title: Assessing health program performance in low- and middle-income countries: building a feasible, credible, and comprehensive framework.
abstract: BACKGROUND
  Many health service delivery models are adapting health services to meet rising demand and evolving health burdens in low- and middle-income countries. While innovative private sector models provide potential benefits to health care delivery, the evidence base on the characteristics and impact of such approaches is limited. We have developed a performance measurement framework that provides credible (relevant aspects of performance), feasible (available data), and comparable (across different organizations) metrics that can be obtained for private health services organizations that operate in resource-constrained settings.
  
  
  METHODS
  We synthesized existing frameworks to define credible measures. We then examined a purposive sample of 80 health organizations from the Center for Health Market Innovations (CHMI) database (healthmarketinnovations.org) to identify what the organizations reported about their programs (to determine feasibility of measurement) and what elements could be compared across the sample.
  
  
  RESULTS
  The resulting measurement framework includes fourteen subgroups within three categories of health status, health access, and operations/delivery.
  
  
  CONCLUSIONS
  The emphasis on credible, feasible, and comparable measures in the framework can assist funders, program managers, and researchers to support, manage, and evaluate the most promising strategies to improve access to effective health services. Although some of the criteria that the literature views as important - particularly population coverage, pro-poor targeting, and health outcomes - are less frequently reported, the overall comparison provides useful insights.
authors.affiliation: Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B1, Canada. onil.bhattacharyya@wchospital.ca.|Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada. onil.bhattacharyya@wchospital.ca.
authors.forename: Onil
authors.initials: O
authors.lastname: Bhattacharyya
authors.affiliation: Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B1, Canada. kate.mossman@rotman.utoronto.ca.|Rotman School of Management, University of Toronto, 105 St. George Street, Toronto, ON, M5S 3E6, Canada. kate.mossman@rotman.utoronto.ca.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Mossman
authors.affiliation: Toronto Health Organization Performance Evaluation (T-HOPE), University of Toronto, 105 St. George Street, Toronto, ON, M5S 3E6, Canada. john.ginther@gmail.com.
authors.forename: John
authors.initials: J
authors.lastname: Ginther
authors.affiliation: The Scarborough Hospital, 3030 Lawrence Avenue East, Suite 108, Toronto, ON, M1P 2V5, Canada. lhayden@tsh.to.
authors.forename: Leigh
authors.initials: L
authors.lastname: Hayden
authors.affiliation: Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B1, Canada. raman.sohal13@rotman.utoronto.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada. raman.sohal13@rotman.utoronto.ca.
authors.forename: Raman
authors.initials: R
authors.lastname: Sohal
authors.affiliation: Department of Surgery, University of British Columbia, 950 West 10th. Avenue, Vancouver, BC, V5Z 1 M9, Canada. jieun.r.c.cha@gmail.com.
authors.forename: Jieun
authors.initials: J
authors.lastname: Cha
authors.affiliation: Department of Anesthesia, University of Toronto, 123 Edward Street, Toronto, ON, M5G 1E2, Canada. ameya.bopardikar@mail.utoronto.ca.
authors.forename: Ameya
authors.initials: A
authors.lastname: Bopardikar
authors.affiliation: MIT Sloan School of Management, 30 Memorial Dr., Cambridge, MA, 02142, USA. johnangusmacdonald@gmail.com.
authors.forename: John A
authors.initials: JA
authors.lastname: MacDonald
authors.affiliation: Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B1, Canada. parikh.himanshu@gmail.com.
authors.forename: Himanshu
authors.initials: H
authors.lastname: Parikh
authors.affiliation: Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B1, Canada. ilan.shahin@gmail.com.
authors.forename: Ilan
authors.initials: I
authors.lastname: Shahin
authors.affiliation: Rotman School of Management, University of Toronto, 105 St. George Street, Toronto, ON, M5S 3E6, Canada. anita.mcgahan@rotman.utoronto.ca.
authors.forename: Anita
authors.initials: A
authors.lastname: McGahan
authors.affiliation: Rotman School of Management, University of Toronto, 105 St. George Street, Toronto, ON, M5S 3E6, Canada. william.mitchell@rotman.utoronto.ca.
authors.forename: Will
authors.initials: W
authors.lastname: Mitchell
mesh_terms: D003906:Developing Countries; D006297:Health Services Accessibility; D006801:Humans; D007182:Income; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D017149:Private Sector / Q000639:trends*; D016730:Program Development / Q000379:methods*