Dimensions of Health System Performance Assessment: A Scoping Review

Khadije  Safizade; Hossein  Dargahi; Alimohammad  Mosadeghrad; Ebrahim Jafari  Pooyan

doi:10.18502/ijph.v54i11.20387

Khadije Safizade Department of health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Hossein Dargahi Department of health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Alimohammad Mosadeghrad Department of health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Ebrahim Jafari Pooyan Department of health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/ijph.v54i11.20387

Keywords: Health system assessment; Health; Performance management; Monitoring and evaluation

Abstract

Background: Performance assessment is a key approach to understanding how functions and processes are operating. The first essential step in this process is to determine what aspects should be covered in the assessment. We aimed to identify the dimensions of health system performance assessment in Iran.

Methods: A scoping review was conducted in this study from 2000 to 2024. It was carried out in both Persian and English databases. A total of 17 frameworks or models were identified. Their dimensions, components, and interrelationships were extracted and synthesized. Subsequently, a new framework was developed using the framework analysis approach.

Results: We identified 6 main dimensions and 28 sub-dimensions for health system performance assessment, adopted as a logic model comprising inputs, output, and outcomes. The major dimensions include: Governance and Leadership-vision, policy and planning, communication, monitoring and evaluation; infrastructure, knowledge; standards of care and service of delivery.

Conclusion: Despite the overlap of some of the main dimensions of the frameworks, the consolidated framework has differences from the previous ones, which emphasizes the assessment of qualitative feedback based on their experiences. Therefore, this integrated framework offers a comprehensive structure that is particularly suitable for evaluating the performance of Iran’s health system, taking into account its specific environmental context.