# Face and content validity of a prospective multidimensional performance instrument for service delivery in district health systems in low-income countries: a Delphi study

## TL;DR

This study tested the validity of performance indicators for health services in low-income countries and found most indicators related to facility capacity and quality care.

## Contribution

The study provides a validated set of performance indicators for improving health service delivery in low-income countries.

## Key findings

- 59 out of 238 indicators were agreed upon for face validity.
- Content validity of the overall set reached 100% agreement.
- Most retained indicators focused on facility capacity, maternal and child health, and HIV care.

## Abstract

Valid performance indicators help to track and improve health services. The aim of this study was to test the face and content validity of a set of performance indicators for service delivery in district health systems of low-income countries.

A Delphi method with three stages was used. A panel of experts voted (yes vs no) on the face value of performance indicators. Agreement on the inclusion of indicators was a score of >75% and ≥50% during stages one and two, respectively. During stage three, indicators with a mean score of ≥3.8 on a five-point scale were included. The panel also rated the content validity of the overall set of indicators.

The panel agreed on the face value of 59 out of 238 performance indicators. Agreement on the content validity of the set of indicators reached 100%. Most of the retained indicators were related to the capacity of health facilities, the quality of maternal and child health services and HIV care and treatment.

Policymakers in low-income countries could use a set of performance indicators with modest face and high content validity, and mainly aspects of capacity and quality to improve health service delivery in districts.