Table 1 Attributes of a normative HSPA Framework

Process of development (and review) of the framework should be inclusive, with the participation of key stakeholders, and involve the explicit use of evidence to indicate causal links.

Embedded in an explicit health system conceptual model, including the determinants of health, system goals, constitutive elements, and actors.

Relate to the national policy, organizational set-up and societal context including consideration of the level of development, epidemiological and demographic patterns, mode of government, levels and sources of health financing, governance, principles and values of society.

Well developed with a conceptual model, a clear purpose, dimensions and sub-dimensions, and with appropriate indicators .

Supported by an institutional set-up for performance assessment with appropriate resources and networks, including champions for performance assessment and an enabling environment.

Explicitly provide mechanisms for eliciting change in the health system – indicating how the measurement of performance is linked to changes in policy, management, and delivery of services by various levels and players in the health system.

Adaptable to different contexts- with history of use and or adaptation in different contexts, the length of time it has been in use and changes made to improve or adjust the framework in view of major reforms in the health system or elsewhere.

Source: Tashobya et al. , 2014