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Table 4 Lessons and identified gaps from review of selected HSPA frameworks

From: Health systems performance assessment in low-income countries: learning from international experiences

Attribute

Lesson

Identified gaps/Areas for further research

Process of development

• It is possible and useful to involve a range of stakeholders in the development and review of HSPA framework as done in Canada, and involvement of researchers as in the Netherlands

• Limited involvement of beneficiaries of health systems

• A private entity can act as lead agency as seen in South Africa

Clarity of HS conceptual model

• Explicit HS conceptual models facilitate relating the HSPA framework to the HS model, e.g., the WHO HS model was developed just prior to developing the HSPA framework

• In the absence of explicit HS models, it is difficult to determine system goals and whether the right things are being measured

• Explicit HS model coupled with clarity in partitioning the HS for PA highlights linkages and enables attribution – the Netherlands framework provides an example with the Lalonde HS model and the Balanced Score Card for the HSPA framework

• Lack of delineation between HS and healthcare systems provides challenges for HSPA

• Contribution of healthcare to health often difficult to estimate, and responsibility for delivery and reporting on non-healthcare determinants is challenging

Relating to policy and organizational context

• Variations in context are reflected in the HSPA frameworks; 2 diverse examples provide different lessons for countries intending to develop HSPA frameworks:

• The effect of governance and various aspects of empowerment on HSPA and their relationship to literacy are not well documented

○ Canada – very contextualized

○WHO – intended to support HSPA in member countries and thus fashioned generically

Elaboration

• Similarities noted between HICs and differences between HICs and L/MICs at the level of dimensions and lower level indicators, with HICs emphasizing service and provider-specific indicators & L/MICs emphasizing population-based indicators

• There are still challenges in relating the different pieces of data in most frameworks to tell a story, to determine what is not working well

Institutional set-up

• Canada and WHO made substantial investment in HSPA including methodological aspects and technology for data collection, analysis, and dissemination, which has yielded results

• What is the right balance – how much do you invest in LICs given competing obligations?

• Ghana & South Africa demonstrate that you can start simple & build useful systems for HSPA

• Champions for HSPA have been noted to have made an impact in Australia and Canada (ministers of health) and the Netherlands (researchers)

Mechanism for eliciting change in the HS

• Working with various pieces of information from different sources validates, enriches, and supports interpretation for decision-making

• There is still limited information on what works in terms of eliciting change in the HS using HSPA, and more research needs to be done in specific contexts to learn more about this

• Use of appropriate technology and strategies for analysis and dissemination helps provide information to more people, as seen in Canada

• There is not much noted in these experiences about unintended/negative consequences of HSPA

• Combination of mechanisms (internal & external) facilitates change, as seen in Canada

• Combinations of stakeholder groups and skills (e.g., statisticians/researchers/policy makers/health managers/generic managers/professional bodies) facilitate decision-making – different combinations noted in Australia, Canada, Netherlands

Adaptability

• HICs adapt HSPA frameworks from other HICs; LICs from international agencies

Given the contextual differences and their implications for HSPA, case studies of HSPA frameworks are likely to provide further understanding of what works (or does not) and why

 

• The frameworks that have been in place for longer have evolved/changed with circumstances to remain relevant