Health System Performance Assessment Framework for the Slovak Republic

5. HSPA governance and implementation in the Slovak Republic

Abstract

The chapter presents a governance arrangement proposal to support implementation, feasibility and sustainability of the Slovak HSPA. The proposal involves four interconnected bodies, operationalising the HSPA by building on existing institutional responsibilities and the HSPA development project. While three of the bodies are linked to the Ministry of Health through IZA, the fourth includes a broader stakeholder group. Albeit there is no legal mandate on HSPA in the Slovak Republic, the proposed structure sets clear accountability and would help facilitate timely use of findings in policymaking.

The chapter also outlines the consultative process of designing the Slovak HSPA governance proposal, identifies its key institutions and describes their HSPA-related roles. In addition, the chapter explores strategies to embed HSPA outputs in policymaking processes and shows that about 80% of the Slovak HSPA indicators connect to national health plans and strategies. Further, next steps are outlined to operationalise the Slovak HSPA.

5.1. HSPA governance structure and roles of key stakeholders

A clear governance mechanism with defined roles and a roadmap is key for sustaining future HSPA cycles and ensuring they have real impact in the Slovak Republic.

5.1.1. Process undertaken to design the Slovak HSPA governance proposal

The completion of the HSPA framework development and its indicator population marked the beginning of discussions on establishing an appropriate and sustainable governance structure for HSPA in the Slovak Republic. These discussions were initiated through a joint meeting of the Luxembourgish and Slovak PMTs, the OECD and the EC representatives in November 2025. This stage precedes the implementation of the first HSPA cycle and the routine running of subsequent cycles, ensuring that a clear governance plan would be in place before the first full reporting cycle began (Figure 5.1).

Figure 5.1. Phases for establishing Slovak HSPA governance and delivering HSPA reports

The OECD and the Slovak PMT held follow-up meetings to support the drafting of the first HSPA governance proposal to be presented to HLAB members. The discussions focussed on ways of translating the Slovak HSPA framework into an operational structure by clarifying four key questions: who should be involved, what functions and tasks need to be carried out, how responsibilities should be allocated, and when and how often the HSPA cycle should run. For instance, as part of this process, a set of governance functions and related tasks in a regular HSPA cycle was identified to support a clear understanding of the main tasks and to facilitate the allocation of responsibilities across bodies (Figure 5.2). These functions served as a starting point for reflection, helping structure conversations on how different governance components could interact throughout the HSPA cycle.

Figure 5.2. Common main tasks and functions in a regular national HSPA cycle

At the subsequent HLAB meeting held in November 2025, the PMT presented a proposal for the Slovak HSPA governance and implementation structure to the HLAB members. The proposal aimed to build on the existing HSPA Development project arrangements and transition them into a sustainable long-term governance model. Rather than creating entirely new bodies, the approach focussed on formalising and transforming the current project structures into permanent HSPA governance entities.

The meeting also addressed the design of the HSPA cycle and its outputs. Participants discussed the scope and format of deliverables, including a comprehensive HSPA report complemented by a dashboard or overview of indicator results and summaries of individual indicator sheets. In addition, the development of a dedicated webpage with regularly updated indicator results and short indicator-specific commentaries was considered for the future. A four‑year reporting cycle with first report foreseen for 2027/28, independent of the political cycle, was proposed to ensure regularity and analytical stability. Initial reactions to the HSPA governance proposal were positive, and no substantive amendments were suggested at that stage.

As part of the final stage of defining the governance structure, five bilateral meetings were held with key data and indicator custodians, OVZ (MoH), NCZI, ŠÚ SR, ÚDZS and ÚVZ, to clarify responsibilities for data provision, indicator calculation, interpretation and ongoing engagement in the HSPA process. These discussions aimed to ensure that custodians clearly understood their expected roles within the proposed governance model, particularly in relation to preparing indicator sheets, validating data and contributing to the interpretation of indicator results. The meetings also served to address practical and institutional considerations. Stakeholders sought clarification on how the Slovak HSPA would function over time, how indicators would be tracked and updated, and how the HSPA framework would align with ongoing reforms and parallel initiatives. Organisational changes within certain institutions were also discussed, including the transfer of responsibilities of some HSPA indicators to newly established departments or units.

