FIGURE 4-1 From inputs to outputs logic model.

NOTE: The thickness of some arrows denotes the present report’s focus on those interactions.

The committee recognizes that detailed performance objectives may be identified and measurements conducted at each step of the continuum depicted in Figure 4-1 by all stakeholders in the system. For example, there may be specific objectives for public health agencies or for hospitals that assess their community’s health needs, objectives for the process of planning (such as the number of partners engaged in planning and collaborative planning activities undertaken), objectives that monitor resource use, and so on. In this chapter, however, the committee focuses on the “macro” or broader accountability for the entire continuum of community-health improvement (from needs assessment to the most distal outcomes) and not on any detail of the “micro” accountabilities that could be examined and described for each step in the process.

In the process of community-health improvement, after a community’s health needs are assessed, priorities are identified, and plans are made and implemented, performance measurement is needed to hold implementers (the full spectrum of system stakeholders in addition to public health agencies) accountable and to spur continuous quality improvement to increase the effectiveness, efficiency, and equity of actions taken to improve population health. Performance measurement is the main way to monitor accountability in the health system.

The measurement framework for accountability discussed in this chapter applies to the delivery of funded public health programs by public health agencies; the role of public health agencies in mobilizing the overall public health system; and the roles, contributions, and performance of health-system partners (other governmental agencies, private-sector stakeholders, and communities).

Assessing and measuring accountability at any level (local, state, or