Health System Performance Assessment (HSPA) is a systematic approach for comprehensively evaluating a health system, therefore serving as a critical tool for health policymakers to achieve high-performing health systems. In particular, an HSPA framework is a tool that provides a structure for countries to systematically assess whether their health systems meet population needs, deliver high‑quality care, and make progress toward strategic health objectives.
The decision of Slovak authorities to develop a national HSPA reflects a shared recognition of the necessity to strengthen evidence‑based health policy and decision making with a suitable tool, in line with international good practice. Regulation and management in healthcare have traditionally been fragmented across multiple stakeholders in the Slovak Republic. In this context, national authorities and stakeholders have agreed that strategic planning is necessary to cope with the health system sustainability issues stemming from trends such as demographic pressure, financial constraints, and health workforce availability. Therefore in 2024, the Ministry of Health initiated the process of developing a national HSPA framework that would be tailored to the Slovak health system and policy needs and co-developed with health sector stakeholders. The project “Developing HSPA Frameworks for Luxembourg and Slovakia” benefited from EU funding and technical support from the OECD, in co‑operation with the European Commission, and allowed the two countries to develop their HPSA frameworks in parallel, enhancing cross-country learning and mutually sharing experience on HSPA development.
The development process of the Slovak HSPA included broad stakeholder participation in formulating the framework and selecting HSPA indicators, which ensured that the resulting HSPA framework is nationally relevant and enjoys shared ownership. The inclusive development of the Slovak HSPA framework was achieved through stakeholder engagement in workshops, focus groups, high‑level advisory meetings, iterative consultations, and indicator selection.
The purpose of the Slovak HSPA is to act as a monitoring tool on health system and healthcare performance, designed to facilitate public reporting, improve accountability and to inform policymaking. By design, the Slovak HSPA aims to monitor regional differences, time trends, international comparisons, and healthcare quality. The scope of the Slovak HSPA involves the whole Slovak population, with an indirect emphasis on disadvantaged communities, and extends beyond the healthcare system by linking to educational, environmental and socio-economic determinants of health.
The Slovak HSPA framework has 18 domains grouped in the following five areas, comprehensively covering the Slovak population health, healthcare and health system: resources, prevention and risk factors, healthcare services, outcomes, and efficiency. The domain areas have been inspired by the international practice of structuring performance assessment in three categories of inputs, processes and outcomes, while adapting them to Slovak local needs and data realities, including for the cross-cutting area on efficiency. An emphasis on prevention and health risk factors led to creation of a separate domain area in the Slovak national framework, highlighting the interest of stakeholders to monitoring this area closely to address underperformance.
The framework is populated by 110 indicators which are distributed across its 18 domains. The balanced selection allows for a technically feasible yet comprehensive assessment of the Slovak health system performance, acknowledging that further indicator refinement might occur when data infrastructure improves. Indicators were selected through a stepwise process, engaging health system stakeholders in several discussions, voting on indicator prioritisation, and approving the final set of HSPA indicators in November 2025.
A use case example on equity illustrates how the Slovak HSPA framework allows moving beyond isolated indicators towards a structured assessment and coherent understanding of health and care performance, to uncover areas of underperformance and guide policy recommendations. The case study shows how a particular policy topic can be explored using the national framework, and how HSPA indicators from various domains across the framework can be linked through a selected common theme.
The proposed HSPA governance structure involves four governance bodies to support implementation, feasibility and sustainability of the Slovak HSPA. It builds on existing institutional responsibilities and the HSPA development project and links the HSPA governance bodies to the Ministry of Health through IZA, while also involving a broader stakeholder group. Consideration of country health needs and health system context were instrumental for the development the Slovak HSPA framework; as a result, about 80% of the Slovak HSPA indicators are connected to national health plans and strategies, which will help facilitate the use of HSPA findings in policymaking.
The purpose of this report is to provide the foundation for a transparent and accountable process of HSPA implementation in the Slovak Republic, based on a commonly shared HSPA purpose, scope and framework. By describing the HSPA framework for the Slovak Republic and its indicators in detail, as well as the processes and methodology used for the construction of the framework and indicator selection, the report aims to foster greater awareness and engagement across health system stakeholders and the public. Implementing the Slovak HSPA framework will help enhance accountability and transparency of key stakeholders, support evidence‑based policymaking, and promote continuous improvement in the Slovak health system.