Perdana Determinants

Public implementation framework · Version 0.2 · 7 October 2026

The Perdana Determinants are a structured way to examine why a health intervention reaches some people but not others. Within #VISION HEIS, the framework connects the context of a problem to the responsibilities, resources and practical changes needed to address it.

The central question

“What works?” is only the beginning. A PerdanaHealth implementation brief also asks: for whom, in which setting, under what constraints, and with whose authority and participation?

Health equity is shaped by the conditions in which people are born, grow, live, work and age, and by their access to power, money and resources (WHO World report on social determinants of health equity, 2025). The Perdana Determinants use that broader perspective to organise locally relevant implementation questions.

Practical lines of enquiry

The nine areas below structure implementation enquiry. They are not a validated composite score.

• Authority and institutions: Who can authorise the work, make a decision and be held accountable?
• Affordability and resources: What do transport, time away from work, service costs and care responsibilities prevent people from doing?
• Social context: Which relationships and access barriers affect participation?
• Cultural context: Which languages and experiences shape trust without stereotyping?
• Personal values and purpose: What matters to the individual? Support is optional, never scored and never a condition of access.
• Health and care needs: What clinical capability, continuity and accessible referral arrangements are required?
• Geopolitical context: Which external dependencies affect supply, access and continuity?
• Regional context: What can connect across boundaries while respecting local authority?
• Territorial context: How do place, mobility and accessibility affect the pathway?

Partnerships, One Health and the environment, digital and data governance, and statistical evidence are considered across these areas.

From assessment to action

• Define: Select one bounded problem and identify who experiences it.
• Listen: Combine appropriate existing evidence with consented community or workforce input.
• Map: Describe barriers, affected groups, service responsibilities and assumptions.
• Design: Select a feasible change with a named owner, budget and implementation window.
• Measure: Agree the denominator, timeframe, subgroup analysis and data safeguards before implementation.
• Review: Decide what to continue, modify or stop on the basis of the observed evidence.

What this framework is

Perdana Determinants is the public name of this conceptual and implementation framework. It is not a validated diagnostic instrument, a licensed clinical decision rule or an automatic allocation score.

The framework may inform the development of PHEI-R and PHEI-WSR. Each instrument retains its own construct definition, permissions, study design and validation pathway; evidence from one is not automatically transferable to another.