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Reliability and Validity of an Innovative High Performing Healthcare System Assessment Tool

Kelly Saldaña, Abt Global; Answer Aqil, Credence Management Solution, LLC / Office of Health Systems, USAID; Naeem uddin Mian, Contech International; Mary Ndu, University of Western Ontario


March 31, 2023

New tool measures health systems performance and dimensions of universal health coverage (UHC).

UHC is an important but elusive global goal, in part because it is difficult to define and measure. A new article in BMC Health Services Research presents a framework for assessing High Performing Healthcare Systems (HPHC) to provide standards and clarity for measuring their functioning and improvements. Its authors include Abt Global’s Vice President of Resilience and System Strengthening Kelly Saldaña.

With reliable methods to track the multidimensional indicators comprising UHC, governments and agencies can target and incentivize more equitable, efficient and integrated health systems strengthening (HSS) efforts needed to accelerate health progress. The HPHC tool is designed to capture the complexity of health systems through low cost (and therefore repeatable) data to create the needed evidence linking HSS activities to health outcomes. Currently, the limited evidence on health systems interventions leads many to question the effectiveness of their investments—and complex and costly measurement tools slow evidence generation and thus, progress toward UHC and other global health goals.

The HPHC tool collects information about and provides real-time analysis on four criteria of better healthcare—accountability, affordability, accessibility, and reliability—as well as how the community, private sector, and other factors such as supply and demand affect the health system. In addition to evidence that the tool is reliable and valid, the authors discuss how the model can be used for monitoring and promoting adaptive management, policy, and program development for better health outcomes.

BMC Health Services Research is an open access, peer-reviewed journal focused on digital health, governance, health policy, health system quality and safety, healthcare delivery and access to healthcare, healthcare financing and economics, implementing reform, and the health workforce.

Contributing author Kelly Saldaña leads solutions to integrated, locally-driven program design across Abt Global’s global portfolio. She previously spent nearly 20 years at USAID, where she oversaw the agency’s health systems strengthening and capacity-building portfolio and the programming of its $6 billion COVID-19 response.

Latin America & the Caribbean
Middle East & North Africa
South & Central Asia
Sub-Saharan Africa