title: Monitoring the ability to deliver care in low- and middle-income countries: a systematic review of health facility assessment tools.
abstract: BACKGROUND
  Health facilities assessments are an essential instrument for health system strengthening in low- and middle-income countries. These assessments are used to conduct health facility censuses to assess the capacity of the health system to deliver health care and to identify gaps in the coverage of health services. Despite the valuable role of these assessments, there are currently no minimum standards or frameworks for these tools.
  
  
  METHODS
  We used a structured keyword search of the MEDLINE, EMBASE and HealthStar databases and searched the websites of the World Health Organization, the World Bank and the International Health Facilities Assessment Network to locate all available health facilities assessment tools intended for use in low- and middle-income countries. We parsed the various assessment tools to identify similarities between them, which we catalogued into a framework comprising 41 assessment domains.
  
  
  RESULTS
  We identified 10 health facility assessment tools meeting our inclusion criteria, all of which were included in our analysis. We found substantial variation in the comprehensiveness of the included tools, with the assessments containing indicators in 13 to 33 (median: 25.5) of the 41 assessment domains included in our framework. None of the tools collected data on all 41 of the assessment domains we identified.
  
  
  CONCLUSIONS
  Not only do a large number of health facility assessment tools exist, but the data they collect and methods they employ are very different. This certainly limits the comparability of the data between different countries' health systems and probably creates blind spots that impede efforts to strengthen those systems. Agreement is needed on the essential elements of health facility assessments to guide the development of specific indicators and for refining existing instruments.
authors.affiliation: Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, Bruyère Research Institute, Ottawa, ON, Canada, Orvill Adams and Associates, Ottawa, ON, Canada, Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, Canadian Society for International Health, Ottawa, ON, Canada and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, Bruyère Research Institute, Ottawa, ON, Canada, Orvill Adams and Associates, Ottawa, ON, Canada, Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, Canadian Society for International Health, Ottawa, ON, Canada and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada Jason.Nickerson@uottawa.ca.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Nickerson
authors.affiliation: Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, Bruyère Research Institute, Ottawa, ON, Canada, Orvill Adams and Associates, Ottawa, ON, Canada, Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, Canadian Society for International Health, Ottawa, ON, Canada and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Orvill
authors.initials: O
authors.lastname: Adams
authors.affiliation: Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, Bruyère Research Institute, Ottawa, ON, Canada, Orvill Adams and Associates, Ottawa, ON, Canada, Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, Canadian Society for International Health, Ottawa, ON, Canada and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, Bruyère Research Institute, Ottawa, ON, Canada, Orvill Adams and Associates, Ottawa, ON, Canada, Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, Canadian Society for International Health, Ottawa, ON, Canada and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Amir
authors.initials: A
authors.lastname: Attaran
authors.affiliation: Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, Bruyère Research Institute, Ottawa, ON, Canada, Orvill Adams and Associates, Ottawa, ON, Canada, Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, Canadian Society for International Health, Ottawa, ON, Canada and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Hatcher-Roberts
authors.affiliation: Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, Bruyère Research Institute, Ottawa, ON, Canada, Orvill Adams and Associates, Ottawa, ON, Canada, Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, Canadian Society for International Health, Ottawa, ON, Canada and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell
mesh_terms: D003695:Delivery of Health Care; D003906:Developing Countries; D006268:Health Facilities / Q000600:supply & distribution*; D006295:Health Resources; D006297:Health Services Accessibility; D006801:Humans; D020380:Needs Assessment; D000078329:Workforce
keywords: Health system; health care surveys; health facilities; health services accessibility; methodologies