Carolyn Gulas -

Assessing the quality of adolescent health services in Brazil


Workshop participants visited a local health facility on the last day

In 1960, the national capital of Brazil re-located from Rio de Janiero, on the Atlantic coast, to Brasilia, which is in the central-west highlands of Brazil. Even though Oscar Niemeyer’s masterpiece in modern urban architecture doesn’t boast the beaches or invoke the same image of Brazilian life and culture as Rio does, Brasilia is still a city to be reckoned with. For one, Brasilia houses the federal government, including the Ministry of Health (MoH), which has the distinct responsibility of overseeing healthcare in the entire country and setting health policy for the 275,000+ public health facilities, or Unidades de Saúde, that cater to adolescents in Brazil.

I recently traveled to Brasilia to take part in a very special workshop hosted by the Brazil MoH. Government health officials from across the country were invited to the workshop for a lively 3-day discussion on the status of adolescent healthcare in the country and strategies for improving the quality of care that adolescents receive when visiting these public health facilities. During the workshop, I led a training on using an online monitoring tool that Ona built for the Brazil MoH to better assess the quality of adolescent health services in the country.

The online monitoring tool is based on the WHO Quality Assessment Guidebook for assessing health services for adolescents. The guidebook contains interview guides for adolescents, healthcare providers, and other key members in the community. The interview results are used to calculate quality indicator scores for the health facility, which gives the health facility an opportunity to improve adolescent healthcare quality in areas identified by the tool.

As a standalone paper tool, the WHO guidebook requires users to conduct the surveys and calculate the scores by hand, leaving room for human error. It also means scores cannot be calculated until all of the survey data has been collected. Our colleagues at WHO quickly saw the value in digitizing these guidelines as a way to eliminate human error in the scoring and as a way to monitor the results of the assessment in near real-time, making the system more efficient and responsive to the user’s needs.

Working with our WHO and Brazil MoH partners, Ona digitized the WHO guidebook by translating the paper interview guides into XLSForms. For viewing the results of the assessment, Ona built an online monitoring tool on top of our existing data collection platform. The online monitoring tool uses the data housed in Ona to automatically calculate and display the scores of each health facility. Scores are then aggregated across each municipality and state in Brazil.


The WHO Quality Assessment Guidebook was converted to XLSForms for electronic data collection


Scores are automatically calculated and aggregated using the online monitoring tool

Using the online monitoring tool, the MoH and local partners can then target specific health facilities with interventions based on areas that require improvement. Results of the quality assessments can then be tracked over time, so that the MoH can see where their interventions have improved adolescent healthcare.

It was very exciting and rewarding to travel to Brasilia and see the forms and the online monitoring tool in action. On the last day of the workshop, the entire group traveled to a nearby health facility where the MoH teams interviewed adolescents at the health facility and from the community and engaged in valuable conversations with health facility staff on how to improve the quality of healthcare for adolescents at their facility.

Going forward, I’m excited to see how the Brazil MoH teams successfully implement this tool across the country and use the results to improve the quality of adolescent healthcare in Brazil. I’m honored that Ona was able to be a part of this impressive initiative and I am looking forward to seeing how this tool can be used in Brazil to drive change in the lives of adolescents.