Data on health facilities are collected for the MCE from first-level health-facility surveys. Indicators measured at these facilities include those related to the quality of case management, the availability of health systems support for IMCI, care-taker satisfaction, and selected indicators of utilization, care-seeking behaviour and clinic organization. Descriptive information is also collected, including facility services and service hours, availability of patient registers and drug records, information on the number and types of facility visits by children, staff time allocation, and additional information needed to estimate costs. The tools were tested in Peru and Bolivia and have been applied in Tanzania, Uganda and Bangladesh.

The first-level health facility surveys include the following six activities:

• Observation of case management by a trained surveyor;

• A gold-standard re-examination of the child;

• An exit interview with the caretakers of the children who were observed during case management;

• An inventory of facility supplies, drugs and registers of attendance;

• Collection of information on health facility costs;

• A series of interviews with facility staff to obtain information on facility operations and costs, and in some cases, to assess their ability to manage children with severe illness.

Although adequate referral facilities are essential for IMCI, a full survey of such facilities is outside the scope of MCE. Instead, a simple tool has been prepared to describe the key components of facility care, including aspects of admission patterns, emergency triage, diagnostic facilities, treatment, and patient monitoring. The methods include interviews with facility staff, a review of facility equipment and supplies, and a limited record review.