title: Health systems performance assessment in low-income countries: learning from international experiences.
abstract: BACKGROUND
  The study aimed at developing a set of attributes for a 'good' health system performance assessment (HSPA) framework from literature and experiences in different contexts and using the attributes for a structured approach to lesson learning for low-income countries (LICs).
  
  
  METHODS
  Literature review to identify relevant attributes for a HSPA framework; attribute validation for LICs in general, and for Uganda in particular, via a high-level Ugandan expert group; and, finally, review of a selection of existing HSPA frameworks using these attributes.
  
  
  RESULTS
  Literature review yielded six key attributes for a HSPA framework: an inclusive development process; its embedding in the health system's conceptual model; its relation to the prevailing policy and organizational set-up and societal context; the presence of a concrete purpose, constitutive dimensions and indicators; an adequate institutional set-up; and, its capacity to provide mechanisms for eliciting change in the health system. The expert group contextualized these attributes and added one on the adaptability of the framework.Lessons learnt from the review of a selection of HSPA frameworks using the attributes include: it is possible and beneficial to involve a range of stakeholders during the process of development of a framework; it is important to make HSPA frameworks explicit; policy context can be effectively reflected in the framework; there are marked differences between the structure and content of frameworks in high-income countries, and low- and middle-income countries; champions can contribute to put HSPA high on the agenda; and mechanisms for eliciting change in the health system should be developed alongside the framework.
  
  
  CONCLUSIONS
  It is possible for LICs to learn from literature and the experience of HSPA in other contexts, including HICs. In this study a structured approach to lesson learning included the development of a list of attributes for a 'good' HSPA framework. The attributes thus derived can be utilized by LICs like Uganda seeking to develop/adjust their HSPA frameworks as guidelines or a check list, while taking due consideration of the specific context. The review of frameworks from varied contexts, highlighted varied experiences which provide lessons for LICs.
authors: Institute of Tropical Medicine Antwerp, Nationalestraat 155, Antwerp, B 2000, Belgium. cktashobya@gmail.com.
authors: Christine Kirunga
authors: CK
authors: Tashobya
authors: Valéria Campos
authors: VC
authors: da Silveira
authors: Freddie
authors: F
authors: Ssengooba
authors: Juliet
authors: J
authors: Nabyonga-Orem
authors: Jean
authors: J
authors: Macq
authors: Bart
authors: B
authors: Criel
mesh_terms: D003695:Delivery of Health Care; D003906:Developing Countries; D006801:Humans; D038622:Internationality; D011203:Poverty; D011785:Quality Assurance, Health Care / Q000379:methods*; D014454:Uganda