Readiness assessment of health facility services in Yaoundé, Cameroon
Description
This study employed an analytical cross-sectional design with three specific aims: a) to describe health facility characteristics, b) to evaluate service availability, and c) to measure the service readiness index. These analyses were conducted to identify factors associated with health facility readiness in Yaoundé. It was conducted from November to December 2024 in the city of Yaoundé, the capital of Cameroon, located in the Centre region. Yaoundé is a metropolis with nearly 5 million inhabitants and comprises eight health districts: Biyem-Assi, Cité Verte, Djoungolo, Efoulan, Mvog-Ada, Nkolbisson, Nkoldongo, and Odza. Our study targeted all functioning health facilities within the eight health districts. A sample of 205 health facilities was drawn from the master facility list (MFL), which contained 666 facilities. The sampling frame for this study was the Yaoundé Master Facility List (MFL), maintained by the Ministry of Public Health of Cameroon, which enumerated all registered health facilities across the eight health districts of Yaoundé at the time of study initiation. The MFL was cross-validated against district health office records and updated immediately prior to sampling to minimize coverage error. A stratified random sampling design was employed to ensure proportional representation of health facilities across key structural dimensions. This approach was selected over simple random sampling to guarantee adequate representation of each health district and ownership type. The sampling frame was first stratified by health and then by facility ownership type within each district (public; private secular; private denominational). Within each stratum, individual health facilities were selected by simple random sampling without replacement, using computer-generated random numbers. The number of facilities allocated to each stratum was proportional to the stratum's share of the total MFL.
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Data were collected using a structured questionnaire adapted from the standard Service Availability and Readiness Assessment (SARA) tool developed by the World Health Organization. For this study, the standard questionnaire was contextualized to the Cameroonian setting through adaptation of: facility category classifications consistent with national health system nomenclature; institutional management hierarchies; national clinical guidelines and service protocols; cadre-specific personnel categories; and the national essential medicines list (including disease-specific lists for HIV/AIDS and tuberculosis). These adaptations did not alter the core domains or tracer items of the SARA tool, preserving cross-study comparability. The adapted questionnaire was pre-tested in five health facilities not included in the main sample, located in Yaoundé, to assess clarity, length, and cultural appropriateness. The final instrument comprised 47 tracer items spanning five readiness domains. Data were collected through a combination of two complementary methods, in accordance with standard SARA protocol: (i) structured interviews with the facility head or, in their absence, the most senior clinically qualified staff member available; and (ii) direct observation of tracer items (equipment, medicines, guidelines, and infection prevention supplies) on the day of assessment. This combined approach was used to minimise social desirability bias and to verify self-reported availability of key inputs. Field data collection was conducted by trained data collectors using electronic data capture on Android tablets running Google Forms, with printed questionnaires retained as backup. Data collectors received standardised training covering SARA methodology, interviewing techniques, facility navigation procedures, and quality assurance protocols. Each completed form was reviewed on the same day by the supervising investigator for completeness and internal consistency. Material resources included tablets, memory cards, printed questionnaires, stationery, and informed consent forms. All facilities were visited in person; data collectors obtained written informed consent before administering the questionnaire. Data collected were exported to Microsoft Excel 2013 for cleaning, verification, and coding. Cleaning involved checking for missing values, out-of-range entries, and logical inconsistencies. Tracer items were coded binarily (1 = present and functional; 0 = absent or non-functional). Domain scores and the overall readiness index were computed in Excel before the dataset was exported to IBM SPSS Statistics version 27.0 (IBM Corp., Armonk, NY, USA) for all statistical analyses.