Developing an appropriate district health system performance assessment framework for Uganda

Christine Kirunga Tashobya

Research output: ThesisDoctoral dissertation - Doctoral dissertation


Health systems performance assessment is still in its infancy, globally, and certainly in low income countries. In 2003, Uganda launched the innovative District League Table (DLT) for comparison of performance across districts. The instrument is designed upon a number of input, process and output indicators pertaining to the district level, that eventually lead to the construct of a composite index ranking districts from good to poor performers. A number of important achievements have been noted, but also challenges and criticisms. This study sought to critically analyse the rationale, historical development and current functioning of the DLT as a tool for performance assessment, but also to formulate suggestions for its adjustment. A multiphase case study approach with mixed research methods was used. An extensive literature review and the involvement of an expert group supported the construction of a theoretical model of a Health Systems Performance Assessment (HSPA) framework. A comprehensive critique of the DLT was then undertaken, on the basis of qualitative and quantitative data, which formed the basis for the development of proposals to adapt the framework and to transform it into a tool that would effectively support decision-making and facilitate change at district level, and pave the way to more accountability from districts both upward and downward.
Original languageEnglish
Publication statusPublished - 2016


  • B680-public-health


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