Health System Performance Assessment In The Who European Region

Health systems performance assessment (HSPA) varies across the WHO European Region. This review summarizes HSPA domains and indicators used by Member States in their HSPA or health system-related reports. Thirty Member States published in the English language and from their latest documents, 1485 distinct indicators were extracted. The number of indicators reported per Member State ranged from 9 to 146, with a mean of 50. Among the 14 domains of the WHO 2007 framework, service delivery and improved health were covered by virtually all Member States analysed (30 and 29, respectively), but coverage varied for the other 12 domains, with health workforce and financing having good coverage (25 and 26, respectively) but others, such as safety, efficiency, coverage or responsiveness, covered in only 20-30% of documents. Further refinement of frameworks, both in clarity on scope and function and in the conceptual robustness of domains, is warranted and further standardization of generic sets of indicators should be sought.

Ensuring a robust and resilient health system involves policy actions which need to be implemented based on the best available evidence. This requires health systems to be monitored regularly to build on their strengths and to overcome any apparent shortcomings. In order to assist in that process, this volume, a collaboration between the World Health Organization and the European Observatory on Health Systems and Policies, presents a new framework to support monitoring of health system performance, with a focus on detailed conceptual links between health system functions and overall system goals. This HSPA framework for Universal Health Coverage thus represents a comprehensive attempt to address fundamental questions regarding regular assessment of health systems, including health system boundaries, component elements and outcomes. In this book, each of the health system function chapters outlines the purpose of the function, the sub-functions that enable it to carry out the key activities necessary to fulfil its purpose, as well as the assessment areas and proposed indicative measures to evaluate how well a system performs. The framework will thus assist policy-makers in understanding possible origins or impact of poor performance on a particular health system outcome, triggering more in-depth analysis.

This report, jointly developed by the European Observatory, OECD, and WHO Europe, serves as a proof of concept for a Health Systems Performance Assessment (HSPA) dashboard. HSPA is pivotal for health system transformation, providing policymakers with key indicators to identify and address system performance issues. This brief represents a step towards more policy-friendly dashboards, emphasizing the need for a focused set of HSPA indicators aligned with policy goals. The brief highlights the alignment and complementarity of the WHO-Observatory global HSPA framework and OECD's renewed framework, which aid policymakers in navigating health systems with actionable, policy-relevant indicators. These frameworks establish connections between performance indicators, health system functions, and overarching goals, supporting a coherent policy dashboard. Tracer indicators, like workforce, digital health, and service delivery outcomes, are emphasized as crucial for assessing key policy areas. The report underscores the importance of investing in data collection and infrastructure at national and international levels to make HSPA effective. It advocates for continuous improvement and collaboration among major international organizations, including WHO, OECD, EU, and the Observatory, to align methodologies and support informed policy decision-making.

Increasing health system performance is critical in creating resilient health systems. If health policies are to foster the ability to withstand shocks like the COVID-19 pandemic, they need to focus on the right interventions that strengthen health systems - those that improve performance.1. Assessing the performance of a health system effectively is the first step to improving it. 1.1. This requires a conceptual lens through which to view the health system structures, its inputs and the outputs and outcomes that they feed into.2. The Health System Performance Assessment (HSPA) Framework for Universal Health Coverage (UHC) offers policy-makers a conceptual tool to assess performance effectively. 1.1. It provides a rigorous description of the four health system functions - governance, resource generation, financing and service delivery - and their sub-functions that matter most for the function-level and overall system performance.1.2. It builds on existing tools and frameworks but orients the analysis of health system assessment exercises towards system performance.1.3. It identifies impacts on health system performance and encourages operational focus.3. The HSPA Framework for UHC has real-world applications and helps direct policy action. 1.1. It allows policy-makers to understand how the health system works and how its functions and sub-functions are linked to the "assessment areas" that explain performance.1.2. It provides an explanation of the health system bottlenecks that contribute to specific policy challenges.1.3. This will support efforts to pinpoint the person, group or institution that can and should take responsibility for remedial action and promote accountability.1.4. Its insights into the governance function will help policy-makers to use governance as a lever to achieve health system goals.

The health system performance assessment (HSPA) framework for the Czech Republic is an initiative designed to help the Czech health system improve policy planning, monitoring, and decision taking. This report describes the HSPA framework for the Czech Republic, its development process, governance structure and implementation roadmap. It also details the Czech HSPA framework domains, populated by indicators selected through a comprehensive review process. As such, the framework enables the assessment of strengths and weaknesses of the Czech health system. Its implementation will increase the accountability of national authorities and principal healthcare stakeholders, improve public involvement, smooth flow of information across the health sector, and allow reform planning and monitoring.

International comparison of health system performance has become increasingly popular, made possible by the rapidly expanding availability of health data. It has become one of the most important levers for prompting health system reform. Yet, as the demand for transparency and accountability in healthcare increases, so too does the need to compare data from different health systems both accurately and meaningfully. This timely and authoritative book offers an important summary of the current developments in health system performance comparison. It summarises the current state of efforts to compare systems, and identifies and explores the practical and conceptual challenges that occur. It discusses data and methodological challenges, as well as broader issues such as the interface between evidence and practice. The book draws out the priorities for future work on performance comparison, in the development of data sources and measurement instruments, analytic methodology, and assessment of evidence on performance. It concludes by presenting the key lessons and future priorities, and in doing so offers a rich source of material for policy-makers, their analytic advisors, international agencies, academics and students of health systems.

The World Health Report 2000 has generated considerable media attention, controversy in some countries, and debate in academic journals. This volume brings together in one place the substance of many of these key debates and reports, methodological advances, and new empiricism reflecting the evolution of the WHO approach since the year 2000. Specifically, the volume presents many differing regional and technical perspectives on key issues, major new methodological developments, and a quantum increase in the empirical basis for cross-country performance assessment. It also gives the full report of the Scientific Peer Review Group's exhaustive assessment of these new approaches.