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Table 1 T-HOPE framework: performance dimensions

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

Performance dimension

Example indicators

Examples from CHMI profiles: healthmarketinnovations.org

A. Health Status

A1. Population Coverage: Volume of clients served as a percentage of a defined target population per reporting period.

• Percentage of the target population using program services or products per reporting period.

Bangladesh Urban Primary Health Care Project (Bangladesh): Between 1998 and 2011, the primary care program had covered 82.6 % (approximately 7.78 million) of the target population in Bangladesh.

A2. Health Output: Quantitative evidence about the number of health services/products provided and/or clients served/trained per reporting period.

• Number of clients served per reporting period.

• Number of products provided per reporting period.

World Health Partners (WHP) (India, Kenya): 25,836 patient visits conducted by WHP providers between January 1, 2013 and December 31, 2013.

A3. Health Outcome: Quantitative evidence of impact on intermediate or long-term health outcomes demonstrated by changes in learning, actions, and/or health status of clients/target population per reporting period.

• Change in mortality rate in target population per reporting period.

• Change in disease incidence in target population per reporting period.

• Change in uptake of healthy behaviours in target population per reporting period.

Deepak Foundation Gujarat (India): Initiated in 2005 to save lives and promote institutional deliveries, the Foundation’s Safe Motherhood and Child Survival Project observed a 38.7 % decline in maternal mortality from 430 cases per 100,000 live births in 2005 to 263 in 2011.

B. Health Access

B1. Affordability: Quantitative evidence about the price of services and products compared to the average price of similar services and products in the local context, or as a proportion of income at a given time period.

• Price of service/product compared to price of the same service of a local competitor at a given period.

• Price of product/service as a proportion of average household income at a given period.

• Product/service provided for free.

PROSALUD (Bolivia): Charges approximately US$4 for an appointment with a general practitioner, compared to US$28 in the private sector.

B2. Availability: Quantitative evidence about the ability of clients/patients to access health services at the needed place and time per reporting period.

• Number of providers, facilities or hospital beds per target population per reporting period.

• Average geographic distance or time needed for the target population to reach the facility.

• Percentage of health care workers absent from the facility per reporting period.

• Change in stockouts of medications or supplies per reporting period.

• Hours of facility operation per reporting period.

Hygeia Community Health Plan (Nigeria): Hygeia has achieved a 95 % reduction in stock outs of anti-malarials and other essential drugs among its network of providers between January 2007 and December 2010.

B3. Pro-Poor Targeting: Proportion of clients that are economically disadvantaged and criteria used to identify and target the poor; includes whether the program is targeting a poor area or targeting the most disadvantaged group within a population.

• Percentage of a program’s clients that are in the bottom 20 % income quintile.

• Percentage of a program’s clients living on less that US$2 per day.

• Percentage of a program’s clients that live in a predominantly poor area.

HealthyBaby/HealthyLife Vouchers (Uganda): A 2010-2011 survey found that 29.3 % of women using the HealthyBaby voucher were in the poorest quintile of the household wealth index.

C. Operations/Delivery

C1. Clinical Quality: Quantitative evidence of providing safe, evidence-based care, which can include comparison to other providers of similar services, and/or demonstrating change over time.

• Medical error rate per time period.

• Surgical complication rate compared to providers of similar services.

• Percentage of cases meeting predetermined quality standards.

• Percentage of patients receiving appropriate care according to approved guidelines.

• Readmission rate per time period.

Aravind Eye Care System (India): Aravind has managed to keep its infection rates low, with an average of about 4 cases per 10,000 patients, compared to an average of 6 per 10,000 in the U.K.

C2. User Satisfaction: Quantitative or qualitative evidence that is collected using a systematic methodology and reflects the clients’ perceptions of the quality of services provided.

• Client renewal rates.

• Client retention rates.

• Percentage of patients satisfied with services based on patient survey.

• Percentage of patients that would recommend the program to others.

Red Segura Nicaragua (Nicaragua): In a customer satisfaction survey conducted in 2011, the average score women of reproductive age gave to the medical attention they received at Red Segura clinics was 4.8 on a scale of 1 to 5, with 5 being the highest quality of care.

C3. Management Quality: The procedures, systems, and processes the program has implemented to strengthen quality in key aspects of operations and delivery.

• Description of implementing a monitoring and evaluation system.

• Description of establishing a Board of Governors to provide guidance and oversight.

• Description of internal audit conducted on a regular basis.

• Description of accreditation or certification by a reputable organization.

• Description of receiving international awards for excellence and/or achievement.

Mahila Swahsta Sewa (Nepal): Quality assurance mechanisms include: 1) Quality assurance visits focused on the service delivery of intrauterine devices (IUDs) using the Lot Quality Assurance Sampling Method; 2) Development and use of quality monitoring checklists; 3) Quality action plans to address issues.

C4. Economic Efficiency: Quantitative evidence about the cost of delivering the product/service to patients/clients.

• Unit cost of providing a service/product for a single client/patient.

• Average total cost to provide services/products to clients/patients.

Operation ASHA (Cambodia, India): Operation ASHA has developed a model in which the cost of providing complete TB treatment to a patient is US$80, as compared with the cost of US$300 among other not-for-profit organizations.

C5. Non-Economic Efficiency: Quantitative evidence about how long it takes for a program to deliver a product/service compared to a previous reporting period or providers of similar services.

• Patient or procedure volume per time period compared to a previous reporting period.

• Patient or procedure volume per time period compared to providers of similar products/services.

RapidSMS Malawi (Malawi): The RapidSMS mHealth data collection system results in a significant reduction in data transmission delay. While Malawi’s current paper-based system takes 1–3 months to transmit child nutrition data, the RapidSMS system takes only 2 minutes.

C6. Human Resources Supply: Description of the program’s human resources supply and strategy to recruit, retain, and train staff.

• Description of initiatives that seek to promote recruitment or retention of staff.

• Description of staff training programs.

• Turnover or retention rate per reporting period.

• Description of staff satisfaction and/or factors contributing or detracting from recruitment and retention.

Living Goods (Kenya, Uganda): Community health promoters are trained to provide basic health counselling on a variety of topics to their communities and make a modest living by selling health products. All health promoters are trained to give basic public health counselling on the use of products and to facilitate referrals to acutely ill patients. Field agents meet community health promoters at least once a month to resupply, collect payments, communicate current promotions, and provide ongoing health education and business coaching.

C7. Political Support: Qualitative evidence of a relationship or partnership with a local, regional, or national government entity.

• Description of financial or technical support from a local, regional, or national government entity.

• Description of authorization of activities by a government entity.

• Description of successful advocacy resulting in policy change.

• Description of providing training for government officials.

Chiranjeevi Yojana (India): This program aims to reduce maternal and infant mortality through government contracts with private providers. Qualified providers sign a memorandum of understanding with the district government and are financially compensated for deliveries provided to eligible patients.

C8. Financial Management: Financial data related to the program’s balance sheet, income statement, cash flows, and ratios, concepts and calculations.

• Value of total assets at the end of the reporting period.

• Net income resulting from all business activities during the reporting period.

• The net cash flow of the organization during the reporting period, which is calculated by subtracting outflows from inflows of cash and cash equivalents.

• Value of equity and/or other financial contributions in the organization provided by the entrepreneur(s) at the time of investment.

Naya Jeevan (Pakistan): The operational revenue of this microinsurance program in Pakistan increased by 350 % between 2010 and 2011; earned income increased from US$2850 in 2010 to US$10,500 in 2011.