Table 1 HPHC AAAR domains and subdomains by Cronbach Alpha (overall alpha = 0.92); N = 213

Account_1 ● Communities, civil society, and the private sector engage with local, regional, and national governments as partners in the management, funding, and oversight of health institutions.

Alpha = .81

Afford_1 - ● Routine or unexpected health care costs, including medications or supplies, do not impoverish people.

Alpha = .58

Access_1: ● Health facilities and medicines are located within a reasonable distance and are consistently open on a regular schedule known to the community and have the staff and equipment to fulfill their designated functions.

Alpha = .82

Reliable_1 ● Health facilities and health workers have the right supplies and quantity of commodities needed to deliver care, including running water and sanitation services, reliable sources of energy, and appropriate procedures to prevent infections. Alpha = .75

Account_2 - ● Mechanisms are in place to ensure patients’ privacy and satisfaction with care.

Alpha = .74

Afford_2 - ● People continue to seek needed care after considering the total cost of that care (e.g., the cost of services, drugs, supplies, transport, and care for family members left behind or who accompany the patient). Alpha = 88

Access_2: ● Alternative care options exist to extend the reach of traditional health facilities, including both paid and voluntary community health workers, as well as digital or e-health applications, drug shops/pharmacies, mobile outreach, etc.

Alpha = .80

Reliable_2 ● Health workers have the knowledge, skills, motivation, credentials, and cultural understanding to provide care; are engaged in continuing education; are regulated through professional and licensing associations and supported through retention strategies.

Alpha = .86

Account_3 -● Information regarding health financing, delivery, and outcomes (at a population level) are publicly available.

Alpha = .79

Afford_3 ● People opt to participate in pre-payment schemes or insurance plans to improve their ability to access health care and protect themselves from financial hardship because of illness.

Alpha = .73

Access_3 -● Quality of care for priority interventions meets established standards from both providers and consumers, and is consistent across all facilities, regardless of whether they are public, private, non-profit, or faith-based.

Alpha = .89

Reliable_3 ● Health facilities are able to meet the standards of accrediting organizations, and effectively engage their communities, and the people they serve.

Alpha = .84

Account_4 ● Good health outcomes, supported by self-directed and family-centered positive health behaviors, are sustained.

Alpha = .68

Afford_4 -● Governments allocate financial and human resources for health to meet priority needs, and work with the private sector and civil society to increase domestic funding and ensure the adequate distribution of such resources Alpha = .58

Access_4 -● Emergency health care and related transportation are available.

Alpha = .81

Reliable_4 ● Pharmaceutical and logistics management systems are in place so that medicines, devices, and commodities are safe and of expected quality, and with controls that minimize the risks of theft or falsification.

Alpha = .90

Account_5 ● Licensing agencies and professional organizations are responsible for credentialing providers, accrediting facilities, and setting standards in partnership with national (and/or local) government. Alpha = .74

Afford_5 - ● Safe and effective essential medicines are available without undue financial hardship to obtain them, along with mechanisms to ensure their responsible use (at the right time, for the right conditions, and at the right doses).

Alpha = .78

Access_5 -● People understand when, why, and where to get the care they need and are motivated to seek it.

Alpha = .88

Reliable_5 ● Health workers are safe from violence, assault, or harassment and are protected against natural disasters, disease outbreaks and emergencies.

Alpha = .87

Account_6 -● Recourse or appeal options are available for patients or communities dissatisfied with health care.

Alpha = .78

Access_6 -● Providers deliver health care in a manner that ensures equitable health outcomes and promotes dignity and respect for all patients and providers.

Alpha = .87

Reliable_6 ● Patients trust that institutions and providers will give them the care they need in a way that meets their needs respectfully, without stigma, shame, fear, or abuse.

Alpha = .87

Reliable_7 ● Care continues during times of disruption, shock, or crisis.

Alpha = .90