Public Health Assessment Framework - South Asian Health Systems

How to Use This Assessment Framework

Scope Definition: Identify geographic area, population, and health priorities
Data Collection: Gather quantitative data and conduct stakeholder interviews
Building Block Analysis: Rate each health system component (1-5 scale)
Equity Assessment: Analyze disparities across population groups
Gap Identification: Identify priority areas for intervention
Action Planning: Develop targeted improvement strategies

Time Required: 2-4 weeks for comprehensive assessment | Team: 3-5 people with diverse expertise

1. Health System Building Blocks Assessment

Rating Scale (1-5)

1 - Critical
Major gaps, system failure

2 - Poor
Significant deficiencies

3 - Adequate
Basic functions, room for improvement

4 - Good
Well-functioning, minor gaps

5 - Excellent
Optimal performance, best practice

Service Delivery

Geographic Access

• Distance to nearest health facility
• Transportation availability
• Coverage of remote areas

Your Rating: ___/5

Service Availability

• Facility operating hours
• Essential services offered
• Emergency care capacity

Your Rating: ___/5

Quality of Care

• Clinical protocols followed
• Patient satisfaction scores
• Health outcomes achieved

Your Rating: ___/5

‍ Health Workforce

Workforce Density

• Doctors per 1,000 population
• Nurses per 1,000 population
• CHW coverage ratio

Your Rating: ___/5

Distribution & Retention

• Rural vs urban distribution
• Vacancy rates in facilities
• Staff turnover rates

Your Rating: ___/5

Competency & Performance

• Training and certification
• Supervision quality
• Performance incentives

Your Rating: ___/5

Health Information Systems

Data Collection

• Routine data systems (HMIS)
• Disease surveillance
• Vital registration coverage

Your Rating: ___/5

Data Quality & Use

• Completeness and accuracy
• Timeliness of reporting
• Evidence-based decision making

Your Rating: ___/5

Digital Health

• Electronic health records
• Telemedicine platforms
• Mobile health applications

Your Rating: ___/5

Medical Products & Technologies

Essential Medicines

• Availability of essential drugs
• Quality assurance systems
• Rational use practices

Your Rating: ___/5

Medical Equipment

• Equipment availability
• Maintenance systems
• Technology appropriateness

Your Rating: ___/5

Supply Chain

• Procurement efficiency
• Distribution networks
• Stock management

Your Rating: ___/5

Health Financing

Financial Protection

• Health insurance coverage
• Out-of-pocket expenditure
• Catastrophic health spending

Your Rating: ___/5

Resource Mobilization

• Government health spending
• Revenue diversification
• Aid effectiveness

Your Rating: ___/5

Resource Allocation

• Budget execution efficiency
• Priority setting processes
• Cost-effectiveness focus

Your Rating: ___/5

Leadership & Governance

Policy & Strategy

• Health policy framework
• Strategic planning process
• Intersectoral coordination

Your Rating: ___/5

Regulation & Oversight

• Regulatory framework
• Quality assurance
• Provider licensing

Your Rating: ___/5

Accountability

• Transparency mechanisms
• Community participation
• Performance monitoring

Your Rating: ___/5

2. Health Outcomes & Performance Indicators

Indicator Category	Key Metrics	Current Value	National Average	Target/Benchmark	Performance Gap
Maternal Health	Maternal Mortality Rate (per 100,000) Institutional delivery rate (%) Skilled birth attendance (%)	____ ____ ____	103 89% 88%	<70 >95% >95%	____ ____ ____
Child Health	Under-5 mortality rate (per 1,000) Full immunization coverage (%) Stunting prevalence (%)	____ ____ ____	35 76% 36%	<25 >90% <20%	____ ____ ____
Communicable Diseases	TB incidence (per 100,000) Malaria cases (per 1,000) HIV prevalence (%)	____ ____ ____	199 0.7 0.22%	<100 <0.1 <0.1%	____ ____ ____
Non-Communicable Diseases	Diabetes prevalence (%) Hypertension prevalence (%) Cancer incidence (per 100,000)	____ ____ ____	8.9% 28% 100	<7% <25% Stable	____ ____ ____
Environmental Health	Access to improved water (%) Access to improved sanitation (%) Household air pollution exposure (%)	____ ____ ____	93% 70% 61%	>98% >95% <20%	____ ____ ____

3. Health Equity Analysis

Disaggregated Health Outcomes Analysis

Analyze health indicators across different population groups to identify inequities:

Population Group	Child Mortality Rate	Institutional Delivery	Full Immunization	Stunting Rate	Equity Ratio*
Wealth Quintile
• Poorest 20%	____	____	____	____	____
• Richest 20%	____	____	____	____	____
Social Group
• Scheduled Caste/Tribe	____	____	____	____	____
• General Category	____	____	____	____	____
Geographic
• Rural	____	____	____	____	____
• Urban	____	____	____	____	____

