Developing an Index to Measure Health System Performance: Measurement for Districts of Nepal
DOI:
https://doi.org/10.31729/jnma.2764Keywords:
health system performance; health system performance index; human development index; socioeconomic index; infrastructure index.Abstract
Various frameworks for measuring health system performance have been proposed and discussed. The scope of using performance indicators are broad, ranging from examining national health system to individual patients at various levels of health system. Development of innovative and easy index is essential to measure multidimensionality of health systems.
We used indicators, which also serve as proxy to the set of activities, whose primary goal is to maintain and improve health. We used eleven indicators of MDGs, which represent all dimensions of health to develop index. These indicators are computed with similar methodology that of human development index. We used published data of Nepal for computation of the index for districts of Nepal as an illustration. To validate our finding, we compared the indices of these districts with other development indices of Nepal.
An index for each district has been computed from eleven indicators. Then indices are compared with that of human development index, socio-economic and infrastructure development indices and findings has shown the similarity on distribution of districts. Categories of low and high performing districts on health system performance are also having low and high human development, socioeconomic, and infrastructure indices respectively.
This methodology of computing index from various indicators could assist policy makers and program managers to prioritize activities based on their performance. Validation of the findings with that of other development indicators show that this can be one of the tools, which can assist on assessing health system performance for policy makers, program managers and others.
Keywords: health system performance; health system performance index; human development index; socioeconomic
index; infrastructure index.
References
assessment: debates, methods and empiricism. Geneva:
WHO; 2003.
2. World Health Organization. Health Systems Performance:
a comprehensive resource from WHO. [Online]. 2003 [cited
2011 Jul 16]. Available from: URL: http://www.who.int/
health-systems-performance/concepts.htm
3. Preston SH. Mortality and development revisited. Popul Bull
UN. 1985;(18):34-40.
4. The World Bank. World development report 1993: investing
in health. New York; Oxford University Press for The World
Bank; 1993.
5. Murra Murray CJ, Frenk J. A framework for assessing the
performance of health systems. Bull World Health Organ.
2000;78(6):717–31.
6. Ibrahim JE. Performance indicators from all perspectives. Int
J Qual Health Care. 2001 Dec;13(6):431-2.
7. World Health Organization. The world health report 2000:
health systems: improving performance. Geneva: WHO;
2000.
8. Beaglehole R, Bonita R. Global public health: a scoreboard.
The Lancet. 2008 Dec 6;372(9654):1988-96.
9. Hurst J, Jee-Hughes M. Performance measurement and
performance management in OECD health system. OECD
Labour Market and Social Policy Occasional Papers. 2001 Jan
29;47:69.
10. Smith PC. Developing composite indicators for assessing
health systems efficiency. In: OECD. Measuring up:
improving health system performance in OECD countries.
France: OECD Publishing; 2002. p. 295-316.
11. Jee M, Or Z. Health outcomes in OECD countries a framework
of health indicators for outcome-oriented policymaking.
OECD Labour Market and Social Policy Occasional Papers.
1999 Jan 21;36:86.
12. Meyer G. Quality measurement initiatives in the US Federal
Government. Presentation at the Commonwealth Fund:
March 1999
13. Aday LA, Begley CE, Lairson DR, Balkrishnan R. Evaluating
the healthcare system: effectiveness, efficiency, and equity.
Ann Arbor (MI): Health Administration Press; 1993.
Knowles JC, Leighton C, Stinson W. Measuring results of
health sector reform for system performance: a handbook
of indicators. Special Initiatives Report Number 1. Bethesda
(MD): Partnerships for Health Reform, Abt Associates; 1997.
15. Hurst J. An assessment of health system performance across
OECD countries. Paris: OECD, Health Policy Unit; 2000.
16. Pan American Health Organization. Guidelines for the
preparation of the health services system profile in the
countries of the region. Washington DC: PAHO; 1999.
17. Hoffmeyer UK, McCarthy TR. Financing Health Care.
Netherlands: Kluwer Academic Publishing; 1994.
18. Dunlop D, Martin JM. An international assessment of health
care financing. Economic development institute seminar
series. Washington DC: World Bank; 1995.
19. United Nations Development Programme. Human
development report 2010. Technical Notes. UNDP. 2010;
215:225.
20. United Nations Development Group. Indicators for
monitoring the millennium development goals: definitions,
rationale, concepts and sources. New York: UN; 2003.
21. World Health Organization. World health statistics 2011.
Indicator compendium. Geneva: WHO; 2011.
22. International Planned Parenthood Federation. Glossary:
IPPF. [Online]. 2009 [cited 2011 Sep 11]. Available from: URL:
http://www.ippfwhr.org/en/en/resources/glossary#C
23. David LP, Asra A, Castro MD. Poverty incidence in the asian
and pacific region: data situation and measurement issues.
Manila: Economics and Development Resource Center,
Asian Development Bank; 1999.
24. World Health Organization. The world health report 1999:
health systems: improving performance. Geneva: WHO;
1999.
25. Department of Health Services, Ministry of Health and
population, government of Nepal. Annual report 2006-07.
Nepal: DoHS; 2008.
26. Central Bureau of Statistics, Government of Nepal, United
Nations World Food Programme, Nepal, The World
Bank. Small area estimation of poverty, caloric intake and
malnutrition in Nepal. Kathmandu: CBS, WFP, WB; 2006.
27. National management information section, Department
of water supply and sewerage. annual report 2008. Nepal:
DoWS; 2008.
28. Intensive study and research center. District and VDC
profile of Nepal-2010: A socio-economic database of Nepal.
Kathmandu: ISRC; 2010.
29. Evans DB, Tandon A, Murray CJ, Lauer JA. Comparative
efficiency of national health systems: cross national
econometric analysis. BMJ. 2001 Aug 11;323(7308):307-10.
30. Giuffrida A, Gravelle H, Roland M. Measuring quality
of care with routine data: avoiding confusion between
performance indicators and health outcomes. BMJ. 1999 Jul
10;319(7202):94-8.
31. Mant J. Process versus outcome indicators in the assessment
of quality of health care. Int J Qual Health Care. 2001
Dec;13(6):475-80.
32. Zaslavsky AM. Statistical issues in reporting quality data:
small samples and casemix variation. Int J Qual Health Care.
2001 Dec;13(6):481-8.
33. United Nations Development Programme. Nepal human
development report 2004. Kathmandu: UNDP Nepal; 2004.
p. 27.
34. Central Bureau of Statistics. Districts of Nepal. Indicators of
development: update 2003. Kathmandu: CBS; 2003.
35. Almeida C, Braveman P, Gold MR, Szwarcwald CL,
Ribeiro JM, Miglionico A, et al. Methodological concerns
and recommendations on policy consequences of the World
Health Report 2000. Lancet. 2001 May 26;357(9269):1692-7.
36. Nolte E, McKee M. Measuring the health of nations: analysis
of mortality amenable to health care. BMJ. 2003 Nov
15;327(7424):1129.
37. Richardson J, Robertson IK, Wildman J. A critique of the
World Health Organization’s evaluation of health system
performance. Health Economics. 2003;12(5):355-66.
38. Magnussen L, Ehiri J, Jolly P. Comprehensive versus selective
primary health care: lessons for global health policy. Health
Aff (Millwood). 2004 May-Jun;23(3):167-76.
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