This article is the third in a new series called “MLE Tools” that explores TCI’s innovative monitoring tools.
Health systems are complex and multifaceted, involving numerous stakeholders and contributing factors across various levels. The COVID-19 pandemic highlighted the importance of evaluating a health system’s resilience, responsiveness to population needs, and capacity to sustain improvements. However, the complexity and unique characteristics of health systems in different countries make it challenging to design, monitor, and evaluate effective strengthening efforts.
To address this gap, The Challenge Initiative (TCI) adapted the World Health Organization’s health systems building blocks framework, which outlines six core components, to create an effective monitoring tool for health systems strengthening (HSS). TCI developed HSS Checklists that customize the building blocks to assess the capacity of health systems to support robust implementation of family planning high-impact practices and interventions. It captures critical insights into each component’s performance, enabling stakeholders to track progress and identify areas needing further improvement.
Figure 1: TCI’s Theory of Change showing the HSS building blocks in the purple circle.
TCI’s HSS Checklist tools, highlighted in Table 1, provide insights into critical areas of a city’s family planning program such as local leadership, coaching programs, financial commitment and spending, quality of facility records and reports, utilization of data, and supplies management. The data gathered through these tools not only helps assess current system performance but also informs evidence-based decisions to strengthen family planning services at scale. TCI works with the local governments to address the specific gaps identified in the tools. By offering a detailed view of system capacities, the HSS Checklists fosters collaboration among stakeholders, ensuring targeted investments and coordinated efforts for sustainable improvements.
- Organization of a local family planning implementation team
- Good representation of relevant stakeholders in the regular family planning meetings
- Identification of gaps and action steps based on evidence
- Coordination with partners including the private sector
- Coordination with partners including the private sector
- Established system for providing regular trainings to health providers on family planning
- Maintaining a list of master coaches to support facilities on family planning Established system for recording outputs and outcomes from coaching
- Financial commitment of local government for family planning relative to the TCI Challenge Fund
- Tracking of family planning budget and expenditure
- Availability of expense reports
- Skills and training of staff handling data collection and entry
- Use of the correct data collection tools
- Timely, complete, and accurate inclusion of data in District Health Information Software (DHIS) reports
- Data validation practices
- Discussions around collected data at family planning meetings
- Outlined steps based on accurate understanding of data reports with clear timelines and assigned personnel
- Completion of required forms for managing family planning commodity logistics
- Trained staff on family planning commodities logistics management
- Availability of proper storage facilities
- Availability of family planning methods
The data collection process for these tools varies based on the level of implementation, with some conducted at the facility level and others at the city level. At the facility level, a sample of 10% of facilities or a minimum of five facilities is selected (whichever is lower) where TCI hub staff perform site visits, conduct observations, interview facility staff, and review means of verification. Similarly, at the city level, interviews with appropriate city staff, observations, and documentation review are conducted. Both facility and city-level monitoring take place quarterly, ensuring consistent assessment and continuous improvement of health system strengthening efforts.
For more details about the HSS Checklist and its application, please feel free to contact TCI for further details.
