On 2nd October 2023, the Chief Director of the Ministry of Health, Alhaji Hafiz Adam on behalf of the Honourable Minister of Health launched the results of the Ghana Harmonised Health Facility Assessment (HHFA). 

During the Dissemination of the Harmonised Health Facility Assessment, the Chief Director, Alhaji Hafiz Adam, extended his congratulations to all participants. He pointed out that the presence of key stakeholders at the event signifies a significant commitment and a strong demonstration of their readiness to support the Health Sector. He also mentioned that Universal Health Coverage (UHC) is not just a goal, but it is a fundamental human right and a cornerstone of sustainable development. While Ghana has made significant strides in recent years, there is still much work to be done to ensure every citizen has access to high-quality healthcare without facing financial hardships. 

He stated that one cannot ignore the rapidly evolving landscape of global health. The challenges grow more intricate, driven by shifting demographics, environmental factors, and emerging health threats. The Harmonised Health Facility Assessment (HHFA) therefore represents a pivotal step in our efforts to strengthen the health system, enhance healthcare delivery and ensure equitable access to quality healthcare across the country. The assessment holds great significance for the Ministry of Health and the entire health sector, as it addresses the urgent need for a comprehensive and comparable approach to assessing health service availability and readiness. 

He added that multisectoral collaboration is vital to ensure that policies align with the overarching goal of UHC, promote best practices, endorse data-driven decision-making, and adhere to global standards. He stated the need to prioritize the results of this assessment in the planning for future interventions, aiming to enhance equitable and accessible healthcare, particularly concerning service availability and readiness. 

He extended special appreciation to the World Health Organization for their invaluable technical and financial support in making the assessment possible and also applauded the Director General of the Ghana Health Service and his dedicated team whose tireless efforts contributed to the success of this survey. He concluded by thanking all for their unwavering commitment to improving the health and well-being of Ghanaians using evidence-based results. 

During the dissemination, the Director General of the Ghana Health Service, Dr. Patrick Kuma-Aboagye in his opening remarks stated he was particularly happy that Ghana is the first country to use the revised HHFA tool to assess service availability and readiness as well as our Governance and Management. He added that significant efforts have been made to assess the state of health facilities and services to strengthen the country’s progress towards UHC. 

He also indicated that Ghana has conducted three landmark assessments of its primary health care system (Vital signs profile assessment, CHPS verification survey (2018) and the 2020 EmONC survey). The data from these surveys provide valuable information on the status of health facilities in the country. However, these assessments were not comprehensive enough (in terms of coverage and content) to inform the ongoing innovations in healthcare delivery such as the Networks of Practice. The Harmonised Health Facility Assessment conducted in 2022 comes in to address the urgent need for not only a comprehensive but also a comparable approach to assessing health service availability and readiness. 

The adoption of the WHO Harmonised Health Facility Assessment (HHFA) in Ghana has ushered in a new era of standardized and comprehensive evaluation of health service availability, readiness, and quality. This assessment has equipped the Service with reliable and objective data on the capacity of healthcare facilities to provide services at the required standards of quality. Such data is instrumental in shaping evidence-based decision-making and supporting health sector reviews, thus fortifying our nation’s healthcare services. He concluded by stating that the findings from the HHFA are foundational data for costing health investments outlined in Ghana’s UHC Roadmap 2030 and the data will support health sector reviews, planning and policymaking, and enable evidence-based decision-making for strengthening Ghana’s health service delivery systems.

The special guest of honour and also the Country Representative of the World Health Organisation Professor Francis Kasolo stated that the lessons of the COVID-19 pandemic strongly suggested the need for updated information on all service delivery availability, readiness and demand and other details of health services that are not available in other surveys. He added that Ghana for the past years has not carried out a nationwide, comprehensive service delivery readiness, availability and demand survey that addresses all health areas to deliver services at required standards of quality, and the effectiveness of the services. 

