Conducting systematic evidence-based health system assessments is critical for designing and implementing health reforms. How well a health system performs is assessed by how well it achieves its end goals and intermediate outcomes. Health system assessments are different from the evaluation of interventions and programs because of the need to be more comprehensive than measuring health outcomes indicators like mortality and morbidity.
Our work stems from the “Control Knob” framework that was developed by Harvard faculty to study health systems (Getting Health Reform Right, Roberts et al., 2008). The performance of a health system is measured by how well it achieves three final goals (health status, citizen satisfaction, and financial risk protection) and three intermediate goals (access, efficiency, and quality of care). Assessments can also be more advanced in order to diagnose the underlying causes behind the performance of a health system, especially in relation to policy levers (financing, strategic purchasing and provider payment methods, organization of the delivery system and market dynamics, and regulation) and various inputs (health facilities, human resources, drugs, supplies, and infrastructure).
In 2021, we developed a series of interactive webinars to help Indian researchers and practitioners with the practical task of undertaking health system assessments and use evidence to eventually design health system reforms. By examining goals and intermediate outcomes, and the underlying causes of good/poor performance, researchers and reformers can support the diagnosis of health system problems and generate evidence-based solutions that improve health system performance.
We hope these resources are useful to health researchers, analysts, and policy makers in India and elsewhere who contribute to innovations in health system reforms. The evidence generated by health systems analyses, combined with careful reviews of international and Indian experiences, can inform the design and proposal of health system reform options, especially as India embarks on new reforms post-COVID-19.
Collaboration with the India Health Systems Collaborative and ACCESS Health India as well as financial support from the Bill and Melinda Gates Foundation are gratefully acknowledged.