Assessing health system performance

Key messages

This brief serves as proof of concept for a Health Systems Performance Assessment (HSPA) dashboard. It paves the way for the development of a policy-friendly dashboard of key HSPA indicators that will help policy-makers to identify and respond to performance issues.

• HSPA is a tool to support health systems transformation. It provides an overview of how health systems perform so that policy-makers can pinpoint issues and design appropriate responses.
• Using selected indicators to explain performance and guide policy responses would help foster understanding of and trust in the health system and support policy change. Gathering HSPA indicators into a subset with critical policy relevance, focusing on fewer relevant metrics and making policy questions central to the HSPA process, improves policy relevance.
• The WHO-Observatory global HSPA framework and the OECD renewed HSPA framework allow policy-makers to navigate health systems. Populating them with policy-relevant indicators makes them more actionable and useful in practice. The two frameworks outline performance linkages between indicators, health system functions and health system goals. They align in identifying key elements of health system performance and both support a policy dashboard.
• Tracer indicators reflect key policy issues and priority areas. Workforce, digital health, people-centredness and outcomes of service delivery have been used as they are key policy domains of interest for the WHO, the OECD and the European Observatory, and because they are pivotal to high-performing and resilient health systems.
• Policy questions are used as a way of framing indicator selection in light of policy-makers’ priorities. Starting with a concrete policy question helps to select system-level indicators that speak to policy-making so that health system performance assessment is relevant and anchored in system policy goals.
• Tracer indicators are selected with a focus on specific health system areas but also have limitations. They signal potential systemic issues and flag problems but cannot provide precise measures of performance or define policy responses. When they are understood in context, they signal areas for further in-depth investigation into the root causes of sub-optimal performance.
• Investment in data collection is key to making HSPA work for policy. It is important to allocate resources to enhance data collection and resolve ingrained data issues and to develop tools that facilitate the development of adequate data infrastructure supporting information flows at the national and international levels.
• Making HSPA results more policy-friendly is a continuous process that will have high policy dividends. Shifting the focus to policy questions, revising existing health data, addressing key gaps and finding innovative ways to use existing indicators cannot happen overnight. Careful collaboration across key international organizations is needed, notably the WHO, the OECD, the EU and the European Observatory, so that methodologies can be aligned to support policy decision-making.

Contents

• Acknowledgements
• List of Abbreviations
• Executive summary
• POLICY BRIEF
  • 1. Introduction
    • Current HSPA approaches may make it difficult for policy-makers to prioritize action
    • Tracer indicators can support policy-makers to assess and address health systems performance
    • HSPA Frameworks allow policy-makers to see performance linkages between areas measured by indicators
    • A policy brief as a proof of concept and a step towards a performance dashboard
    • References
  • 2. Assessing the health workforce
    • 2.1. Policy question: Are we building an adequate supply of health workers and ensuring they are distributed equitably?
    • 2.2. Policy question: Are we investing enough in skill-mix and the primary care workforce?
    • 2.3. Policy question: Are there adequate recruitment and retention policies in place?
    • 2.4. Looking to the future
    • References
  • 3. Assessing digital health
    • 3.1. Policy question: Are there digital health governance standards in place to ensure digitalization efforts are aligned and outcome-oriented?
    • 3.2. Policy question: Does the health sector have the right Information and Communication Technologies available?
    • 3.3. Policy question: Is the health system leveraging digital tools to deliver health services?
    • 3.4. Policy question: Are staff and users well prepared to use digital health services?
    • 3.5. Looking to the future
    • References
  • 4. Assessing people-centredness
    • 4.1. Policy question: Does the system support the ability of health service users to act as the co-producers of care?
    • 4.2. Policy question: Does the system enable people to participate in the development of health policy?
    • 4.3. Policy question: Can improvements in people-centredness lead to increased trust in the health system?
    • 4.3. Looking to the future
    • References
  • 5. Assessing access and quality
    • 5.1. Policy question: Are health services sufficiently accessible?
    • 5.2. Policy question: Are health services effective?
    • 5.3. Looking to the future
    • References
  • 6. Discussion and conclusions
    • References
• Appendix 1. An updated WHO-Observatory global HSPA framework
• Appendix 2. Rethinking HSPA: a renewed OECD framework
• The Policy Brief Series

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Suggested citation

Figueras J, Karanikolos M, Guanais F, Lessof S, Dedet G, Azzopardi Muscat N, Permanand G, Colombo F. Assessing health system performance: proof of concept for a HSPA dashboard of key indicators. Copenhagen, WHO Regional Office for Europe, and Paris, OECD Publishing; 2024. Licence: CC BY-NC-SA 3.0 IGO.

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