Measuring the efficiency of programs, services delivered, and general operations allows for increased effectiveness. We support metrics in the below areas.


Calculating the actual cost of running a health service program can help managers track how many resources are invested in operations over time, and with what results.

This is a departure from the commonly used method of estimating cost effectiveness by calculating the ratio of donor contributions to program outputs. As programs decrease reliance on donor funds, this method of calculation is becoming less meaningful. The Metrics Working Group, hosted by Metrics for Management, has outlined a method for calculating cost.

  • Understand if service-delivery is becoming more efficient over time
  • Identify which service-delivery models yield the greatest value for money
  • More broadly, use of data for setting global benchmarks

The chart below offers guidance on how to calculate cost. The MWG designed this approach after testing it in three social franchising programs. This guidance takes into consideration the variability across different organizations’ accounting systems.

Cost*Programs that should factor in this costHow to calculate this cost
Cost of support received from a global headquarters office.Programs that receive technical support from a global headquarters office.This is calculated as 100 x (total cost to operate the global headquarters office)/total cost of the global organization).
Cost of support received from the agency administering the program.Programs that receive technical support from a parent agency.This is the total operational cost of the parent agency, multiplied by the approximate percentage of parent agency staff time allocated to support the program.
Cost of discounts or subsidies on commodities that are sold to the program.Programs that sell commodities to programs below purchase price.A subsidy is calculated as the cost to purchase the good minus the price of commodities sold directly to the program.
Cost of operating a program.All programs.These are the costs that are directly attributable to the program, such as training, field visit costs, etc.

*All values should be calculated from the same time period.

Cost effectiveness is calculated by dividing cost by health impact. This webpage provides guidance on how to calculate cost. Learn how to calculate health impact using the metric of DALYs averted. Read the briefing paper on cost effectiveness.


Patient Flow Analysis (PFA) is a set of quantitative and qualitative measurements used to assess the movement of patients and resources in a hospital or clinic. It is used to identify possible inefficiencies where improvements can be made.

  • Optimize resource use and minimize patient discomfort and wait times through better management of hospital and/or clinic operations.

A patient flow metric has the ability to:

  • Decrease average length of stay in a hospital
  • Better use facility space
  • Save nursing and physician time
  • Improve patient safety
  • Enhance patient satisfaction
  • Shorten waiting times

Waiting times for an appointment, or in a crowded lounge to see a physician, or for diagnostic tests and results can often be long. An emergency department in a hospital may be face congestion and difficulty finding enough beds. An operating theater may be empty for much of the day. Beds in a ward may be unoccupied due to lack of communication. PFA can be used in small or large facilities, or across a network of facilities, to help health managers make strategic infrastructure, staffing, and resource decisions.

The strongest cases of success have been in high-income countries, where documentation is easier and there is more institutional support for PFA measurement. Some evidence of success has been seen in low- and middle-income countries (LMICs), but more research is needed.

Metrics for Management has partnered with Aceso Global, a nonprofit that supports improvements in hospital systems, to carry out the necessary exploratory research in Mexico to assess PFA’s viability in LMICs.

Our initial research demonstrates that PFA is a major challenge in LMICs. Common challenges include long wait times, housing patients in hallways spaces, transfers and surgeries that are refused or delayed, and incomplete, rushed or missing patient assessments. These PFA challenges result in patient dissatisfaction, lower quality of services, risks to patient safety, staff burnout, and higher costs. Metrics for Management and Aceso Global are exploring development of a suite of PFA metrics to alleviate these challenges.

Learn more about our interest in Patient Flow Analysis. Read the results of the initial PFA research in Mexico.


Although sustainability can be broadly defined as sustaining impact over time, there is no one standardized definition of sustainability. Recognizing this, Metrics for Management is working with the MWG, under leadership from the Economist Intelligence Unit, to develop a clear definition for sustainability that will be broadly applicable for health service organizations. Initial testing will be conducted within social franchise organizations. The metric will encompass financial, organizational, and program-related goals.

Definitions of sustainability

Financial SustainabilityA financially sustainable program should have diverse sources and mechanisms of funding to assure resilience and adaptability to meet the needs of a changing health context and health market.
Programmatic SustainabilityWithin a programmatically sustainable program there is continuation of effect – availability of services continues and clients can access high quality healthcare.
Organizational SustainabilityAn organizationally sustainable program has sustained improvement in health impact and clinical outcomes, though some external financial support may still be required.

Measure the continued provision of clinical services to meet a population’s’ health needs while reaching self-sufficiency in funding.

A sustainability metric will:

  • Increase understanding of how to sustain and grow health impact over time
  • Consider the increased demand for more comprehensive health service delivery approaches
  • Ensure the continuation of quality services that benefit the entire health system
  • Identify key performance indicators to help track sustainability in the short and long term
  • Allow existing resources to be directed more effectively
  • Enable international donors to set clear expectations around program results

Based on current data from the business world, we believe key performance indicators can be established to measure sustainability. We will also examine situations where one element of sustainability is reached, but not others. For example, an organization may grow their health impact, but not achieve self-sufficiency in funding.

Our next steps will include:

  • Developing a more nuanced definition for sustainability in clinical service delivery; and
  • Standardizing key facets of sustainability within social franchising to track growth and impact over time.

The implications of a standardized metric to measure sustainability are drastic, since donors, funders, and implementing agencies will be able to determine what types of programs require continuous funding, and what types may be sustainable on their own.

Contact the Project Lead, Harri Mandhar, to learn more about our work on Sustainability.



Contact us to learn how Metrics for Management can help you use targeted, accurate & measurable data to expand & improve your services.