The GFF supports country-led efforts to improve the timely use of data for decision-making, ultimately leading to stronger primary healthcare (PHC) systems and better reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N) outcomes¹. This set of initiatives and technical support is referred to as Frequent Assessments and System Tools for Resilience (FASTR).

Why Rapid-Cycle Monitoring?

Existing health systems data sources are critical but can sometimes come with challenges that limit their utility for country decision-makers. Health management information system data are often perceived as too low-quality to use for decision making. Traditional in-person household and facility-based surveys demand extensive resources and time to use for routine monitoring, with long lags between survey design, the collection of data, and the availability of findings for use. This prevents decision-makers from using data in a timely manner to drive meaningful improvements in health outcomes.

To fill this gap, the GFF supports countries to develop and use rapid- cycle monitoring approaches.

How does Rapid-Cycle Monitoring Work?

Rapid-cycle monitoring approaches provide timely, rigorous, and high-priority data that responds to each country's specific priorities and data use needs. Employing a collaborative and country-led approach, these analyses are further reinforced by learning and capacity enhancing activities to use the data for practical purposes. All approaches are customized to the specific country context and aim to support country initiatives. This continuous cycle of analyze-learn-strengthen-act seeks to improve the systematic use of data for decision-making towards improved RMNCAH-N outcomes (Figure 1).

Figure 1. FASTR's Rapid Cycle Monitoring Approach: Analyze, Learn, Strengthen, Act

FASTR’s four technical approaches, underpinned by capacity strengthening and data use support, enable rapid-cycle monitoring for strengthening PHC systems and improving RMNCAH-N outcomes through the timely and high-frequency analysis and use of data (Figure 2).

Figure 2. Rapid-cycle analytics under the Frequent Assessments and Systems Tools for Resilience (FASTR) initiative

These approaches are highly adaptable to each country's specific priorities and data use needs and are designed to be triangulated with other data sources, such as in-person household and health facility surveys.

Continual Service Monitoring Through Routine Data Sources

Rapid-cycle approaches using routine health management information system (HMIS) data can be used to:

• Evaluate the quality of HMIS data both at the national and sub-national levels to help address gaps in quality and completeness.
• Measure monthly changes in the utilization of critical health services, enabling a rapid response to challenges and the opportunity to gain insights on the progress of reforms.
• Compare service coverage trends with country targets, facilitating the continuous monitoring of RMNCAH-N progress.

Through collaboration with Ministries of Health, the GFF assists countries in developing and reviewing regular analyses of HMIS data, focusing on specific priority health service indicators linked to national health care reforms, as well as GFF and World Bank investments. The findings derived from these analyses are translated into actionable strategies through the country's planning processes and are integrated into the project cycles of the GFF and the World Bank.

PHC system monitoring through longitudinal health facility phone surveys

Effective PHC systems are critical to scaling up high-impact interventions to improve RMNCAH-N outcomes. Rapid-cycle longitudinal phone surveys conducted with health care facilities establish an ongoing monitoring platform, enabling countries to:

• Continuously evaluate PHC readiness and identify obstacles to delivering high quality care, with feedback loops to inform strengthening actions at multiple levels.
• Keep a close watch on the implementation of health care reforms, providing the needed insights to course correct or scale-up implementation.
• Capture the effects of unexpected events – such as epidemics, natural disasters, or violence – on the health system, allowing for the measurement of the PHC system’s resilience in near-real time.
• Track changes in health system performance over time.

Through collaborative efforts with Ministries of Health and national survey organizations, the GFF supports countries in developing a flexible health facility phone survey platform that can adapt to evolving health system dynamics. This allows countries to utilize phone surveys as a monitoring mechanism in between traditional, in-person assessments that occur less frequently, such as the World Bank’s Service Delivery Indicators survey and other health facility assessment tools. In 2024, the rapid cycle health facility phone survey will undergo a side-by-side validation with the Service Delivery Indicators survey, further strengthening the approach.

