Today, health care is at a high level of dynamism. To survive in such conditions, performance assessment can play an effective role in providing quality health care. To develop and compete, health system units need a productivity assessment system to measure their programs and processes' efficiency and effectiveness.The purpose of this study is to measure the productivity changes of health system units using the Malmquist index. Productivity assessment of health system units provides the necessary information for managers to monitor these centers' current situation and activities. The present study's statistical population includes 28 units of the world health system with a minimum of 42 days of exposure to COVID-19. In this study, the performance of health system units has been measured based on 4 indicesthat include "Day of Infection, Total Cases" as inputs and "Total Deaths, Total Recovered" as outputsthat are from the "Worldometer" database.The present descriptive study was conducted in three 14-day COVID-19 incubation periods after the countries were exposed. The results showed that the mean of the productivity changes of the health system units did not have a steady growth trend so that the average changes of the total productivity of the health system units from the first to second incubation period was 0.92 and from the second to third incubation period was 1.58, which is an indication of the unstable growth in the productivity of the studied health system units.
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