Name: Equity and Quality of Care and Health Worker Survey: A Component of the  National Integrated Health Facility Assessment (NIHFA)
Year: 2011
Client: Ministry of Health and Child Welfare
Country: Zimbabwe
Background: The Zimbabwe health system is recovering from unprecedented decade-long socio-economic decline which significantly compromised the availability, accessibility, affordability, use, and quality of health services. Evidence from assessments by the Ministry of Health and Child Welfare clearly shows that there has been system-wide deterioration in health indicators such as maternal, new-born and child mortality rates. However, most of the evidence was derived from higher levels of the health system with limited information on equity and quality of service delivered at lower levels. Equity in accessing health services a key aspect of the National Health Strategy 2009 – 2013, and as such this component sought to capture the current status of households’ access to and utilization of health services with emphasis on maternal, child and new born services.

As new monies are being invested in the health sector, more studies are being proposed. There has thus been an urgent need to get all those who want to fund activities in the health sector to agree on one assessment that will fill the information gaps for various interest groupings.

It is against this background that a National Integrated Health Facility Assessment  (NIHFA) was commissioned through collaboration between the MOHCW and multilateral and bilateral donors, United Nations (UN) Agencies and Non-Governmental Organization (NGOs) partners The assessment was designed to collect information to answer the following critical questions:

1.        Do our health facilities have the capacity to provide quality services in terms of resources or tools to be used by those providing services?

2.        Do we have the human resource base to provide the required services?

3.        What is the quality of services being provided with current levels of resources and tools?

4.        Have we ensured equity in the delivery of essential health services?

5.        What do we need to do to improve the quality and equity of health services in Zimbabwe?

Objectives: The overall objectives of the assignment were to obtain information on functionality, coverage and access to health services at public and private health facilities in Zimbabwe, with a particular focus on Maternal, New born and Child Health services; to assess availability, distribution and functional status of available human resources, medical supplies, equipment and infrastructure necessary for high coverage of quality health services; and assess the quality of Maternal, New born and Child health services provided by health facilities through assessment of knowledge and competency.
Activities: The survey covered a sample of 309 health facilities with proportional allocation across all types of facilities in Zimbabwe in 47 districts. A total of 70 state-registered nurses and midwives were recruited, trained, deployed and supervised as Enumerators for the survey. The survey covered the full spectrum of public health facilities – central hospitals, provincial hospitals, rural hospitals, polyclinic, rural health centre/clinic, satellite clinic or health post – and different ownership types: government, private and churches. The survey also included visits to facilities in the remotest parts of the country. In addition to the exit interviews JIMAT also conducted facility, management and human resources assessments in 192 health facilities across all types and ownership also as part of NIHFA. The following samples sizes were covered:

  • Antenatal Care Clients exit interviews – 927 interviews
  • Guardians of children under five years old – 927 interviews
  • Health worker interviews – 610

The work also involved data entry, cleaning and analysis.