Table 1.

Framework for monitoring and evaluating PBF’s health systems effects

Result chain	Service delivery	Human resources	Governance	Health financing
Inputs	Development of quality assurance/improvement tools (like treatment protocols, scorecards)	Changes to working conditions for staff and staff remuneration	Development of governance capacity & systems – e.g. separation of functions	Volume of funds, relative to other sources (globally, and at facility level); and their predictability and variability over time
	Changes to the availability of necessary infrastructure, medicines and supplies	Any change to central level HRH policies and allocation	Investments in improving information and M&E systems	Costs of related investments
		Changes to training (e.g. on good prescribing and evidence-based treatment protocols)	Changes to participation of external stakeholders – especially those representing demand-side	Effect on other financing sources, as relevant. Changes to funds reaching front-line providers
Processes	Changes to organization of services -Effects on quality and convenience for users (“acceptability”). Effects on availability of services, including support services, like diagnostics, lab tests	Changes to availability, retention and distribution of staff (of different types). Change to staff motivation, job satisfaction, teamwork and working patterns, and skills sets	Changes in performance management systems at all levels. Changes to accountability, autonomy, organizational culture and contractual obligations of main actors. Development of leadership skills, at different levels	Allocation of funds (across services, facility types and areas) & link to local needs. Changes to transactions costs (including costs of new governance arrangements, monitoring etc.). How funds are used and any knock-on financial effects (e.g. changes to charges for users)
Outputs	Changes to utilization of services (targeted and untargeted). Changes to coverage – absolute and for different socioeconomic groups. Changes to quality of care (cure rates, readmission, detection etc.). Changes to range and type of services (appropriate to local needs or not)	Changes to staff behavior (working hours, absenteeism, dual practice, informal charging etc.). Evidence of changes to responsiveness and quality of care provided by staff	Changes to health data: regularity, reliability, comprehensiveness. Greater (or less) voice for stakeholders, especially patients. Strategic purchasing practiced. Centralisation/decentralization of functions within sector; changed power relationships within system	Changes to technical & allocative efficiency of services. Sustainability of funding mechanisms & their synergies over time. Changes to affordability for users & financial protection – overall and disaggregated
Health system goals	Better health; greater equity in health; financial protection; responsiveness of health system