5.1.2. Setting accountability in the Slovak HSPA governance

The proposal for HSPA governance in the Slovak Republic operates across three interconnected bodies, which are linked to the Ministry of Health through IZA, while the fourth body includes a broader stakeholder group. The three bodies include the HSPA Committee (strategic oversight), the HSPA Core Team (co‑ordination and report production), and the Technical Implementation Groups (indicator development and analysis) (Figure 5.3).

The key stakeholders involved in the Slovak HSPA governance mirror the broader health data ecosystem in the Slovak Republic and represent the evolution of former HLAB and PWG member institutions into a structured HSPA governance model. The MoH and its analytical arm IZA function as the major wheel of the implementation, providing policy direction and analytical leadership that anchor the HSPA Committee. The NCZI, as the dominant custodian of national health information and administrator of the National Health Information System, brings essential data stewardship and system-wide infrastructure oversight to the Committee. The ÚVZ and the ŠÚ SR contribute population health monitoring, disease surveillance, and official statistics that underpin many HSPA indicators, while the three health insurance companies (HICs) supply detailed claims data feeding both NCZI datasets and MoH analyses. The ÚDZS, as the regulator of health insurance operations and maintainer of key administrative registries, supports methodological consistency and guides data flows across insurers and providers.

The HSPA Committee provides the strategic and organisational mandate that enables participating institutions to engage in the HSPA process by assigning resources and endorsing roles. It brings the senior-level management of key national bodies (MoH, Ministry of Finance, NCZI, ÚVZ, ŠÚ SR, AZP, and ÚDZS) together to ensure high-level ownership, alignment across institutions, and the authorisation needed for the HSPA to operate. Its role is to set the overall direction of each cycle by defining the expected outputs, timeline, and resource needs (staff in particular), and to create the conditions that allow participating organisations to contribute effectively. It also provides an organisational perspective and inputs into new HSPA cycles, including the approval of changes proposed by the Core team for future cycles. In the current governance structure,

• The Committee approves the scope and roadmap proposed by the Core Team, allocates or confirms resources, and mandates respective organisations to participate in the technical work. This includes formally giving organisations the mandate to work with the Core Team and assigning staff resources to the Technical Implementation Groups (TIGs).

• It reviews progress throughout the cycle, provides strategic guidance, and validates the final outputs.

• It is also responsible for embedding HSPA in organisational decision making and disseminating information within their institutions.

• It ensures that HSPA findings are used system-wide and supports communication and dissemination of results across the health sector.

The HSPA Core Team serves as the “engine room” of the HSPA cycles. Led by IZA and supported by relevant MoH departments, it is responsible for maintaining coherence across the analytical work, co‑ordinating contributions from the Technical Implementation Groups, and ensuring that the process moves according to the agreed timeline. Its role is to turn the Committee’s strategic direction into a structured, implementable cycle and to produce a high-quality HSPA report. It also leads co‑ordination, communication and dissemination, and engagement with stakeholders throughout the cycle. In more detail,

• The Core Team prepares the cycle’s detailed plan, including the timeline, deliverables, and implement any proposed methodological adjustments. It manages the flow of inputs from the TIGs, conducts or consolidates indicator analysis, reviews indicator sheets, and drafts and edits the report.

• It also publishes the report, communicates progress throughout the cycle, and organises the stakeholder forum to gather feedback on report structure and future improvements.

• The Core Team regularly reports to the Committee on progress and risks, co‑ordinates consultations, and ensures the report meets agreed quality and consistency standards.

.

Figure 5.3. The proposed governance structure for the Slovak HSPA

Note: HICs: health insurance companies. IZA: Institute for Health Analyses. MoH: Ministry of Health. MoF: Ministry of Finance. NCZI: National Health Information Centre. PWG: principal working group. ŠÚ SR: Statistical Office of the Slovak Republic. TIGs: Technical implementation groups. ÚDZS: Healthcare Surveillance Authority. ÚVZ: Public Health Authority.

Source: Developing the HSPA framework for the Slovak Republic project, HLAB meeting in November 2025.

