Box 1.

High Quality Health System Framework Domains and Sub-Domains [7]

Domain Sub-Domain	Definition
Domain: Process of Care
Competent care and systems	Evidence-based, effective care: systematic assessment, correct diagnosis, appropriate treatment, counseling, and referral; capable systems: safety, prevention and detection, continuity and integration, timely action, and population health management
Positive user experience	Respect: dignity, privacy, non-discrimination, autonomy, confidentiality, and clear communication; user focus: choice of provider, short wait times, patient voice and values, affordability, and ease of use
Domain: Quality Impacts
Better health	Level and distribution of patient-reported outcomes: function, symptoms, pain, wellbeing, quality of life, and avoiding serious health-related suffering
Confidence in system	Satisfaction, recommendation, trust, and care uptake and retention
Economic benefit	Ability to work or attend school, economic growth, reduction in health system waste, and financial risk protection
Domain: Foundations
Population	Individuals, families, and communities as citizens, producers of better health outcomes, and system users: health needs, knowledge, health literacy, preferences, and cultural norms
Governance	Leadership; policies: regulations, standards, norms, and policies for the public and private sector, institutions for accountability, supportive behavioral architecture, and public health functions; financing; learning and improvement: institutions for evaluation, measurement, and improvement, learning communities, and trustworthy data
Platforms	Assets: number and distribution of facilities, public and private mix, service mix, and geographic access to facilities; care organization; connective systems: emergency medical services, referral systems, and facility community outreach
Workforce	Health workers, laboratory workers, planners, managers: number and distribution, skills and skill mix, training in ethics and people-centered care, supportive environment, education, team work, and retention
Tools	Hardware: equipment, supplies, medicines, and information systems; software: culture of quality, use of data, supervision, and feedback