| Indicator ID | H11 |
|---|---|
| Indicator full statement | % of primary health facilities that have benefited from the improvement of at least one of the six WHO building blocks of the health systems with the active participation of their communities and other local stakeholders. |
Purpose
| Importance | This indicator measures the extent to which primary health care facilities have implemented improvements in health system building blocks with the support from Tdh; which are (i) service delivery, (ii) health workforce, (iii) health information systems, (iv) access to essential medicines, (v) financing, and (vi) leadership/governance; with meaningful participation from local communities and stakeholders, where Tdh is conducting related activities. Enhancements in these areas are crucial for strengthening health systems and improving the overall quality and accessibility of health care services. |
|---|---|
| ToC pathway | This indicator directly refers to the Tdh Theory of Change (ToC) as it aims to contribute to 3the three inter-related pathways of change, namely 1) local health system, 2) communities, and 3) mothers, children, and their families. It is used depending on the service provided by Tdh. |
Definition
The proportion of primary health care facilities that have achieved improvements in one or more of the six WHO health system building blocks through community and stakeholder engagement.
The six building blocks are:
Health service delivery: Quality and accessibility of health services.
Health workforce: Availability and competency of health personnel.
Health Information Systems (HIS): Collection, analysis, and use of health data.
Access to essential medicines: Availability and management of essential medicines and technologies.
Health systems financing: Mechanisms for funding and financial protection.
Leadership and governance: Policies, regulations, and oversight mechanisms.
Active participation refers to the involvement of community members and local stakeholders in planning, decision-making, and implementation processes and results related to these improvements.
How to collect & analyse the data
| What do we count? | Health facilities |
|---|---|
| How to calculate the indicator's value | Numerator: The number of primary health care facilities that have experienced improvements in at least one of the six WHO building blocks, with support from Tdh and with documented community and stakeholder involvement. Denominator: The total number of primary health care facilities within the target area and timeframe. Formula: Percentage of facilities with improvements = (Number of facilities with improvements / Total number of facilities) x 100. |
| Data sources | Health facility records: Documentation from health facilities regarding improvements and community involvement. Health Information Systems (HMIS): Data from HIS tracking enhancements in health system building blocks. Community reports: Reports or feedback from community and stakeholder engagement activities. |
| Data collection methods and tools | Health facility assessments: Conduct assessments to determine improvements in each building block and the level of community participation following standardized assessment tools. AND Qualitative research: Surveys or interviews with community members and local stakeholders to verify their involvement and assess the improvements made. OR (and least preferred) Review health facilities reports from health programs (i.e., data from Health Information Systems, annual project report) or initiatives focused on strengthening health systems (i.e., community-based projects reports). |
| Disaggregation | Data should be disaggregated by :
|
| Important considerations | Frequency and Timing: Routine Reporting: Monthly, quarterly and annual reporting from health facilities and programs Facility assessments: Conduct facility assessments every year to evaluate ongoing improvements and participation. Survey/interviews: Conduct qualitative research on perceived improvement and community and/or stakeholders’ participations |
Limitations and precautions
The level and quality of community participation and engagement can be challenging to measure and may vary across different contexts. It is important to accurately document and verify the information to avoid over or underestimation. The use of a proper and standardized survey questionnaire and key stakeholders’ list is the first stone to compare the project baseline and the endline results.
Improvements for each building blocks should be measured with a standardized and internationally recognized tool which would allow reproducibility and comparison. It should address monitoring and evaluation needs for different targets and multiple purposes, including the monitoring and evaluation of program investments, inputs, processes, and results; and health systems performance assessment, as the key for country decision-making processes; and identifying which approaches work best.
It is expected that different building blocks may vary significantly, which would require a detailed narrative analysis in addition to the comprehensive scoring to assess the root causes of those improvements and the actual community engagement impact and effectiveness.
Context analysis is key to correctly interpret this indicator. Indeed, plethora of factors might affect one or several building blocks as well as improvements efforts. While certain factors might be mitigated by community efforts and/or Tdh programs, some others might have inevitable impact (threats and/or opportunity) at short or long-term on several components of this indicator.
This indicator would provide a trend of improvements at health facility level in a defined catchment area and since numerous global, regional, national and local factors may interfere the results, it is advisable to cross-analyze this indicator from other similar areas (i.e., one district where Tdh is supporting health programs with a comparable district from the same state in terms of population size, culture and economic incomes).
What further analysis are we interested in?
The percentage of primary health care facilities that have improved in at least one of the six WHO building blocks, with active community and local stakeholder involvement, provides insights into health system performance over a specified period. This indicator is valuable for monitoring program results and evaluating impacts on sustainability, equity, and community engagement. It measures the coverage of facilities showing progress in one or more building blocks and assesses whether certain areas are prioritized or neglected. By cross-analyzing with health service indicators, such as maternal and child health, it estimates the impact of these improvements on population health outcomes like maternal mortality and neonatal infection rates. Additionally, the indicator highlights disparities in health facility improvements, particularly among marginalized populations, and evaluates the effectiveness of community involvement in driving these changes. Facilities with strong community engagement and capacity-building initiatives tend to show more significant improvements in service delivery. Contextual analysis is crucial, as factors like governance shifts, political changes, and population movements can influence community participation and continuity of improvements. This indicator also aids in mobilizing support from local stakeholders, NGOs, and international organizations for further funding and innovation in health programs.
Additional guidance
Resources: Under the technical assistance of HQ, Tdh M&E and operational teams in each delegation should work closely with health authorities and local communities to collect and interpret the data. Countries with limited health system infrastructure may consider partnerships with international organizations (e.g., WHO, UNICEF) and academic institutions to support capacity-building for data collection.
Delegations with limited resources to conduct surveys and interviews, should consider using a consultant and/or a reliable local partner involved at the community level.
World Health Statistics 2024: Monitoring Health for the SDGs. World Health Organization 2024.
Monitoring the Building Blocks for Health Systems Strengthening: A Handbook of Indicators and their Measurement Strategies, World Health Organization. Available at: https://iris.who.int/bitstream/handle/10665/258734/9789241564052-eng.pdf (Accessed: 13 September 2024).
Coordination tools, UHC 2030. Available at : https://www.uhc2030.org/resources/coordination-tools/ (Accessed: 13 September 2024)
Community Engagement: Partnering with communities so they can lead the change process, UNICEF. Available at: https://www.sbcguidance.org/understand/community-engagement (Accessed: 13 September 2024)
Strengthening Health Systems to Improve Health Outcomes, WHO’s framework
for action, WHO. Available at: https://iris.who.int/bitstream/handle/10665/43918/9789241596077_eng.pdf (Accessed: 13 September 2024)
Health System Performance Assessment, 2022, World Health Organization. Available at: https://www.who.int/publications/i/item/9789240042476 (Accessed: 29 September 2024).