The Technical Implementation Groups (TIGs) provide the technical and analytical backbone of the HSPA. Composed of HSPA indicator custodians such as IZA, NCZI, ÚVZ, ŠÚ SR, HICs, and ÚDZS, they bring the methodological and indicator-specific expertise needed for robust performance assessment. Their role is to operationalise the indicator framework by analysing data, maintaining indicator definitions, and supporting the development of new or placeholder indicators. In the current governance structure,

• TIGs produce indicator sheets with brief preliminary indicator analyses, and update or refine methodological elements as needed.

• They supply the Core Team with timely, high-quality inputs for the drafting process and respond to requests for clarification or additional analysis. This also includes developing placeholder indicators for future iterations. They can also contribute to the drafting of reports where needed.

• They collaborate closely with the Core Team to ensure consistency of interpretation, contribute to the review of draft analytical sections, and support the technical accuracy of the final HSPA report.

• After publication, they provide feedback for improving the next HSPA cycle.

Stakeholders represent the broader group of institutions that engage with the HSPA findings but are not directly involved in the governance or analytical production of the report. They include former PWG organisations as well as newly interested ones across the health system who may rely on HSPA outputs for planning, monitoring, and decision making within their own organisations. Their role is to act as an extended community of practice: following the progress of each HSPA cycle, interpreting results for their context, and supporting system-wide uptake of the findings:

• They contribute to the cycle through feedback, dissemination, and structured engagement activities.

• They disseminate the published report and its findings within their organisations and provide reflections that help shape future HSPA cycles.

• They participate in stakeholder forums organised by the Core Team, offering input on report structure, priority areas, and user needs, ensuring that the HSPA remains relevant and usable.

• After each report is published, stakeholders provide feedback that the Core Team and HSPA Committee consider when preparing the next cycle, strengthening the iterative learning process that underpins the HSPA model.

5.1.3. Indicator custodianship and data governance in the Slovak HSPA

A timely and credible HSPA process depends on clearly defined custodianship arrangements for indicator production, validation and interpretation. In the Slovak Republic, two types of indicator custodians are present: single and joint custodianships. In case of single indicator custodianship, custodian take the main responsibility for indicator production, including calculation, analysis and drafting of results, processing the technical sheet for the indicator, subsequently providing expert commentary on the data itself and the situation in the Slovak Republic and a comparison with abroad in future HSPA reports. In case of joint custodianships, primary custodians take the main responsibility for indicator production, including calculation, analysis and drafting of results, while secondary custodians play a supporting role ranging from analytical insights to providing underlying data, but without leading the analytical process.

The Slovak HSPA framework comprises 110 indicators, with custodianship distributed across multiple institutions (Table 5.1). The NCZI has the largest overall responsibility for indicator production, acting as single custodian for 30 indicators and as secondary custodian in three joint arrangements, resulting in involvement in about 30% of indicators in total. The IZA is responsible for 19 indicators overall, serving as single custodian for 14 and participating in five joint custodianship arrangements (four as primary and one as secondary). Other MoH departments are provisionally responsible for 18 indicators in total, including 11 as single custodians and 7 as joint custodians. These departments, with the exception of ÚVZ, will be engaged by IZA to confirm custodianship arrangements. The ÚVZ serves as single custodian for nine indicators, while the ŠÚ SR holds primary responsibility for 10 indicators independently and for five additional indicators in joint arrangements (15 in total). Other institutions (such as Ministry of Labour and Social Affairs, NOI, ŠÚKL, CVTI or RRZ) are also proposed to hold responsibility for smaller subsets of indicators, either individually or within joint custodianship arrangements. Their roles will be further clarified through bilateral discussions, with IZA providing support for indicator analysis if needed.

