The Maternal Health Facility Readiness (MHFR) Self-Assessment Tool is a standardized, evidence-based tool developed by SPHERES, Inc. for use in Philippine maternal health facilities. It assesses facilities across seven domains and 108 indicators, producing a readiness scorecard and Facility Improvement Plan that support targeted, data-driven improvement of maternal health services.
The MHFR Self-Assessment Manual is grounded in the World Health Organization (WHO) three-delay model developed by Thaddeus and Maine (1994), which attributes maternal mortality to delays in recognizing danger signs, reaching care, and receiving adequate care at the facility. By assessing facility readiness across seven domains, the tool identifies where each delay is most likely to occur and what specific gaps are driving it.
The framework draws on three internationally recognized methodologies: the WHO Service Availability and Readiness Assessment (SARA), the WHO Harmonized Health Facility Assessment (HHFA), and the Department of Health (DOH) standards for maternal and newborn care under Administrative Order 2012-0012 and Administrative Order 2020-0047, as well as the Universal Health Care (UHC) Act (Republic Act 11223). Indicators are adapted to the facility types operating under local Health Care Provider Networks (HCPNs).
SPHERES, Inc. was engaged as the technical assistance partner for this component of the project following a competitive selection process, subcontracted by the Philippine Society for Responsible Parenthood (PSRP) against the Terms of Reference (TOR) for the design and rollout of a facility-level maternal health readiness assessment, under a UNFPA Philippines-funded initiative. The engagement covers the project period of June 20 to August 31, 2026. SPHERES developed the assessment framework, digital data collection instrument, automated scoring system, and facility mapping output as part of its technical assistance under the project.
Each domain covers a distinct dimension of facility readiness. Indicators within each domain are tailored by facility type, covering birthing homes and lying-in clinics, rural health units (RHUs) with and without delivery services, and hospitals at various levels of care. Only the indicators applicable to a given facility type appear in the digital form.
Each indicator is scored on a scale of 0 to 4: 0 (Absent), 1 (Inadequate), 2 (Partially Functional), 3 (Mostly Functional), and 4 (Fully Functional). Domain scores are expressed as a percentage of the maximum possible score for the facility type, and these are aggregated into an overall facility readiness rating.
Overall facility readiness is classified into five levels based on the aggregate score across all applicable domains.
| Score | Classification | Meaning |
|---|---|---|
| 85% and above | Highly Ready | The facility meets or exceeds readiness standards across most domains. Maintenance and continuous quality improvement are the priority. |
| 70% to 84% | Moderately Ready | Core services are in place but notable gaps exist. A targeted Facility Improvement Plan should address specific domain deficiencies. |
| 55% to 69% | Partially Ready | Significant gaps across multiple domains. Systematic strengthening is needed before the facility can be considered reliably ready. |
| 40% to 54% | Minimally Ready | Fundamental deficiencies in readiness. Immediate attention and substantial resource investment are required. |
| Below 40% | Critical Gap | The facility has critical deficiencies that represent serious risk to maternal and newborn health. Urgent intervention is needed. |
Beyond scoring, the digital form captures the GPS coordinates of every facility at the point of assessment. Once a set of facilities within a locality has completed the self-assessment, their readiness scores and locations can be plotted together on a single map, showing how each facility sits within its Health Care Provider Network (HCPN) and how readiness varies across the referral pathway from community-level facilities up to hospitals.
This turns individual facility results into a locality-wide planning tool, useful for city and municipal health offices identifying where to prioritize support, and for HCPN coordination bodies visualizing gaps across their referral network.
An example of this mapping output, built from facility assessments in San Pablo City, Laguna.
View Sample Mapping →The assessment is completed by a team of at least two facility staff members with direct knowledge of the facility's services, personnel, medicines, and equipment, ideally including the facility head or officer-in-charge and at least one clinical staff member. External supervisors or city and municipal health office staff may support the process but should not complete the form on behalf of the facility.
Each indicator has defined means of verification, described in full in the manual. These include logbooks, training certificates, drug inventories, equipment inspection records, and direct observation of the facility. Gather this documentation before the team begins, the assessment takes approximately one hour with records on hand.
Download and read the full manual before starting. It covers the assessment framework, scoring methodology, means of verification for every indicator, and the Facility Improvement Plan template.
A password is required to download this file. Contact SPHERES, Inc. at info@spheresphinc.com for the password.
The form adapts automatically to the facility type selected, so the team only answers the indicators that apply, and it captures the facility's GPS coordinates for network mapping. Submissions cannot be edited afterward, so verify all entries carefully before submitting.
Open Self-Assessment Form →A password is required to access this page. Contact SPHERES, Inc. at info@spheresphinc.com for the password.
Upon submission, the completed assessment form and the computed Facility Readiness Scorecard, showing domain scores, overall readiness rating, and a prioritized list of gaps, are emailed automatically to the address provided. Use the Facility Improvement Plan template in the manual to turn these findings into concrete, time-bound actions.
The form locks after submission. Corrections require a full new submission, and the system automatically retains only the most recent one per facility.
City or Municipal Health Office coordinators can contact SPHERES, Inc. to request aggregate readiness reports across their network of facilities, including HCPN-level summaries and comparative gap analyses by domain and facility type.
SPHERES provides technical assistance in maternal health project design, facility readiness assessment, Health Care Provider Network formation, community monitoring, and monitoring and evaluation framework development. Reach out to discuss how we can support your project.
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