Table 3 Platforms that can be harnessed by SSA governments to create and update HFDBs

Routine health information

Systems have a huge potential in supporting development of HFDBs. Forty-three SSA countries have implemented a national health information management system based on DHIS2, a web-based open-source platform [13] that provides a significant transformation in health information in SSA. For a country to set-up a DHIS2, it will obviously require a form of a HFDB. Facilities will then make monthly reports, which can be used to infer their capacities and services, with some having their geographical locations mapped, information that can feed back to the HFDB. The DHIS2 list should theoretically be the same as the country’s HFDB, but a previous audit in Kenya showed a discrepancy of 17% [8]. As governments have implemented DHIS2 over time, this information can be harnessed to understand the temporal changes in facility levels and operational status. However, reporting completeness and data quality are still poor. For example, some of the unique IDs do not match between DHIS2 and HFDBs in some countries, though progress is being made [8, 64, 85, 86]

The Polio Eradication Programme

In the WHO African region has implemented strategies to strengthen surveillance, routine immunization, and monitoring and evaluation. One strategy uses open-source data collection tools for integrated supportive supervision and electronic surveillance visits to healthcare facilities [26]. To facilitate this process, countries submit a list of health facilities (45 of the 47 member states) which are often incomplete with no GPS coordinates. During visits to facilities, data on facility name, their locations and routine immunization capabilities are collected and used to develop, update, and validate HFDB for the WHO African region countries [26]. This initiative started in 2017 with the inauguration of the AFRO-GIS Centre to support innovative technologies for Polio surveillance [26]

Through the health resources and services availability monitoring system (HeRAMS)

The WHO facilitates a collaborative process through which health service providers exchange, analyze, and validate information on essential health resources and services. This includes the compilation, maintenance, update, and dissemination of an authoritative HFDB. As of June 2024, HeRAMS was available in nine SSA countries, with two additional countries in a preparatory phase [87]. It shows geolocated health facilities with attributes including service offered, e.g., 1241 facilities in DRC and 8077 facilities (including community health workers) in Mali [88]. The system offers a mechanism to produce, maintain, and validate a HFDB. However, access and use of facility-based indicators in the HeRAMS database are dependent on ad hoc permission by service providers engaged in the process at the national level. Once access is granted, the data can also be prepared via an R package for subsequent geospatial analysis to identify the populations that are geographically marginalized [89]

The Service Provision Assessment (SPA)

Is a health facility survey that collects data on service availability within a country’s health system. While the sample size is about 400–700 (or a census of facilities, depending on the total number of facilities and funding available), SPAs can be used to update some aspects of HFDB. Between 2004 and 2022, 17 SPA surveys have been conducted in 10 countries. With seven annual SPA surveys between 2012 and 2017, Senegal used SPA data to in curate its HFDB [27]. The SPA, together with WHO’s service availability and readiness assessment (SARA) and the World Bank service delivery indicators are now part of the harmonized health facility assessment [24]

Health Electrification and Telecommunications Alliance (HETA)

Is a USAID, Global Development Alliance aiming to reach health facilities across the region for electrification. Through HETA, facility attributes can be updated in HFDBs [90]

Health insurance companies

In SSA countries often hold a very detailed list of facilities with whom they have contracts. Such lists can be harnessed to improve HFDBs [91]