Result chain | Service delivery | Human resources | Governance | Health financing |
---|---|---|---|---|
Inputs | Development of quality assurance/improvement tools (like treatment protocols, scorecards) | Changes to working conditions for staff and staff remuneration | Development of governance capacity & systems – e.g. separation of functions | Volume of funds, relative to other sources (globally, and at facility level); and their predictability and variability over time |
Changes to the availability of necessary infrastructure, medicines and supplies | Any change to central level HRH policies and allocation | Investments in improving information and M&E systems | Costs of related investments | |
Changes to training (e.g. on good prescribing and evidence-based treatment protocols) | Changes to participation of external stakeholders – especially those representing demand-side | Effect on other financing sources, as relevant. Changes to funds reaching front-line providers | ||
Processes | Changes to organization of services -Effects on quality and convenience for users (“acceptability”). Effects on availability of services, including support services, like diagnostics, lab tests | Changes to availability, retention and distribution of staff (of different types). Change to staff motivation, job satisfaction, teamwork and working patterns, and skills sets | Changes in performance management systems at all levels. Changes to accountability, autonomy, organizational culture and contractual obligations of main actors. Development of leadership skills, at different levels | Allocation of funds (across services, facility types and areas) & link to local needs. Changes to transactions costs (including costs of new governance arrangements, monitoring etc.). How funds are used and any knock-on financial effects (e.g. changes to charges for users) |
Outputs | Changes to utilization of services (targeted and untargeted). Changes to coverage – absolute and for different socioeconomic groups. Changes to quality of care (cure rates, readmission, detection etc.). Changes to range and type of services (appropriate to local needs or not) | Changes to staff behavior (working hours, absenteeism, dual practice, informal charging etc.). Evidence of changes to responsiveness and quality of care provided by staff | Changes to health data: regularity, reliability, comprehensiveness. Greater (or less) voice for stakeholders, especially patients. Strategic purchasing practiced. Centralisation/decentralization of functions within sector; changed power relationships within system | Changes to technical & allocative efficiency of services. Sustainability of funding mechanisms & their synergies over time. Changes to affordability for users & financial protection – overall and disaggregated |
Health system goals | Better health; greater equity in health; financial protection; responsiveness of health system |