The tools proposed in this document are ﬁrst and foremost intended for use by district health management teams (DHMTs) with the objective of generating the information that will serve as a basis for improving the operationality of district health systems. In addition, the repeated application of the tools will facilitate the establishment of an information base for the monitoring and evaluation of the operationality of health districts as well as allowing for the follow-up of the impact of health sector reforms on district health systems. Since the responsibility of the assessment rests primarily with the district health management team, the tools have been designed as self-assessment tools. The methodology can be used to establish the evidence base for health development. A comparison of results with those from neighbouring districts could be the basis for a structured exchange of experiences and solutions between them. At the central level of the health system the results of the district self-assessments should be used to guide policy development, planning and resource allocation for strengthening district health systems
The Assessment Tools consist of a guideline and two questionnaires. The guideline contains background information on the objectives and the assessment criteria and provides practical guidance and suggestions on how the assessment can be conducted.
It is divided into four parts: Part I: General introduction. Part II: Role of the central level of the Ministry of Health in the preparation and facilitation of the assessments within the districts. Part III: Guidance for the preparation, implementation and follow up of the assessment at the district level. Part IV: Guidelines for ﬁlling in the questionnaires. One of the questionnaires focuses on the district level and will be completed by the assessment team for the entire district health system after the relevant information has been collected from the health facilities. The other questionnaire is to be used for collection of data from individual health facilities. This questionnaire is also intended to be used in non-public health facilities. The tools need to be adapted to the individual country situation before being introduced. For example, they should reﬂect the local names of structures and categories of personnel. Suggestions for adapting the tools to country situations are given in Part II. An overview of how the tools were developed is presented in Box 3.