Experts from the World Health Organization (WHO) and the European Observatory on Health Systems and Policies have produced a long-awaited framework to conceptualize the assessment of health system performance.
Health system performance assessment: a framework for policy analysis, published with support from the UHC2030 Health System Assessment technical working group (TWG) and the Universal Health Coverage Partnership, will help policy-makers to analyze possible origins and impact of poor performance on a particular health system outcome. In countries, especially those that receive external assistance, different and overlapping health systems assessments are often supported by different partners. The entry point for the UHC2030 TWG to develop this framework was the need for harmonizing and aligning the analysis of health system assessment (HSA) information across countries and HSA tools.
The book places the newly introduced framework within the current evidence base while ensuring it is fit for the policy challenges of the 21st century. It offers policy-makers a strong performance orientation to analyze health system data and information.
Dheepa Rajan, Health Systems Adviser at WHO and one of the book editors, explains: “The core added value of this framework is the in-depth work we did to define the linkages between health system inputs, or functions, on the one hand, and health system outcomes, or goals, on the other. For each of the functions we also identify which topical areas need to be assessed to really understand that function’s contribution to overall system performance – information which is extremely policy-relevant.”
Strengthening health systems towards universal health coverage
The innovation behind the new framework thus consists of diving deep into each of the four functions of the health system (governance, financing, resource generation and service delivery) and linking it with five specific performance goals: health improvement, people centredness, financial protection, efficiency, and equity of the health system.
“The best way to use this framework is not to identify one single fix that can be tweaked in a sub-function to improve one of the health system goals,” explains Taavi Lai, former official in the Ministry of Health & Social Affairs, Estonia. “Rather, it can be used to more generally assess the performance of the different components of the system.”
The framework encapsulates the areas where countries need health system strengthening interventions in order to move closer to universal health coverage. It is meant to organize the thinking around health system strengths and weaknesses in a way which offers insights into how health systems perform overall.
The HSPA Framework for UHC is thus a conceptual aid to analyze information emanating from health system assessments rather than an operational tool per se. It also allows for a common way of presenting health system assessment results, which can make comparisons between different assessment approaches and a shared focus on system performance easier.