# High-quality health facility–based measurement is crucial for World Bank COVID-19 operations

Facility preparedness and response is integral to addressing current and future pandemics and is a key feature of the World Bank’s response to COVID-19. Specifically, the World Bank’s COVID-19 Strategic Preparedness and Response Program (SPRP) Multiphase Programmatic Approach (MPA)<sup>21</sup> suggests 11 Project Development Objectives (PDO) indicators<sup>22</sup> (plus 12 more Intermediate Results Indicators) for inclusion, the majority of which require facility-based measurement. For example, assessing both baseline (before the operation) and endline availability of diagnostic and treatment inputs in facilities, or the numbers of acute health care facilities with isolation capacity (PDO indicators two and three) requires reliable and objective health facility data. A clear picture of project implementation and impact can only be achieved by high-quality data collection.

# Current measurement tools are not adequate

Unfortunately, current internationally used health facility assessment tools are not designed to comprehensively measure pandemic preparedness. Specifically, the SDI, SARA, and SPA are the three most widely used globally comparable health facility surveys, sponsored by the World Bank, World Health Organization, and USAID, respectively. The ability of the SDI to shed light on pandemic preparedness is discussed in depth above; importantly, 11 of the 18 WHO-recommended items are not captured in the SDI (Appendix Table 1). Similarly, while the SPA survey typically contains more information on PPE availability than the SDI (and recent work<sup>23</sup> documents what can be learned from recent SPA surveys about preparedness to protect health workers from COVID-19), it does not collect information on any more of the 18 domains. For example, no information is available on backup human resources for surge capacity, triage or ambulance dispatch systems, or continency plans or drills.<sup>24</sup> Even the SARA, which is considered the most comprehensive of the three surveys in terms of covering inputs (such as equipment and supplies), does not, for example, ask about respirators/ventilators, mortuary handling (i.e., body 21 Task Team Guidance on Preparing IPF Financed Project PAD under the COVID-19 Strategic Preparedness and Response Program (SPRP) using the Multiphase Programmatic Approach <u>https://worldbankgroup.sharepoint.com/sites/wbunits/opcs/Knowledge%20Base/PAD%20Guidance%20Sample%2 0for%20IPF%20Projects%20under%20the%20Global%20MPA.pdf</u> 22 As of April 6, 2020: (1) Country has activated their public health Emergency Operations Center or a coordination mechanism for COVID-19. (2) Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents. (3) Number of acute health care facilities with isolation capacity. (4) Number of suspected cases of COVID19 reported and investigated per approved protocol. (5) Number of diagnosed cases treated per approved protocol. (6) Personal and community non-pharmaceutical interventions adopted by the country (e.g., installation of handwashing facilities, provision of supplies and behavior change campaigns, continuity of water and sanitation service provision in public facilities and households, school closures, telework and remote meetings, reduce/cancel mass gatherings). (7) Policies, regulations, guidelines, or other relevant government strategic documents incorporating a multisectoral health approach developed/or revised and adopted. (8) Multi-sectoral operational mechanism for coordinated response to outbreaks by human, animal, and wildlife sectors in place. (9) Coordinated disease surveillance systems in place in the animal health and public health sectors for zoonotic diseases/pathogens identified as joint priorities. (10) Mechanisms for responding to infectious and potential zoonotic diseases established and functional. (11) Outbreak/pandemic emergency risk communication plan and activities developed and tested.

23 Gage and Bauhoff. “Health Systems in Low-Income Countries Will Struggle to Protect Health Workers from COVID-19”. Blog post. Published March 31, 2020. https://www.cgdev.org/blog/health-systems-low-income- <u>countries-will-struggle-protect-health-workers-covid-19</u> 24 Measure DHS Service Provision Assessment Survey Inventory Questionnaire <u>https://dhsprogram.com/pubs/pdf/SPAQ1/INVENTORY_06012012.pdf</u> 21