Open Access Open Badges Research article

A critical assessment of the WHO responsiveness tool: lessons from voluntary HIV testing and counselling services in Kenya

Mercy K Njeru12*, Astrid Blystad24, Isaac K Nyamongo3 and Knut Fylkesnes2

Author Affiliations

1 Centre for Public Health research, Kenya Medical Research Institute, Nairobi, Kenya

2 Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway

3 Institute of Anthropology, Gender and African studies, University of Nairobi, Nairobi, Kenya

4 Department of Public Health and Primary Health Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway

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BMC Health Services Research 2009, 9:243  doi:10.1186/1472-6963-9-243

Published: 22 December 2009



Health, fair financing and responsiveness to the user's needs and expectations are seen as the essential objectives of health systems. Efforts have been made to conceptualise and measure responsiveness as a basis for evaluating the non-health aspects of health systems performance. This study assesses the applicability of the responsiveness tool developed by WHO when applied in the context of voluntary HIV counselling and testing services (VCT) at a district level in Kenya.


A mixed method study was conducted employing a combination of quantitative and qualitative research methods concurrently. The questionnaire proposed by WHO was administered to 328 VCT users and 36 VCT counsellors (health providers). In addition to the questionnaire, qualitative interviews were carried out among a total of 300 participants. Observational field notes were also written.


A majority of the health providers and users indicated that the responsiveness elements were very important, e.g. confidentiality and autonomy were regarded by most users and health providers as very important and were also reported as being highly observed in the VCT room. However, the qualitative findings revealed other important aspects related to confidentiality, autonomy and other responsiveness elements that were not captured by the WHO tool. Striking examples were inappropriate location of the VCT centre, limited information provided, language problems, and concern about the quality of counselling.


The results indicate that the WHO developed responsiveness elements are relevant and important in measuring the performance of voluntary HIV counselling and testing. However, the tool needs substantial revision in order to capture other important dimensions or perspectives. The findings also confirm the importance of careful assessment and recognition of locally specific aspects when conducting comparative studies on responsiveness of HIV testing services.