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Public health assessment framework

Comprehensive health systems analysis for South Asian contexts
Practical Tool for Health Practitioners, Policy Makers & Development Organizations

How to use this assessment framework

  1. Scope Definition: Identify geographic area, population, and health priorities
  2. Data Collection: Gather quantitative data and conduct stakeholder interviews
  3. Building Block Analysis: Rate each health system component (1-5 scale)
  4. Equity Assessment: Analyze disparities across population groups
  5. Gap Identification: Identify priority areas for intervention
  6. 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 India value (source, year) Target/Benchmark Performance Gap
Maternal Health Maternal Mortality Ratio (per 100,000 live births)
Institutional delivery rate (%)
Skilled birth attendance (%)		 ____
____
____		 87 (SRS 2022-24)
90.6% (NFHS-6, 2023-24)
91.3% (NFHS-6)		 <70
>95%
>95%		 ____
____
____
Child Health Under-5 mortality rate (per 1,000)
Full immunization coverage (%)
Stunting prevalence (%)		 ____
____
____		 29 (SRS 2023)
82.6% (NFHS-6)
29.3% (NFHS-6)		 <25
>90%
<20%		 ____
____
____
Communicable Diseases TB incidence (per 100,000)
Malaria cases (per 1,000)
HIV prevalence (%)		 ____
____
____		 187 (WHO Global TB Report 2025, for 2024)
0.18 (Annual Parasite Incidence, NCVBDC, 2024)
0.20% of adults aged 15-49 (NACO, India HIV Estimates 2023)		 <100
<0.1
<0.1%		 ____
____
____
Non-Communicable Diseases Diabetes prevalence (%)
Hypertension prevalence (%)
Cancer incidence (per 100,000)		 ____
____
____		 17.8% women, 20.9% men with high blood sugar or on medication (NFHS-6)
19.4% women, 22.1% men with elevated blood pressure or on medication (NFHS-6)
see ICMR National Cancer Registry Programme		 <7%
<25%
Stable		 ____
____
____
Environmental Health Access to improved water (%)
Access to improved sanitation (%)
Household air pollution exposure (%)		 ____
____
____		 96.5% (NFHS-6)
70.2% (NFHS-5, 2019-21)
41.4% of households without clean cooking fuel (NFHS-5)		 >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) Evidence/Notes
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* Action Required
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)
  • RCH Portal (successor to the Mother and Child Tracking System)
  • 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 Tool (UN Inter-Agency Working Group): Costing and planning for national health strategies
  • 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

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

Public Health Assessment Framework • ImpactMojo Public Health 101

Based on: WHO Health Systems Framework, USAID Health Systems Assessment Approach, and regional best practices

CC BY-NC-ND 4.0 • Free to use with attribution • www.impactmojo.in