Frameworks for health systems performance assessment: how comprehensive is Ghana’s holistic assessment tool?

Abstract

Background: Measuring the performance of a health system is an essential requirement in creating systems that generate efficient, equitable, patient-focused, accessible and sustainable results. A fundamental requirement for a performance measurement system is the development of an assessment framework within which specific performance measures could be defined and applied regularly. This paper examines the comprehensiveness of Ghana's health system assessment framework called the Holistic Assessment Tool in relation to some of the internationally recognized frameworks. The paper also analyzes trends in the performance of the health system to understand whether or not an improvement has been recorded following the adoption and implementation of the Holistic Assessment Tool. Methods: Mainly secondary data were used in this analysis. Searches were conducted on Google Scholar, PubMed, Scopus and Science Direct between May and July, 2019 for published documents on health system performance assessment. We also obtained unpublished documents from Ghana's Ministry of Health, Ghana Health Service website, and Ghana Statistical Service database. Descriptive statistics were used to examine trends in the performance of the Ghanaian health system. Results: While the tool provides a national framework for evaluating the performance of the Ghana Health system in several domains, the Holistic Assessment Tool does not cover key health system domains such as information systems for health, access to essential medicines, and patient-centeredness. Also, the scope of the assessment program seems limited to the evaluation of the Ministry of Health's annual plans, programs and projects. However, the health system has recorded improvements in population health indicators, such as life expectancy at birth, infant mortality, under-5 mortality, HIV prevalence and disease burden (in terms of disability adjusted life years). Conclusions: The Holistic Assessment Tool is a useful framework, but needs further refinement, both in scope and in conceptual robustness. Future studies should consider exploring factors influencing performance of the Ghanaian health system. Such information will help in strategizing for better and more improvements.

Towards universal health coverage in the WHO African Region: assessing health system functionality, incorporating lessons from COVID-19

“…3 This approach has been used to assess health systems, though this has largely been in high-income countries, [4][5][6][7] with fewer such initiatives in the developing world. [8][9][10][11] Additionally, the uptake and use of results from these assessments by decision makers and their impact on system development has been limited. 12 13 The building blocks conceptualisation however only tells part of the story of what a health system entails.…”

Framework for assessing the performance of the Ghanaian health system: study protocol

“…Many high-income countries have since institutionalized HSPA as an integral component of their respective health systems [ 6 , 12 , 13 ]. However, few studies on HSPA have been documented in LMICs [ 14 – 17 ]. Examples of these few studies in LMICs include an analysis of district-level HSPA within the context of decentralization in Indonesia [ 18 ]; an assessment of the effect of health system reforms between 2001 and 2006 in Mexico, using a report card approach [ 19 ]; an evaluation of the performance of the healthcare delivery system in 16 states of India, using an econometric approach [ 20 ]; and monitoring of the rapid expansion of health services in Afghanistan, using a balanced scorecard approach [ 21 ].…”

“…Despite the existence of the aforementioned assessment programmes, Ghana does not have a full-fledged HSPA tool that provides a holistic health sector-wide approach to assessing health system performance. For instance, our recent analysis revealed that the HAT is merely an assessment tool for monitoring and evaluating the MOH’s annual plans or POWs, as well as assessing progress towards the achievement of the country’s HSMTDPs [ 17 ]. According to WHO, a comprehensive HSPA is balanced in scope, and covers the whole health system and is not limited to specific programmes, objectives or levels of care.…”

Framework for Assessing the Performance of the Ghanaian Health System: Study Protocol

“…Many high-income countries (HICs) have institutionalized HSPA as an integral component of their respective health systems [6,10,11]. However, few studies on HSPA have been documented in LMICs [12][13][14][15]. Examples of these few studies in LMICs include an analysis of district level HSPA within the context of decentralization in Indonesia [16]; an assessment of the effect of health system reforms between 2001 and 2006 in Mexico, using a report card approach [17]; an evaluation of the performance of the healthcare delivery system in 16 states of India, using an econometric approach [18]; and monitoring of the rapid expansion of health services in Afghanistan, using a balanced scorecard approach [19].…”

“…In spite of the existence of the aforementioned assessment programs, Ghana does not have a full-edged HSPA tool that provides a holistic health sector-wide approach to assessing health system performance. For instance, our recent analysis revealed that the Holistic Assessment Tool, which is considered more comprehensive relative to the other assessment methods, does not measure key health system dimensions such as responsiveness of the health system and information systems for health [15]. Per the literature, a comprehensive HSPA encompasses measuring and analyzing how well a health system is meeting its overall goals (i.e.…”