He stated that WHO with support from other development partners such as UK -FCDO plans to support the dissemination of results and the generation of knowledge products to improve uptake and usage of the results at all levels. 

This is to build the capacity of GHS and other partners to do this type of analysis within the health service and provide the needed information that can be used to drive some key service approaches like the Network of Practice. 

Dr. Kasolo mentioned that in the short and long term WHO will work with MOH and GHS to ensure 

  • A visual mapping of the location of essential health services. 
  • Improved use of GIS-based tools and techniques to do geospatial analysis to the desired quality standards using the HHFA data
  • An automated online platform for geospatial analysis and presentation of current and historical changes in health services.

In his final statement, he expressed a strong belief that the investment in the Ghana HHFA  and other completed surveys will feed into evidence-based decisions that will improve health service delivery across the country.

Presentation on the Overview of HHFA

Mr. Dominic Atweam, the Strategic Health Information Systems officer at WHO presented the overview of the WHO Harmonized Health Facility Assessment (HHFA). He mentioned that the HHFA is a comprehensive, standardised health facility survey that provides reliable, objective information on the availability of health services and the capacities of facilities to deliver the services at the required standards of quality. Emphasis was placed on the four (4) modules namely service availability, service readiness, quality and safety of care and management and finance, He mentioned that Ghana opted to initially conduct the assessment using the three modules which were facility based audit hoping to conduct the quality of care module which uses the record review methodology the following year. 

The presenter outlined the steps for the conduct of the HFFA, HFFA indicators, the kind of data to be collected and methods of data collection. It was stated that each module has a stand-alone set of questionnaires and combines questionnaires in such a way that it facilitates data collection from a particular facility. He added that the tool was flexible to meet the country’s needs for adaptation. The CSPro electronic data collection tool was explained as an application tool developed to collect and analyse data from the survey enabling the calculation of indicators, the generation of tables/graphs and the generation of a report online.

Presentation on Ghana HHFA Implementation

The HHFA Survey Lead in the person of Dr. Cornelius Debpuur also made a presentation primarily focusing on the Ghana HHFA design, methodology, implementation process, key activities undertaken and key challenges faced during the survey. His presentation highlighted the purpose of the assessment, its nationwide scope, encompassing both primary and secondary care levels, implementation management, and rollout of the exercise, including the number of targeted and interviewed facilities. There was also a visual representation of the geographic distribution of assessed facilities at all levels. 

Presentation on Findings from the HHFA Snapshots

The presentation outlined key findings, under six thematic areas: Reproductive, Maternal, Newborn, Child, and Adolescent Health; Malaria, TB, HIV/AIDS and NTDs; Non-Communicable Diseases; Surgery, Emergency, Palliative and Rehabilitative Care; Overall general service availability and readiness and Management and Governance. The results from these service areas were represented in well-labelled colourful graphs and charts. The summary of key issues underscored the availability of services and the capacity of facilities to provide quality services with the available resources. There were also significant challenges highlighted like the need for guidelines, underutilization of available services in lower-level facilities, and deficiencies in emergency preparedness, equipment maintenance, and diagnostics. Proposed next steps related to the use of the survey findings were also enumerated. 

Key Next Steps to be undertaken by the Ghana Health Service include:

  • Ghana is also introducing the mini HHFA  called Health Facility Profile which will be used to monitor the progress that is being made in addressing the gaps identified from the HHFA year on year.
  • The HHFA will Support the MoH midterm  review next year  for the HSMTDP to see where we are as a country in achieving our targets by 2025 and what needs to be done
  • Use appropriate technical skills to triangulate and analyze HHFA  data with other sources to provide better information on service utilization and access to care.
  • GHS is working with WHO and other DPs to support equity in access analysis and for future planning of infrastructure and services using spatial analysis techniques.
  • There are current key interventions such as NOPs – P4R that will use the HHFA as the baseline that will be used to track and evaluate these interventions