MWI-MOHP-HHFA-2018-2019-vFINAL World Health Organization 2022-05-14 NADA MWI-MOHP-HHFA-2018-19-vFINAL Harmonized Health Facility Assessment (HHFA) Malawi 2018-2019 MWI-MOHP-HHFA-2018-2019-vFINAL Ministry of Health and Population World Health Organization University of Malawi The World Bank NADA Harmonized Health Facility Assessments[hhfa/sara] vFINAL: Final report (2019) The 2018-2019 Malawi Harmonized Health Facility Assessment (HHFA) was implemented by the Ministry of Health and Population in collaboration with World Health Organization (WHO). The purpose of the 2018/2019 Malawi HHFA was carried out in order to generate critical information for evidence-based decision-making as well as track and monitor progress of Health Sector Strategic Plan (HSSP)/ Essential Health Package (EHP) activities in health facilities. The primary objectives of the 2018/2019 Malawi HHFA were to: (i) assess the structural and clinical quality of health service delivery at the facility level in order to better understand existing gaps and identify potential approaches for improving quality of care; and (ii) better understand supply-side constraints on the provision of reproductive, maternal, newborn, child, and adolescent health (RMNCH) and nutrition services. The survey covered 1106 heath facilities between November 2018 and March 2019. Out of the 1,106 facilities surveyed, 101 were hospitals, 492 were health centres, and 513 were dispensaries, clinics, and health posts. This report covers the following categories of indicators: 1. General service availability • Infrastructure • Health workforce • Service utilization 2. General service readiness • Basic amenities • Basic equipment • Standard precautions for infection prevention • Diagnostic capacity • Essential medicines 3. Service specific availability and readiness • Family planning/birth spacing • Antenatal care • Basic emergency obstetric care • Comprehensive emergency obstetric care • Blood transfusion • Child immunization • Child health preventive and curative care services • Nutrition services • Adolescent health • Essential medicines for mothers • Malaria services • Tuberculosis services • HIV/AIDS care and support services • Antiretroviral therapy (ART) • Prevention of mother-to-child transmission (PMTCT) of HIV • Sexually transmitted infections (STI) service • Non-communicable disease services • Tracer medicines • Advance diagnostic services and high-level diagnostic equipment Malawi Nationally representative, as well as representative at district level Health facilities The survey covered 1,106 heath facilities (101 were hospitals, 492 were health centres, and 513 were dispensaries, clinics, and health posts). Sample survey data [ssd] 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 are assessed for availability: 1. Maternal, neonatal, and child health services - Family planning/birth spacing - Antenatal care - Basic emergency obstetric and newborn care - Comprehensive emergency obstetric care - Essential medicines for mothers - Blood transfusion - Child immunization - Child health preventive and curative care services - Nutrition services - Adolescent health - Essential medicines for mothers 2. Communicable disease services - Malaria - Tuberculosis - HIV/AIDS care and support - Antiretroviral therapy (ART) - Prevention of mother-to-child transmission (PMTCT) of HIV - Neglected tropical diseases 3. Non-communicable disease services - Diabetes - Cardiovascular disease - Chronic respiratory disease - Cancer 4. Surgical services - Basic and comprehensive surgery - Emergency care The survey utilized the Malawi Master Facility List (MFL), a comprehensive database of all the health facilities in the country containing information identifying each health facility and the type of health services provided, as the sampling frame. A random sampling approach was adopted. Face-to-face [f2f] The Malawi HHFA questionnaire was based on the standard SARA and SDI questionnaires harmonized into a single questionnaire and then adapted to the local context to reflect the population and health issues relevant to Malawi. The questionnaire included the following modules: Module 1: Facility inventory Module 2: Health worker roster Module 3: Clinical vignettes/case simulations Module 4: Facility management and finance Module 5: Client experience/ Exit interviews A two-phased training approach was implemented to train a total of 103 participants in the survey methodology. The first phase of the training was a two-day trainers of trainers (TOT). The second phase of the training was a two-week training for enumerators and supervisors. The survey team of 85 enumerators and 10 supervisors was organized into 28 teams and assigned facilities according to the health administrative zones in Malawi, namely; Northern Zone, Central Eastern Zone, Central Western Zone, South Eastern Zone, and South Western Zone. Each zone had two supervisors and between 5-7 enumerator teams. Each enumerator team was comprised of 2-4 enumerators Data cleaning steps included the following: - merged data files downloaded from Survey Solutions; - compared datasets to MFL and ensured all facilities in the sample were surveyed and had the correct facility ID; - checked for completeness of data for each facility; - ensured ID variable information was complete and valid (region, district, facility type, managing authority, GPS); and - labelled and coded all variables in Stata to ensure consistency of the final dataset.