Developing a performance management system for a federal public health program: the Ryan White CARE ACT Titles I and II

Both public and private sector organizations are increasingly being called upon to measure performance. In the public sector, this trend is evidenced by such legislative initiatives as the Government Performance and Results Act (GPRA). Yet performance measurement presents complex analytic and behavioral challenges and few models exist to guide policy makers and program managers in their attempts to respond to legislative mandates and market pressures for accountability through performance measurement. This article describes one approach to introducing performance measurement into a large Federal health program, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, in response to GPRA. It places performance measurement within the broader concept of performance management. This approach is particularly applicable to large grant programs characterized by significant autonomy and variation at the local level. The article also discusses some of the characteristics of the HIV/AIDS epidemic which present unique challenges to performance measurement. (C) 2001 Elsevier Science Ltd. All rights reserved.