Autonomy of the health facility
The degree of autonomy over decision-making at the health facility level.
Autonomy of the health facility is assessed using F1 section 11 of the Health Facility Questionnaire developed by the World Bank (see below).
To determine the level of health facility autonomy, assign one point each for question (i.e. question 11.01 through 11.09), add up all points and divide by 9 to obtain a percentage.
Autonomy of the health facility is assessed using the Heath Results Based Financing Impact Evaluation, F1 section 11 - Health Facility Assessment Questionnaire (developed by the World Bank).
The health facility questionnaires were designed to provide primary data on service delivery, facility structures, process quality, human resources and infrastructure. A health facility survey involves visiting and collecting data for all health facilities identified in the sampling plan.
World Bank health facility survey: Heath Results Based Financing Impact Evaluation, Health Facility Questionnaire: F1 - Health Facility Assessment Questionnaire (Section 11 - Autonomy).
The principle of autonomy is central to results-based financing (RBF) for health; increasing health facility (management) autonomy is vital to RBF success. RBF is not merely a matter of changing funding mechanisms. It is about holding people responsible for the results they obtain, making sure that providers are autonomous in decision-making at the operational level and ensuring that providers are accountable to clients.
Autonomy is needed to allow health service providers and their partners to come to context-specific approaches for results. In order to increase the quantity and quality of health services, health facilities need the autonomy, flexibility and freedom to manage resources effectively via creative and innovative means. To date, the most important strategy in RBF to foster autonomy is linked to the setup of new structures and implementation of approaches such as decentralization, devolution and community involvement.
This indicator provides an estimate of the overall quantity of autonomy as experienced by the health facility leader.
Leadership and governance, Facility management
Vermeersch C, Rothenbühler E, Sturdy JR. Impact Evaluation Toolkit Measuring the Impact of Results-Based Financing on Maternal and Child Health.; 2012.
Toonen J, Canavan A, Vergeer P, Elovainio R. Learning Lessons on Implementing Performance Based Financing, from a Multi-Country Evaluation. Amsterdam: KIT (Royal Tropical Institute); 2009. http://www.who.int/contracting/PBF.pdf.
Fritsche GB, Soeters R, Meessen B. Performance-Based Financing Toolkit.; 2014. doi:10.1596/978-1-4648-0128-0.
The complete toolkit and health facility survey can be found on the World Bank website at: http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTHEALTHNUTRITIONANDPOPULATION/EXTHSD/EXTIMPEVALTK/0,,contentMDK:23262154~pagePK:64168427~piPK:64168435~theSitePK:8811876,00.html
