10.1371/journal.pmed.0020297

Vollständiger Abstract

Worum geht es in dieser Arbeit?

Integrated, people-centred, high-quality health services are essential to achieving universal health coverage, yet traditional health facility assessments often focus on structural inputs and are too resource-intensive to support frequent, programmatic use. The Global Fund to Fight AIDS, Tuberculosis (TB), and Malaria developed the Targeted Health Facility Assessment (tHFA) to inform country plans and monitor progress on the Global Fund Strategy (2023-2028) of maximizing people-centred integrated systems for health. This paper describes the development, methodology, and implementation of the tHFA baseline round and discusses issues related to institutionalizing these assessments to monitor and improve service delivery processes and outcomes in low- and middle-income countries (LMICs). The tHFA is a cross-sectional, multi-country facility assessment designed to monitor progress on four key performance indicators in the Global Fund's strategic monitoring framework and seven programmatic indicators for horizontal program investments. In 2024-2025, the Global Fund implemented a baseline survey across 2,272 facilities in 18 LMICs using a modular questionnaire covering integrated delivery of antenatal care, HIV, TB, and malaria services, supportive supervision, community health worker (CHW) support, and patient-reported experience measures. Probability sampling was used to select 120 health facilities per country, and data were collected through direct observation, health worker interviews, and record reviews. Post-stratification weighting accounted for facility replacement and other sampling deviations, and data quality assurance was embedded throughout via training, pilot testing, and real-time monitoring. The tHFA is a pragmatic, agile, and scalable approach designed to monitor integrated service delivery and people-centred quality of care in LMICs. Its focused scope, inclusion of CHWs, and alignment with the Global Fund's strategic objectives position it as a tool designed to guide decision-making, inform grant monitoring, and strengthen health systems across LMICs. Its impact on these outcomes will be assessed through planned follow-up rounds of the tHFA over the strategy cycle.

Abstract: PubMed · Datensatz