Assessing health system performance in developing countries: a review of the literature

Health Policy. 2008 Mar;85(3):263-76. doi: 10.1016/j.healthpol.2007.09.003. Epub 2007 Oct 10.


With the setting of ambitious international health goals and an influx of additional development assistance for health, there is growing interest in assessing the performance of health systems in developing countries. This paper proposes a framework for the assessment of health system performance and reviews the literature on indicators currently in use to measure performance using online medical and public health databases. This was complemented by a review of relevant books and reports in the grey literature. The indicators were organized into three categories: effectiveness, equity, and efficiency. Measures of health system effectiveness were improvement in health status, access to and quality of care and, increasingly, patient satisfaction. Measures of equity included access and quality of care for disadvantaged groups together with fair financing, risk protection and accountability. Measures of efficiency were appropriate levels of funding, the cost-effectiveness of interventions, and effective administration. This framework and review of indicators may be helpful to health policy makers interested in assessing the effects of different policies, expenditures, and organizational structures on health outputs and outcomes in developing countries.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Delivery of Health Care* / economics
  • Delivery of Health Care* / statistics & numerical data
  • Developing Countries*
  • Health Services Accessibility / statistics & numerical data
  • Health Status
  • Humans
  • Outcome and Process Assessment, Health Care
  • Patient Satisfaction