Table 1

Key frameworks for health systems responsiveness

FrameworkKey pointsNotes
WHO strategy, framework and tools for health systems responsiveness4 25 28 Health systems responsiveness is defined as experiences of health service users along the seven elements: dignity, autonomy, confidentiality, prompt attention, quality of amenities, access to social support networks.
WHO also developed detailed survey tools and guidelines,26 which have been used and adapted in multiple countries.
  • A most widely used framework, guided world health surveys21

  • Framework and tools were used and were found applicable in different contexts35–38 46 52

  • Many studies have proposed modifications to suit the contexts of specific countries, programmes or services34 39–42 47 57

Three-component framework by Valentine et al 9 Responsiveness is viewed as a legitimate outcome of the healthcare process. It draws on the WHO framework and identifies three determinants of responsiveness:
  1. environment (the context of service provision, characteristics of welfare provision, structure of the health system and available resources)

  2. agents (users and providers) defining the need for care and setting the context

  3. process of seeking and receiving care at the individual level

  • No empirical studies were found, which applied this framework

  • This framework was subsequently adapted by Robone et al 21 in a more detailed framework

Conceptual framework of determinants of responsiveness by Robone et al 21 Builds on Valentine et al’s framework and identifies three determinants of responsiveness:
  1. environment (resources, health systems organisation, institutional factors, eg, democratic history or corruption)

  2. characteristics of population (sociodemography, education, values)

  3. access to and use of healthcare

  • Framework was informed from the analysis of world health survey data

Health systems and provider responsiveness by Coulter and Jenkinson24 Three key components of responsiveness were identified:
  1. doctor-patient communication

  2. involvement in treatment decisions

  3. choice of provider

  • This framework emerged from analysis of data from a telephone survey in eight European countries

Framework for social accountability of providers by Berlan and Shiffman29 Two groups of determinants of social accountability of providers were identified:
  1. health system (oversight mechanisms, revenue sources and competition within the health sector—all may lead providers to be accountable to entities other than service users, eg, governments and donors)

  2. social factors (consumer power, information levels and provider beliefs surrounding accountability)

  • Framework emerged from synthesis of literature on health services accountability to users

  • No empirical studies which applied this framework were found

Two-form accountability within health systems by Cleary et al 12 Two forms of accountability are distinguished:
  1. internal or bureaucratic (ie, within health system)

  2. external or social (to the public)

  • No empirical studies which applied this framework were found

SCAN Foundations Framework for advancing person-centred system of care77 Responsiveness is seen as an ultimate objective of healthcare system and includes five pillars:
  1. administrative reorganisation

  2. global budgeting

  3. universal assessment

  4. integrated information systems

  5. quality measurement and monitoring

  • Framework is aimed to inform and advance the person-centred system of care in USA

Health service responsiveness by Hashimoto et al 48 Specific variables of service responsiveness within vector surveillance programmes in three Latin American countries were identified as a combination of:
  1. Health systems context (distance from health centres to capitals; staff numbers, consistent monitoring, decentralised responses to vector reports)

  2. Service characteristics and outcomes (No of households reporting problems, interval between report and response)

  • Although framework as such was not explicitly reported, specific variables guided the data collection and analysis