Health System Maturity: A Narrative Review of Existing Maturity Models

Various health system maturity models have been elaborated in literature but none offers a unified and integrated perspective to facilitate comparison of maturity levels across different health systems. Such a unified and universal health system maturity model would enable various stakeholders-national governments, international agencies, scholars and researchers, and other interested parties to gain insight into maturity of individual health systems while also permitting quantitative and qualitative comparisons across systems. It would facilitate progress tracking and systematic improvement at global, national and sub-national levels. This article explored and examined the various models for health system maturity and proposes robust criteria and framework for health system maturity assessment. Basing on the purpose, functions and goal of the health system, ten (10) maturity dimensions were synthesized to form a benchmark for the critical review of the existing maturity models and constitute a bedrock for the unified and integrated maturity assessment framework. The dimensions are: Universal Health Coverage; Continuity of Care; Continuum of Care; Population Health Status; Quality Management; Responsiveness; Resilience; Partnerships and Collaborations; Global Participation and Integration; and Sustainability. A critical review of the existing maturity models indicated that none of the maturity models covers all the health system maturity dimensions thus confirming the need for the synthesis of a unified and integrated framework for health system maturity assessment. The information from the review was used to formulate metrics and performance indicators for each dimension, thereby giving rise to the proposed comprehensive assessment framework.