Bridging the Gap Between Performance Assessment and Decision-Making in the Zambian Health System: Utilisation of Performance Assessment Findings in Luapula Province

Performance assessment is a key mechanism for strengthening accountability, learning, and service delivery within decentralised health systems. In Zambia, the Ministry of Health has institutionalised performance assessment through the Integrated Guidelines for Improved Health System Performance, which emphasise routine self assessment, structured analysis, and follow up action planning. However, evidence on how performance assessment findings are utilised for decision making at district and facility levels remains limited. This study examined the utilisation of performance assessment findings for planning and decision making in selected districts of Luapula Province. A descriptive mixed methods design was employed, drawing on review of routine programme documents including facility and district level meeting minutes, action point matrices, mentorship reports, and orientation reports related to performance assessment implementation. Data were thematically analysed across districts, hospitals, and rural health centres. Findings showed that performance assessments were largely conducted as required; however, translation of findings into structured analysis and actionable planning was inconsistent. Utilisation was facilitated by mentorship, job aids, and orientation on DHIS2 scorecards, while constraints included limited analytical capacity, weak documentation practices, unclear timelines, and inadequate feedback mechanisms. Guided by the Technology Acceptance Model and the Theory of Effective Use, the study highlights the need to strengthen data to action processes and district level capacity to enhance effective utilisation of performance assessment findings.