Measurement of health system performance at district level: A study protocol

Area of Science:

• Health Services Research
• Public Health Policy
• Health Systems Strengthening

Background:

• District-level health system performance assessment is underdeveloped in low and middle-income countries.
• Lack of standardized tools and summary measures hinders comprehensive evaluation.
• This study addresses the need for a district-level health system performance index.

Purpose of the Study:

• To develop a summary composite health system performance index at the district level.
• To provide a standardized measure for assessing overall health system performance.
• To identify policy and implementation areas for improvement in public health.

Main Methods:

• Utilized a building block framework with 6 domains, 20 sub-domains, and 98 indicators (70 input/process, 28 output/outcome).
• Collected primary and secondary data from 378 health facilities and directorates in Haryana, India.
• Normalized and aggregated indicators to generate a composite performance index and domain-specific scores, with sensitivity analysis for robustness.

Main Results:

• Developed a novel methodology for comprehensive assessment of all health system domains using input, process, output, and outcome indicators.
• The composite index and domain-specific scores offer a standardized approach to performance measurement.
• The methodology has not been previously reported in India.

Conclusions:

• The developed composite index offers a valuable tool for assessing district-level health system performance.
• This index can guide policy decisions and identify areas for targeted interventions.
• Understanding relationships between health system components can lead to more effective public health strategies.