Use of an integrated health facility assessment for planning maternal and child health programs : results from four African countries

The assessment collects information on the case management of all important causes of infant and childhood morbidity and mortality in developing countries (acute respiratory tract infections [ARI], diarrhea, malaria, measles, and malnutrition) and on the facility supports (drug supply, equipment, supervision, and training) that are required for integrated practice. This information is designed to help in planning and prioritizing the program elements essential for integrating child health services, including health worker training, health worker supervision, drug supply, availability of essential equipment, and health facility organization. This report summarizes the background, objectives, and methods of the integrated health facility assessment and planning approach, as well as its application as a program planning tool. Results (summarized as key mediators) from four African countries (Eritrea, Ethiopia, Madagascar, and Morocco) are described, and a summary of how the country programs applied these data is presented. Follow-up actions in most countries involved (1) the development of an integrated maternal and child supervisory checklist, (2) the development of supervisory mechanisms and skills of district-level health staff, (3) training in integrated maternal and child health topics, (4) improving the availability of essential drugs, and (5) improving the time available with mothers and children to conduct essential tasks. Four key lessons were learned from the use of this method. (1) District-level managers and health staff are able to use this approach successfully to evaluate the quality of facility-based care and to plan activities. (2) Routine supervision is possible in most countries. In this context, action plans have focused on using a simple integrated checklist to improve health worker skills and solve problems at health facilities. (3) More important than the data gathered is the process of collecting simple information using direct observation and then using this information to make decisions. (4) Further work is needed to ensure that district staff can replicate this method routinely. The impact of this method on the quality of facility-based care will be evaluated in mid-1998. (Author abstract, modified)