*Equity Ratio = Rate in advantaged group / Rate in disadvantaged group (closer to 1.0 = more equitable)

Social Determinants Assessment

Social Determinant	Current Status	Health Impact	Intervention Opportunities
Poverty & Income	___% below poverty line	Limited healthcare access, malnutrition	Social protection, livelihood programs
Education (especially women's)	___% female literacy	Health knowledge, healthcare seeking	Girls' education, adult literacy
Water & Sanitation	___% improved access	Diarrheal diseases, nutrition	WASH infrastructure, behavior change
Food Security	___% food insecure	Malnutrition, micronutrient deficiency	Food systems, nutrition programs
Social Discrimination	Caste/gender barriers	Healthcare access, quality of care	Sensitization, inclusive policies

4. OneHealth Assessment

Human-Animal-Environment Interface

Zoonotic Disease Risk

Assessment Questions:

□ Is there integrated surveillance for zoonotic diseases?
□ Are there protocols for investigating animal-human disease outbreaks?
□ Is there coordination between human and veterinary health systems?
□ Are wildlife conservation areas near human settlements monitored?

Zoonotic Preparedness Score: ___/5

Environmental Health Risks

Key Indicators:

Air Quality Index: _____ (WHO standard: <50)
Water contamination incidents: _____ per year
Industrial accidents affecting health: _____ per year
Climate vulnerability index: _____ (1-10 scale)

Environmental Health Score: ___/5

Antimicrobial Resistance

Assessment Areas:

□ AMR surveillance system functional
□ Antibiotic stewardship programs in place
□ Infection prevention and control protocols
□ Agricultural antibiotic use regulated

AMR Preparedness Score: ___/5

5. Health System Resilience & Emergency Preparedness

Resilience Component	Assessment Criteria	Current Status (1-5)
Emergency Preparedness	• Emergency response plans • Surge capacity • Supply chain resilience	____
Early Warning Systems	• Disease surveillance • Multi-hazard alerts • Community networks	____
Adaptive Capacity	• Flexible service delivery • Learning systems • Innovation adoption	____
Social Cohesion	• Community trust • Social networks • Collective efficacy	____
Recovery Capacity	• Post-crisis rehabilitation • Service continuity • Build back better	____

6. Priority Setting & Action Planning

Gap Analysis & Priority Matrix

Health System Area	Current Score (1-5)	Importance (1-5)	Feasibility (1-5)	Priority Score*
Service Delivery	____	____	____	____
Health Workforce	____	____	____	____
Health Information	____	____	____	____
Medical Products	____	____	____	____
Health Financing	____	____	____	____
Leadership/Governance	____	____	____	____

*Priority Score = (6 - Current Score) × Importance × Feasibility

Action Planning Template

Priority Area	Specific Objectives	Key Activities	Responsible Party	Timeline	Success Indicators
1. ________________
2. ________________
3. ________________

7. Data Sources & Tools

Key Data Sources for South Asian Health Systems

National Surveys:

National Family Health Survey (NFHS)
Annual Health Survey (AHS)
District Level Household Survey (DLHS)
Coverage Evaluation Survey (CES)

Routine Information Systems:

Health Management Information System (HMIS)
Integrated Disease Surveillance Programme (IDSP)
Mother and Child Tracking System (MCTS)
Electronic Vaccine Intelligence Network (eVIN)

Administrative Data:

Rural Health Statistics (Ministry of Health)
National Health Accounts
Public Financial Management System
Human Resources for Health data

International Sources:

WHO Global Health Observatory
World Bank Health Data
Institute for Health Metrics (IHME)
UN Inter-agency Group estimates

Assessment Tools & Methodologies

WHO Health Systems Assessment Tool: Comprehensive framework for system analysis
Service Availability and Readiness Assessment (SARA): Facility-level capacity
Health Equity Assessment Toolkit: WHO guidance on equity analysis
OneHealth Assessment for Planning and Performance (OH-APP): Multi-sectoral tool
Community Health Assessment Toolkit: Participatory approaches
Health System Resilience Assessment: Emergency preparedness evaluation

8. Summary Dashboard

Health System Performance Summary

Component	Score (1-5)	Status	Priority Rank
Service Delivery	____	____	____
Health Workforce	____	____	____
Health Information	____	____	____
Medical Products	____	____	____
Health Financing	____	____	____
Leadership/Governance	____	____	____
Overall System Score	____	____	-

Health Equity Summary

Most Vulnerable Populations: ________________________

Largest Health Disparities: ________________________

Key Social Determinants to Address: ________________________

Top 3 Action Priorities

Priority 1: ________________________
Priority 2: ________________________
Priority 3: ________________________