Capturing health market innovations for better global health: What works where and why?

By Raman Sohal and Kate Mossman

In resource-constrained settings, many health care organizations targeting the poor confront challenges as they provide their services.  Health personnel can be hard to recruit and retain. Stock-outs of medical supplies occur all too often. Revenue streams are at times not dependable. Despite the challenges, some health services organizations in low-and-middle income countries have developed novel approaches to increase the availability, affordability, and quality of health care services through innovative delivery models.

We need a way to identify these successes. Due to the logistical and operational challenges that many health services organizations experience, they are often unable to systematically collect data on the innovations and processes they use to serve and benefit the poor.  The lack of an evidence-base poses challenges that hinder our ability to characterize these models and identify areas of innovation that have led to the effective provision of care for the poor.

Performance measurement is one way to capture the outcome of innovations in health services delivery. The Toronto Health Organization Performance Evaluation (T-HOPE) team was supported by CHMI to develop and refine a performance framework to assess the over 1450 innovative health programs profiled in the CHMI database. This framework was recently published in Globalization and Health, which describes its development and applications.

Read and download the framework here.

Our team began by reviewing other performance frameworks. There are many frameworks for measuring health services outcomes and impact from the academic literature. They offer metrics for comparing performance within and across disease areas.

What many of these frameworks lack, however, is feasibility. The frameworks are difficult to use, and many impose a high reporting burden on resource-constrained programs and busy managers.

To address this issue and understand what is feasible for programs to report, we explored the program results CHMI has collected from its health programs. By aiming to balance the credibility, feasibility, and comparability of performance measures, we developed the T-HOPE framework, which consists of 14 performance dimensions within three categories of health status, health access, and operations/delivery, along with seven descriptive categories that provide a snapshot of program performance and key activities.

T-Hope Performance Dimensions

A useful framework measures two key things: health impact and organizational sustainability. The T-HOPE framework is a straightforward way to capture data on how healthcare organizations are performing. It achieves simplicity by focusing on measures that are informative without being onerous. It evaluates the performance of innovative health care programs based on what well-documented programs are already doing. In doing so, it offers a means to connect innovators to funders.

The T-HOPE framework has been incorporated into CHMI’s Reported Results framework, which is being used by CHMI to continue to collect more rigorous data and results from program managers on health delivery processes and outcomes. This work also helped to inform a Working Group convened by CHMI and the Global Impact Investing Network (GIIN) tasked with developing a set of standardized, quantifiable health performance measures.  

Through such efforts, our team aims to encourage performance measurement that meet the needs of diverse programs and encourages collaboration, coordination, and sharing of knowledge amongst stakeholders in LMICs and high-income countries.


T-HOPE is led by Dr. Onil Bhattacharyya at Women’s College Hospital, and Drs. Anita McGahan and Will Mitchell at the Rotman School of Management, University of Toronto. To learn more about T-HOPE, please contact Dr. Kate Mossman at: