People should be at the center of health system performance assessment. Populations can provide critical insight on quality of care, confidence in health services, and health outcomes. However, today’s measurement approaches overlook key dimensions of population perspective such as confidence in the health system. Surveys are rarely standardized to enable cross-country comparison. The People’s Voice Survey (PVS) aims to fill this gap. The PVS is a novel multicountry survey of people’s perspective on health system performance. It measures a wide range of domains, including health status, health system utilization patterns, ratings of care quality, and confidence and trust in the health system. The survey allows for a flexible, mixed mode design that uses telephone, online, and in-person data collection approaches to achieve a nationally representative sample of adults. Critically, the survey includes both health system users and non-users. It can be adapted for use in high-, middle-, and low-income countries. We describe the motivation for this new instrument, the multistep collaborative development and validation process, and policy use cases for 19 countries participating in the first wave of data collection. Findings from the survey can be used to integrate people’s voices into health system policymaking and guide strategic investments towards higher quality health systems.