Abstract

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.

Contents

• List of boxes, figures, tables and appendices
• List of contributors
• Acknowledgements
• List of abbreviations
• Chapter 1. Assessing health systems performance for UHC: Rationale and Approach
  Irene Papanicolas, Dheepa Rajan, Marina Karanikolos, and Josep Figueras.
  • 1.1. Introduction
  • 1.2. Health system frameworks and assessments: from labels to content
  • 1.3. The Health Systems Performance Assessment Framework for Universal Health Coverage
  • 1.4. Approach and structure of the volume
  • References
• Chapter 2. Review of existing frameworks and tools
  Marina Karanikolos, Irene Papanicolas, and Katja Rohrer.
  • 2.1. Introduction
  • 2.2. Background: selection of frameworks and tools
  • 2.3. How do we define a health system?
  • 2.4. What are the factors that explain health system performance?
  • 2.5. What are the health system’s goals?
  • 2.6. Assessing performance: how are factors that influence performance linked to the health system objectives?
  • 2.7. Discussion and conclusions
  • References
• Chapter 3. Working towards a common approach: the HSPA Framework for UHC
  Irene Papanicolas, Marina Karanikolos, Josep Figueras, and Dheepa Rajan.
  • 3.1. Introduction
  • 3.2. Introducing key concepts
  • 3.3. The HSPA Framework for UHC
  • 3.4. Conclusions
  • References
• Chapter 4. Governance
  Dheepa Rajan, Kira Koch, Katja Rohrer, and Agnes Soucat.
  • 4.1. Introduction
  • 4.2. Understanding the governance function
  • 4.3. Sub-functions
  • 4.4. Assessing the performance of the governance function
  • 4.5. Conclusions
  • References
  • Appendix 4.1: Overview of key governance frameworks
• Chapter 5. Resource generation
  Dheepa Rajan, Katja Rohrer, Kira Koch, Teena Kunjumen, Khassoum Diallo, Adriana Velazquez Berumen, Claudia Nannei, and Judith Sprunken.
  • 5.1. Introduction
  • 5.2. Understanding the resource generation function
  • 5.3. Sub-functions
  • 5.4. Assessing the performance of the resource generation function
  • 5.5. Conclusions
  • Appendix 5.1 Details on indicative measures for the resource generation sub-function assessment areas
  • References
• Chapter 6. Financing
  Jonathan Cylus, Julia Sallaku, and Matthew Jowett.
  • 6.1. Introduction
  • 6.2. Understanding the financing function
  • 6.3. Sub-functions
  • 6.4. Assessing the performance of the financing function
  • 6.5. Conclusions
  • References
• Chapter 7. Service delivery
  Ellen Nolte, Marina Karanikolos, and Bernd Rechel.
  • 7.1. Introduction
  • 7.2. Understanding the service delivery function
  • 7.3. Sub-functions
  • 7.4. Assessing the performance of the service delivery function
  • 7.5. Conclusions
  • References
  • Appendix 7.1 A brief overview of approaches to categorizing service delivery
• Chapter 8. A framework for Health System Performance Assessment
  Irene Papanicolas, Marina Karanikolos, Dheepa Rajan, Katja Rohrer, Jonathan Cylus, and Josep Figueras.
  • 8.1. Introduction
  • 8.2. The HSPA Framework for UHC
  • 8.3. Applications of the HSPA Framework for UHC: case studies
  • 8.4. Conclusions
  • References
• Chapter 9. Conclusion
  Dheepa Rajan, Irene Papanicolas, Marina Karanikolos, and Josep Figueras.
  • 9.1. Introduction
  • 9.2. The four health system functions: a recap
  • 9.3. Health system performance: intermediate objectives and final goals
  • 9.4. Conclusions and future directions

This publication was produced with support from the Universal Health Coverage Partnership www.uhcpartnership.net (UHC Partnership), one of WHO’s largest platforms for international cooperation on universal health coverage and primary health care. It is funded and supported by: Belgium, Canada, European Union, Germany, Luxembourg – Aid & Development, Ireland – Irish Aid, France – Ministère de l’Europe et des Affaires étrangères, Japan – Ministry of Health, Labour and Welfare, United Kingdom – Department for International Development, World Health Organization (WHO). The UHC Partnership helps deliver WHO’s support and technical expertise in advancing universal health coverage with a primary health care approach in 115 countries, representing a population of at least three billion people.

The European Observatory on Health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of health systems in Europe. It brings together a wide range of policy-makers, academics and practitioners to analyse trends in health reform, drawing on experience from across Europe to illuminate policy issues.

The Observatory is a partnership, hosted by WHO/Europe, which includes other international organizations (the European Commission); national and regional governments (Austria, Belgium, Finland, Ireland, Norway, Slovenia, Spain, Sweden, Switzerland, the United Kingdom and the Veneto Region of Italy (with Agenas)); other health system organizations (the French National Union of Health Insurance Funds (UNCAM), the Health Foundation); and academia (the London School of Economics and Political Science (LSE) and the London School of Hygiene & Tropical Medicine (LSHTM)). The Observatory has a secretariat in Brussels and it has hubs in London (at LSE and LSHTM) and at the Berlin University of Technology.

Health system performance assessment: a framework for policy analysis / Irene Papanicolas, Dheepa Rajan, Marina Karanikolos, Agnes Soucat, Josep Figueras, editors

(Health Policy Series, No. 57)

ISBN 978-92-4-004247-6 (electronic version)

ISBN 978-92-4-004248-3 (print version)

© World Health Organization 2022 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies)

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