## I. **Introduction**

In the last 20 years, household surveys have considerably improved our understanding of health outcomes and health related behavior in developing countries. For example, data from surveys such as the Living Standard Measurement Study (LSMS) surveys and Demographic and Health Surveys (DHS) have shed light on the nature and determinants of health problems in particular contexts, while also providing information on health related behavior, including household expenditure on health care and the utilization of health services. Although these and other surveys have considerably strengthened the basis for policy design and implementation in the health sector, they have also highlighted the need to better understand the supply side of service delivery. The supply side has also received increasing attention as a consequence of many health systems having to grapple with real or perceived problems of inefficiency, low quality, inequalities, and unsustainable financing. In this context, health facility surveys have come to comprise an important source of information, both about the characteristics and activities of health facilities, and the financing and support systems that serve them.

Although these surveys all have the health facility surveys as their focus, they vary along at least four important dimensions. First, they have different motivations. Some aim to understand better how health facility characteristics influence health-seeking behavior and health outcomes, while others make the facility the focus of analysis, emphasizing issues such as cost, efficiency, and quality. In addition, some surveys are designed to shed light on the broader context of service delivery, including links between different providers, or between providers and government. For example, some surveys have tracked public expenditures from the central ministry to rural facilities. A second difference concerns the scope and nature of data collected. For example, while many collect data on inputs, not all collect data on costs or on clinical dimensions of health care quality. Third, surveys have collected data in different ways, and adopted different approaches to measurement. For example, quality is sometimes assessed indirectly through data on inputs, sometimes directly, e.g., through the use of clinical vignettes or consultation observation. Finally, surveys vary in the uses to which the data have been put. In some cases, the focus has been on research. In others, the principal use has been to design interventions, or to monitor and evaluate programs.

In this paper, we seek to provide an introduction to health facility surveys, and to the methodological approaches that underpin them. The paper is organized as follows. In section II we discuss what has motivated different health facility surveys. Section III provide detail on the type of data that have been collected in different surveys, and on approaches to measurement. Section IV outlines how facility data have been used. Finally, in section V, we offer some conclusions, focusing on lessons learnt and emerging themes.

# **II. Motivations for Facility Surveys**

There are two broad motivations for health facility surveys. These can be illustrated with reference to Fig. 1 below, which illustrates how health facilities interact with one other, 1