Assessing health system performance

Josep Figueras; Marina Karanikolos; Frederico Guanais; Suszy Lessof; Guillaume Dedet; Natasha Azzopardi Muscat; Govin Permanand; Francesca Colombo; Marina Karanikolos; Keyrellous Adib; Natasha Azzopardi Muscat; Lucie Bryndova; Reinhard Busse; Francesca Colombo; Stefania Davia; Guillaume Dedet; Josep Figueras; Chris James; Gaetan Lafortune; Suszy Lessof; Yulia Litvinova; David Morgan; David Novillo Ortiz; Dimitra Panteli; Govin Permanand; Katherine Polin; Dheepa Rajan; Bernd Rechel; Eric Sutherland; Michael van den Berg; Ewout van Ginneken; Gemma Williams; Matthias Wismar; Tomas Zapata; Julia Zimmermann; Frederico Guanais

Assessing health system performance

Proof of concept for a HSPA dashboard of key indicators

Policy Brief, No. 60

Contributors

Editors: Josep Figueras, Marina Karanikolos, Frederico Guanais, Suszy Lessof, Guillaume Dedet, Natasha Azzopardi Muscat, Govin Permanand, and Francesca Colombo. Authors: Marina Karanikolos,¹ Keyrellous Adib,² Natasha Azzopardi Muscat,² Lucie Bryndova,³ Reinhard Busse,⁴ Francesca Colombo,³ Stefania Davia,² Guillaume Dedet,³ Josep Figueras,⁵ Chris James,³ Gaetan Lafortune,³ Suszy Lessof,⁵ Yulia Litvinova,⁴ David Morgan,³ David Novillo Ortiz,² Dimitra Panteli,⁵ Govin Permanand,² Katherine Polin,⁴ Dheepa Rajan,⁵ Bernd Rechel,¹ Eric Sutherland,³ Michael van den Berg,³ Ewout van Ginneken,⁴ Gemma Williams,⁶ Matthias Wismar,⁵ Tomas Zapata,² Julia Zimmermann,⁶ and Frederico Guanais³.

Affiliations

¹ European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK

² Division of Country Health Policies and Systems, WHO Regional Office for Europe, Copenhagen, Denmark

³ Health Division, OECD, Paris, France

⁴ Berlin University of Technology, European Observatory on Health Systems and Policies, Berlin, Germany

⁵ European Observatory on Health Systems and Policies, Brussels, Belgium

⁶ European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK

Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2023.

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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.

About the Series

Policy Brief

ISSN: 1997-8073

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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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