New survey tracks people-centred care across 18 countries

Integrated, people-centred, high-quality health services are seen as essential to achieving universal health coverage, but traditional health facility assessments often focus mainly on inputs such as buildings, staff counts and equipment. Those traditional assessments can also be expensive and slow, which limits how often they can be done and how useful they are for day-to-day program decisions. To address that gap, the Global Fund to Fight AIDS, Tuberculosis (TB), and Malaria developed the Targeted Health Facility Assessment (tHFA). As the corresponding author Shivam Gupta and colleagues explain, the tHFA was designed to be a more focused, practical tool that countries can use to inform plans and monitor progress under the Global Fund Strategy (2023–2028), which emphasizes maximizing people-centred integrated systems for health. This paper describes how the tHFA was created and put into practice: a baseline round was carried out in 2024 across 2,272 health facilities in 18 low- and middle-income countries (LMICs). The work lays out how a lighter, repeatable assessment can better track service delivery processes and patient experience, and how it might be embedded in routine monitoring to improve services for communities.

The tHFA is a cross-sectional, multi-country facility assessment built specifically to support countries and to monitor progress on four key performance indicators in the Global Fund’s strategic monitoring framework, alongside seven programmatic indicators tied to Global Fund investments in horizontal programs. For the 2024 baseline, the Global Fund used a modular questionnaire that covered integrated delivery of antenatal care, HIV, TB and malaria services, supportive supervision, community health worker (CHW) support, and patient-reported experience measures. The survey design used probability sampling, aiming for 120 health facilities per country, and resulted in data from 2,272 facilities across 18 LMICs. Data collection combined direct observation, health worker interviews, and record reviews. To handle deviations from the original sampling and cases where facilities needed to be replaced, post-stratification weighting was applied. The Global Fund also embedded data quality assurance through training, pilot testing, and real-time monitoring during data collection. While the paper focuses on design and implementation rather than clinical outcomes, these methods produced a broad, comparable baseline to inform further monitoring and decision-making.

The tHFA offers a pragmatic, agile and scalable way to monitor how services are delivered and how patients experience care across different countries and settings. By focusing on processes and outcomes of service delivery rather than only on structural inputs, and by including community health worker (CHW) support and direct measures of patient experience, the tool aligns with the Global Fund’s current strategic goals and provides information that is immediately relevant to program managers and funders. Institutionalizing the tHFA—making it a routine part of monitoring—could help countries and partners identify gaps in integrated care for antenatal, HIV, TB and malaria services and target improvements where they will matter most to people. The combination of a focused questionnaire, standard sampling approach, and built-in quality checks makes the tHFA potentially useful for repeated assessments, grant monitoring, and efforts to strengthen health systems in low- and middle-income countries.