Key messages

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.
   • 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.
   • 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.
   • It builds on existing tools and frameworks but orients the analysis of health system assessment exercises towards system performance.
   • 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.
   • 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.
   • It provides an explanation of the health system bottlenecks that contribute to specific policy challenges.
   • This will support efforts to pinpoint the person, group or institution that can and should take responsibility for remedial action and promote accountability.
   • Its insights into the governance function will help policy-makers to use governance as a lever to achieve health system goals.

Contents

• Executive summary
• POLICY BRIEF
  • 1. Introduction
  • 2. Understand the core elements of the HSPA Framework for UHC
  • 3. Bringing all the elements together into the HSPA Framework for UHC
  • 4. How to use the framework
  • 5. Policy implications
• ANNEX 1
• ANNEX 2
• ANNEX 3
• References
• The Policy Brief Series

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