Cover of Health system performance assessment

Health system performance assessment

A primer for policy-makers

Policy Brief, No. 49

Authors

,1 ,2 ,3 ,4 ,4 and 1.

Affiliations

1 European Observatory for Health Systems and Policies, Brussels
2 Brown University, Providence
3 European Observatory for Health Systems and Policies, London
4 Health Systems Governance and Financing Department, WHO, Geneva
Copenhagen (Denmark): European Observatory on Health Systems and Policies; .
© 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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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.