Developping an appropriate Health Systems Performance Assessment framework in Low Income Countries: the example of sub national assessment in Uganda.

Low income countries (LICs) are trying to improve the health of their populations. In Uganda, efforts have been made to track health system performance at various levels – national, district and provider. However, current tools often leave more questions than answers. Although the country has articulated some health goals and targets, it is often not clear what the basis is for this determination. Moreover, when such targets are not achieved it is difficult to tell why not and what would need to be done to ensure that they are in the future. This is true at the national, district and provider levels. For example: if a certain district is not performing as well as may have been expected on the basis of the inputs availed, what are the likely reasons, and what can policymakers/ managers do to change this situation? How can we answer such questions? What kind of tool can help the government carry out its stewardship role? There is growing appreciation, globally, for the need for explicit health systems performance assessment (HSPA). Documented efforts of performance measurement in health go back to the middle of the eighteen century (McIntyre et al 2001). Performance assessment in the health sector is complex because of a number of peculiarities such as: the various determinants (including socio-economic) of health, some not directly under the control of the health system; health is considered a public good with a social responsibility dimension; there is a multiplicity of stakeholders in health, including professional groups, with different perspectives of health systems performance, its meaning and measurement (Arah and Westert 2005; Loeb 2004, WHO 2003). Some efforts have been made in developing performance assessment frameworks that take into consideration some of these characteristics including the conceptual approach of Sicotte et al, and the work by the World Health Organisation (WHO) (Murray & Frenk 2000; Sicotte et al 1998; WHO 2000; 2003). These frameworks have been developed largely in the contexts of developed countries and a number of questions arise when they are applied to LICs (Kruk and Friedman, 2008). It is desirable to have appropriate tools to track health systems performance and support evidence-based decision-making in LICs like Uganda.

Trefwoorden:B680-volksgezondheid