Assessing health program performance in low- and middle-income countries: building a feasible, credible, and comprehensive framework.

Published online

Journal Article

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 ( 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.

Full Text

Duke Authors

Cited Authors

  • Bhattacharyya, O; Mossman, K; Ginther, J; Hayden, L; Sohal, R; Cha, J; Bopardikar, A; MacDonald, JA; Parikh, H; Shahin, I; McGahan, A; Mitchell, W

Published Date

  • December 21, 2015

Published In

Volume / Issue

  • 11 /

Start / End Page

  • 51 -

PubMed ID

  • 26690660

Pubmed Central ID

  • 26690660

Electronic International Standard Serial Number (EISSN)

  • 1744-8603

Digital Object Identifier (DOI)

  • 10.1186/s12992-015-0137-5


  • eng

Conference Location

  • England