Table 2 Attributes of HSPA frameworks from literature review and input by expert group

• Participation of various stakeholders to bring on board various perspectives, increase transparency, appreciation, and ownership

• Some categories of stakeholders indicated include public, communities, and funders

• Use of data to explain causal links

• Data use said to make framework more believable and more likely to be used for decision-making

• Embedded in an explicit health system with clarity of HS conceptual framework including determinants of health, goals, elements, and actors

• May require working with stakeholders to develop health system conceptual framework if not in place already

• Relating to general model of government

• Derivation of health system performance assessment attributes in this paper should be recognized as a specific perspective and not as generic

• Relating to organization of the health system, inter- and intra-linkages at different levels of the system

• Societal values and principles determine system goals and trade-offs

• Governance and empowerment influence relationship between values and explicit policies

• Health financing – levels & structure – sources, mechanisms as one of the issues to monitor

• Governance related to levels of literacy

• Includes conceptual framework, purpose, dimensions, sub-dimensions, and indicators

• Highlighting linkages and accountability relationships to facilitate attribution

• Dimensions and sub-dimensions should reflect linkages between different functions and elements of the system

• Indicators – may require some flexibility & dynamism to allow for learning and ownership

• Choice of indicators determined by perceived importance, scientific soundness, and feasibility

• With appropriate institutional set-up, with linkages to other entities, champions, & resources (infrastructural, financial, human) provision

• Information management system requirements should consider feasibility & costs versus benefits

• Regular and systematic application

• Should be usable at lower levels for self-assessment

• Linking measurement of performance with changes in policy & management

• Packaging of information should consider types and needs of users

• Making comparisons across time, different levels, systems, and settings

To consider negative/unintended effects of incentives including on data quality and increasing inequity

• Analysis and use of complementary information from various sources

• Incentives – financial accreditation recognition – name and shame

• History of use over time and in different places and contexts