High-Frequency Household Surveys

Gathering information from households and communities, in addition to health facility and service utilization data, offers a more comprehensive perspective of the health care system. To achieve this, high-frequency household phone surveys are conducted among a selected group of households, offering a snapshot of factors from the demand side of healthcare. These factors encompass health service utilization, financial protection, instances of missed healthcare, and the patient reported perceptions and experiences of the health system.

High-frequency household surveys allow countries to utilize phone surveys as a monitoring mechanism in between traditional, in-person household surveys assessments that occur less frequently. This approach has been tested in partnership with the World Bank’s Living Standards Measurement Study and demonstrated value, both in providing more frequent estimates of household-level factors over time and in triangulating demand and supply side data to give a more comprehensive picture of PHC systems and RMNCAH-N needs.

Rapid qualitative follow-ups on priority policy questions

Rapid qualitative methods offer a deeper understanding of changes in RMNCAH-N service delivery, supporting the analyze-to-action cycle. These methods are employed in response to specific country learning objectives, such as:

• Rapid diagnosis and assessment of the current situation to inform a country’s priority learning agenda for specific programs, policies, or a response to shocks.
• Rapid assessment of interventions and how contextual factors are influencing implementation.
• Capturing the perspective of multiple actors within the health system (e.g., at the national, district, health facility, and community levels).

These approaches also support the GFF’s Implementation Research and Evaluation strategy by providing timely data that is responsive to decision-making and learning needs.

Providing an Up-to-date Snapshot of PHC Performance

Monitoring PHC health facility performance can help decision-makers identify where to direct limited resources to have the most impact.

Figure 3. Illustrative example of rapid-cycle health facility phone survey components

Monitoring Shocks Facing Health Facilities to Track their Resilience Over Time

Rapid-cycle surveys capture change in the health system and the country context over time. This allows countries to track health systems resilience – how the health system absorbs, responds to, and transforms after a shock – to support preparedness, response, and recovery efforts. This illustrative graph quantifies the presence of shocks in communities over time.

Figure 4. Illustrative example of tracking shocks in communities over time

Keeping an Eye on Services

Regularly checking service volumes can spot problems quickly and help countries make decisions faster – for example, quickly identifying a decline in recorded immunizations could prompt decision makers to check for possible supply chain bottlenecks and plan catch-up campaigns.

Figure 5. Illustrative example of service disruptions

Tracking Changes in Data Quality

Regular evaluations of how accurate data are within the HMIS supports data quality improvements and informs which analyses are possible and how to interpret them. Analysis of facility-level data quality suggests improvements in many HMIS systems.

Figure 6. Illustrative example of tracking HMIS data quality over time and by region

Understanding the Impact of COVID-19 on RMNCAH-N Services

During the COVID-19 pandemic, the GFF supported Ministries of Health in 22 countries to track the pandemic’s impact on essential RMNCAH-N service use. These analyses showed that the COVID-19 pandemic reduced the use of childhood vaccination, outpatient consultations, maternal care, and other essential services in many GFF partner countries . Surveys of primary healthcare facilities identified challenges facing frontline health workers, including limited financing, human resources, and personal protective equipment . These findings helped to raise awareness of the impact of the pandemic on essential RMNCAH-N services and led to essential health services grants in several GFF partner countries.

The GFF works with partner countries to ensure that FASTR’s monitoring tools and resources are shared as public goods and that cross-country analyses are publicly available.

Rapid-Cycle Monitoring Analyses

Monitoring of Essential Health Services during the COVID-19 Pandemic

• Report: COVID-19: Impact on Essential Health Services
• Article: Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries
• Article: Vaccination utilization and subnational inequities during the COVID-19 pandemic
• Article: Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries
• Article: Resilience of front-line facilities during COVID-19: evidence from cross-sectional rapid surveys in eight lowand middle-income countries
• Article: Vaccine hesitancy among health workers in low- and middle-income countries during the COVID-19 pandemic: results from facility surveys in six countries
• Article: Availability and use of personal protective equipment in low- and middle-income countries during the COVID-19 pandemic
• Article: What made primary health care resilient against COVID-19? A mixed-methods positive deviance study in Nigeria