Health Facility Assessment (HFA) Phone Survey
Background and purpose
Section titled “Background and purpose”Objective of the module
Section titled “Objective of the module”The Health Facility Assessment (HFA) module complements routine HMIS data by collecting information directly from health facilities through phone surveys. While routine data provides continuous monitoring of service delivery volumes, phone surveys capture additional dimensions that are not available in administrative systems, including service availability, readiness, and facility-level context.
The FASTR HFA phone survey is designed to be rapid, low-cost, and regularly repeatable. By contacting facilities directly, the survey gathers timely information on operational status, staffing, supply availability, and service provision that can be triangulated with routine HMIS data to provide a more complete picture of health service delivery.
Analytical rationale
Section titled “Analytical rationale”Routine HMIS data tells us how much service is being delivered, but not why delivery patterns may be changing. Phone surveys help answer questions that routine data cannot address:
- Is a facility open and functioning?
- Are essential supplies and medicines available?
- Are trained staff present?
- What challenges are facilities facing?
By linking survey responses to routine data patterns, the FASTR approach enables more nuanced interpretation of service delivery trends.
Key points
Section titled “Key points”| Component | Details |
|---|---|
| Inputs | Facility sampling frame from HMIS Standardized phone survey questionnaire Facility contact information |
| Outputs | - Service availability indicators - Readiness scores - Supply chain status - Staffing information - Linked survey-routine analysis |
| Purpose | Complement routine HMIS monitoring with facility-level context to improve interpretation and inform targeted interventions |
Survey methodology
Section titled “Survey methodology”Sampling approach
Section titled “Sampling approach”The FASTR HFA uses a stratified random sample of health facilities, with stratification typically based on:
- Geographic region - Ensuring representation across provinces/districts
- Facility type - Hospitals, health centers, health posts
- Ownership - Public, private, faith-based
- HMIS reporting status - Active reporters vs. non-reporters
Sample size is determined based on the precision required for key indicators and the resources available for data collection.
Data collection
Section titled “Data collection”Phone surveys are conducted by trained enumerators using a standardized questionnaire. Key features include:
- Respondent: Facility in-charge or designated health worker
- Duration: 15-30 minutes per facility
- Frequency: Quarterly or as needed
- Quality control: Call-backs, supervisor monitoring, data validation
Questionnaire structure
Section titled “Questionnaire structure”The standard FASTR HFA questionnaire covers:
- Facility identification - Verification of facility details
- Operational status - Current functioning, any closures
- Service availability - Which services are currently offered
- Staffing - Current staff presence by cadre
- Essential supplies - Stock status of key medicines and commodities
- Infrastructure - Basic utilities (water, electricity)
- Recent challenges - Open-ended on current issues
Questionnaire adaptation
Section titled “Questionnaire adaptation”Adaptation guidelines
Section titled “Adaptation guidelines”The standard FASTR questionnaire serves as a starting point that should be adapted to each country context. Key adaptation considerations:
- Language - Translation and back-translation
- Health system terminology - Align with local naming conventions
- Indicator priorities - Focus on nationally relevant services
- Skip patterns - Adjust based on facility types in country
- Response options - Match local context (e.g., supply names)
Adaptation process
Section titled “Adaptation process”Step 1: Review standard questionnaire Walk through each section with country stakeholders to identify what works and what needs modification.
Step 2: Identify country priorities Determine which services and indicators are most important for the country’s health objectives.
Step 3: Modify questions Adapt wording, add country-specific questions, remove irrelevant items.
Step 4: Pre-test Test adapted questionnaire with a small sample of facilities.
Step 5: Finalize Incorporate pre-test feedback and prepare final version for training.
Survey-routine data linkage
Section titled “Survey-routine data linkage”Linking survey responses to HMIS data
Section titled “Linking survey responses to HMIS data”A key feature of the FASTR approach is linking phone survey responses to routine HMIS data for the same facilities. This enables:
- Validation - Check if survey-reported service availability matches HMIS reporting patterns
- Contextualization - Understand why routine data shows certain patterns
- Triangulation - Compare multiple data sources for the same facilities
Use cases for linked analysis
Section titled “Use cases for linked analysis”- Non-reporting facilities: Survey confirms whether facility is closed or just not reporting
- Service volume changes: Survey reveals if changes are due to stockouts, staffing, or actual demand
- Quality interpretation: Survey data adds context to routine data quality flags
Data use and decision-making
Section titled “Data use and decision-making”Using HFA results
Section titled “Using HFA results”Survey results should inform:
- Routine data interpretation - Explain patterns in HMIS data
- Targeted support - Identify facilities needing intervention
- Supply chain management - Track stockout patterns
- Health system strengthening - Inform broader system improvements
Reporting frequency
Section titled “Reporting frequency”Depending on country needs and resources, HFA surveys may be conducted:
- Quarterly - For ongoing monitoring
- Event-driven - In response to specific concerns (outbreaks, emergencies)
- Annually - As part of routine health system assessment