In this regard, questions remain as to what constitutes a comprehensive health system performance assessment framework, especially, for developing and low-income countries in view of the consideration given to the peculiarities of health systems. Frameworks developed largely in the context of high-income countries (HICs) have dominated these efforts. Thus, over the last few decades, there have been several efforts towards developing comprehensive health system performance assessment frameworks that consider the distinctiveness of particular health systems, including the variety of stakeholders with different perspectives on health system performance and the various determinants of health. By this, HSPA provides a powerful influence on policy. This is especially crucial as countries make efforts towards attaining the Post-2015 Development Agenda or the Sustainable Development Goals (SDGs), particularly target 3.8 of Goal 3 (Universal Health Coverage), which is at the center of current efforts of strengthening health systems. HSPA also ensures tracking the progress of key strategic national health goals of specific indicators. It provides a useful and rich source of evidence for policy makers in decision making regarding priority setting and resource allocation in areas of more need. Health system performance assessment (HSPA) has become a central instrument in governing modern health systems. Such information will help in strategizing for better and more improvements. Future studies should consider exploring factors influencing performance of the Ghanaian health system. The Holistic Assessment Tool is a useful framework, but needs further refinement, both in scope and in conceptual robustness. However, the health system has recorded improvements in population health indicators, such as life expectancy at birth, infant mortality, under-5 mortality, HIV prevalence and disease burden (in terms of disability adjusted life years). Also, the scope of the assessment program seems limited to the evaluation of the Ministry of Health’s annual plans, programs and projects. While the tool provides a national framework for evaluating the performance of the Ghana Health system in several domains, the Holistic Assessment Tool does not cover key health system domains such as information systems for health, access to essential medicines, and patient-centeredness. Descriptive statistics were used to examine trends in the performance of the Ghanaian health system. We also obtained unpublished documents from Ghana’s Ministry of Health, Ghana Health Service website, and Ghana Statistical Service database. Searches were conducted on Google Scholar, PubMed, Scopus and Science Direct between May and July, 2019 for published documents on health system performance assessment. Mainly secondary data were used in this analysis.

The paper also analyzes trends in the performance of the health system to understand whether or not an improvement has been recorded following the adoption and implementation of the Holistic Assessment Tool.

This paper examines the comprehensiveness of Ghana’s health system assessment framework called the Holistic Assessment Tool in relation to some of the internationally recognized frameworks. A fundamental requirement for a performance measurement system is the development of an assessment framework within which specific performance measures could be defined and applied regularly.

Basic set of relevant and measurable indicators should be founded on different aspects of health and health care (health promotion, diseases prevention, clinical treatment, rehabilitation), monitoring and evaluation as a part of everyday's routine in health sector.Measuring the performance of a health system is an essential requirement in creating systems that generate efficient, equitable, patient-focused, accessible and sustainable results. Health indicators, as aggregated health statistical data, present measure instruments in this process, and because of that definition, development and implementation of basic set of health indicators at all levels (public health and clinic) must be the priority activity in the current moment of health sector reform in Bosnia and Herzegovina. Health information should be useful and easy accessible to all potential users in every moment, from health care providers to the general public. The purpose is to produce and use adequately appropriate information about health status, health risks and health outcomes in order to establish priorities.

To have relevant information, it means to have basis for timely reporting, basis for action, and prerequisites for success. Health information undoubtedly has great social, political and economic importance.

Health system indicators