Health systems performance assessment in low-income countries: learning from international experiences
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
Globalization and Health
Abstract
The study aimed at developing a set of attributes for a ‘good’ health system performance assessment
(HSPA) framework from literature and experiences in different contexts and using the attributes for a structured
approach to lesson learning for low-income countries (LICs).
Methods: Literature review to identify relevant attributes for a HSPA framework; attribute validation for LICs in
general, and for Uganda in particular, via a high-level Ugandan expert group; and, finally, review of a selection of
existing HSPA frameworks using these attributes.
Results: Literature review yielded six key attributes for a HSPA framework: an inclusive development process; its
embedding in the health system’s conceptual model; its relation to the prevailing policy and organizational set-up
and societal context; the presence of a concrete purpose, constitutive dimensions and indicators; an adequate
institutional set-up; and, its capacity to provide mechanisms for eliciting change in the health system. The expert
group contextualized these attributes and added one on the adaptability of the framework.
Lessons learnt from the review of a selection of HSPA frameworks using the attributes include: it is possible and
beneficial to involve a range of stakeholders during the process of development of a framework; it is important to
make HSPA frameworks explicit; policy context can be effectively reflected in the framework; there are marked
differences between the structure and content of frameworks in high-income countries, and low- and middleincome
countries; champions can contribute to put HSPA high on the agenda; and mechanisms for eliciting change
in the health system should be developed alongside the framework.
Description
Keywords
Health systems, Performance assessment framework, Low-income countries, Uganda
Citation
Tashobya, C. K., da Silveira, V. C., Ssengooba, F., Nabyonga-Orem, J., Macq, J., & Criel, B. (2014). Health systems performance assessment in low-income countries: learning from international experiences. Globalization and Health, 10(1), 1-19.