county supervisors, and 254 research assistants drawn from the various departments in the national and county governments.
Data collection tools were piloted, and revisions were incorporated into the final version prior to the actual data collection. Data collection for the survey was conducted over a period of four weeks between November and December 2018. Data was collected electronically on Android phones running the CSPro software and stored centrally on a server hosted by the Ministry of Health (MoH).
The survey team composition included one national survey coordinator, 12 survey coordinators, 4 CSPro experts/data managers, 47 national supervisors, 47 county supervisors, and 254 research assistants drawn from the various departments in the national and county governments.
Data collection tools were piloted, and revisions were incorporated into the final version prior to the actual data collection. Data collection for the survey was conducted over a period of four weeks between November and December 2018. Data was collected electronically on Android phones running the CSPro software and stored centrally on a server hosted by the Ministry of Health (MoH).
Questionnaires
Questionnaires
The questionnaire for the Kenya HHFA survey was based on the HHFA standard questionnaire with 4 modules contextualized to the organization of the service delivery platform in Kenya. A fifth module was added which was developed in Kenya to assess the health systems at the community level. The questionnaire was revised to include thirteen smaller service-specific modules to facilitate data collection which were:administration, emergency, intensive care unit, laboratory, maternity, maternal and child health, outpatient department, pharmacy, records, surgical, HIV, tuberculosis and Global Positioning System.
Data Processing
Data Editing
Data was reviewed by a county supervisor before uploading it to the central server. Data was merged across the different modules to identify duplicates and missing/incomplete modules for the visited health facilities. Every week, the county and national supervisors conducted a data validation visit to one of the facilities visited during that same week. After data collection, the KHFA findings for selected indicators were compared with similar indicator data from other sources (e.g. DHIS and KHMFL) for external data validation.
Metadata production
DDI Document ID
KEN-MOH-HHFA-2018-2019-vFINAL
Producers
| Name | Abbreviation | Role |
|---|---|---|
| World Health Organization | WHO | Documentation of assessment |
Date of Metadata Production
2021-11-14
DDI Document version
KEN-MOH-HHFA-2018-19-vFINAL