Percentage of health facilities that offer ART (i.e., prescribe and/or provide clinical follow-up) [disaggregated by sector (public, private)]

Export Indicator

Percentage of health facilities that offer ART (i.e., prescribe and/or provide clinical follow-up). Health facilities include public and private facilities, health centres and clinics (including TB centres), as well as health facilities that are run by fa
What it measures

This indicator measures the capacity of health facilities to provide antiretroviral therapy (ART).

Rationale

Antiretroviral therapy is a cornerstone of effective HIV treatment, and measuring the percentage of health facilities that offer ART provides valuable information about ART availability. One strategy to scale up ART services is to make ART available in more health facilities. This may be achieved by decentralizing ART services from tertiary facilities (e.g., hospitals) to primary or secondary-level health facilities.

Numerator

Number of health facilities that offer ART (i.e., prescribe and/or provide clinical follow-up).

Denominator

Total number of health facilities, excluding specialized facilities where ART services are/will never be relevant.

Calculation

Number of health facilities that offer ART
--------------------------------------------------------------------------------------------------------------------- x 100
Total number of health facilities minus those where ART services
are/will never be relevant

Method of measurement

The numerator is calculated by summing of the number of facilities reporting availability of ART services. Information on the availability of specific services is usually kept at the national or sub-national level. National AIDS Programmes should have a record of all health facilities offering ART services. A health facility census or survey can also provide this information, along with more in-depth information on available services, provided the information is collected from a representative sample of health facilities in the country. In a facility survey (e.g., Service Provision Assessment, Service Availability Mapping), the most knowledgeable person responsible for client services is interviewed using the AIDS Outpatient Department (OPD) module. Responses to a series of questions establish whether providers in that facility provide ART services directly (i.e., prescribe ART and/or provide clinical follow-up for ART patients) or refer patients to other health facilities for these services. In addition, facility records documenting the current status of service provision should be consulted. One potential limitation to facility surveys or censuses is that they are usually only conducted once every few years. Countries should regularly update their programme records on health facilities offering ART services, and supplement these data with those obtained through a health facility survey or census every few years.
 
The denominator is calculated by summing the total number of health facilities included in the sample. Information for construction of the denominator may come from programme records, facility listings, and/or national strategy or planning documents.
 

Measurement frequency

Annual

Disaggregation

Sector: Private, Public

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

This indicator provides valuable information about the availability of ART services in health facilities, but it does not capture information about the quality of services provided. Antiretroviral therapy itself is complex, and it should be delivered as part of a package of care interventions, including the provision of cotrimoxazole prophylaxis, the management of opportunistic infections and comorbidities, nutritional support and palliative care. Simple monitoring of ART availability does not ensure that all ART-related services are adequately provided to those who need them. Nevertheless, it is important to know what percentage of health facilities provide ART services in order to plan for service expansion as needed to meet universal access targets.

Further information