Table 5.1. Stakeholders’ HSPA indicator custodianship in the Slovak HSPA

An HSPA indicator custodian is the organisation that will be producing and providing the indicator for the purposes of the Slovak HSPA

	Single custodian	Joint custodian		Total
Organisation		Primary custodian	Secondary custodian	Total
NCZI	30		3	33
IZA (Ministry of Health)	14	4	1	19
Ministry of Health. OVZ SCRN SFLP SZ NSC	5 1 1 3 1	6	1	18
ÚVZ	9	6		15
ŠÚ SR	10	4	1	15
ÚDZS	6			6
OS ZZS SR	2			2
Others	2	1	4	7
TBD	3			3

Note: Single custodianship refers to one institution holding full responsibility for the indicator. In joint custodianship, the primary custodian leads the analytical work, while the secondary custodian provides supporting data or input without leading the analysis. IZA: Institute for Health Analyses. NCZI: National Health Information Centre. NSC: National Screening Centre. OS ZZS SR: Operational Centre of Emergency Medical System of the Slovak Republic. OVZ: Department of Public Health. RRZ: The Council for Budget Responsibility. SCRN: Hospital Central Management Division. SFLP: section of Pharmacy and Drug Policy. ŠÚ SR: Statistical Office of the Slovak Republic. SZ: Division of Health. TBD: to be determined. ÚDZS: Healthcare Surveillance Authority. ÚVZ: Public Health Authority.

Source: Developing the HSPA framework for the Slovak Republic project, February 2026.

HSPA indicator custodians are not necessarily the same organisations as data owners, i.e. those managing the primary datasets used to generate the indicators. Organisations responsible for maintaining the underlying datasets act as data custodians within the Slovak HSPA governance structure and are referred to as “data custodians” herein. As shown in Table 5.2, the NCZI is the largest data custodian in the Slovak HSPA, responsible for managing the datasets of 40 indicators. The ŠÚ SR follows, accounting for 34 indicators.

Other institutions contribute more limited but still important shares, including MoH, ÚVZ, and ÚDZS. Several other national and international bodies also manage datasets used for a small number of indicators. Seven indicators are subject to joint data custodianship, such as between ŠÚ SR and IZA, or MoH and ŠÚ SR. A further nine indicators are marked as “to be determined”, reflecting the ones which dataset custodianship still needs clarification or placeholder indicators yet to be methodologically defined or designated (such as PaRIS survey indicators).

Table 5.2. Data custodianship among different stakeholders in the Slovak HSPA

Data custodians: organisations managing the dataset used to obtain the HSPA indicator (data owners)

Organisation	Number of indicators
NCZI	40
ŠÚ SR	34
MoH	8 (of which 3 under IZA)
ÚVZ	7
ÚDZS	6
MoH	3
CVTI	2
OS ZZS SR	2
European Commission	1
European Medicines Agency	1
Gallup World Poll	1
IHME	1
Ministry of Labour and Social Affairs	1
OECD	1
Pavol Jozef Šafárik University	1
TBD	9

Note: The total number exceeds 110 because some indicators have joint data custodianship. CVTI: Slovak Centre of Scientific and Technical Information. IHME: Institute for Health Metrics and Evaluation. IZA: Institute for Health Analyses. NCZI: National Health Information Centre. OS ZZS SR: Operational Centre of Emergency Medical System of the Slovak Republic. ŠÚ SR: Statistical Office of the Slovak Republic. ÚDZS: Healthcare Surveillance Authority. ÚVZ: Public Health Authority. TBD: to be determined.

Source: Developing the HSPA framework for the Slovak Republic project, February 2026.

This distribution of data custodianship presents both opportunities and challenges for the Slovak HSPA. On the one hand, the central role of NCZI and ŠÚ SR provides a degree of institutional stability and technical capacity for managing core datasets. On the other hand, the involvement of multiple custodians and yet-to-be‑defined assignments for custodianships require clear co‑ordination mechanisms, agreed data standards, and well-defined accountability arrangements. Without such clarity, fragmented custodianship may lead to inconsistencies in data quality, update cycles or methodological approaches. Conversely, when effectively co‑ordinated, a multi‑institutional custodianship model can strengthen ownership across the system and enhance the robustness of indicator production.

The Slovak Republic’s health information system provides a solid basis for national HSPA: most key health datasets are available and cover virtually the entire population. The administrative claims data use masked individual IDs, creating possibility for further data linkage and sharing across various datasets, including linkages with social sector data. Ongoing initiatives, including the RISEZ health data infrastructure upgrade and strengthened analytical co‑operation between NCZI and the MoH, further create favourable conditions for expanding secondary data use and enhancing the analytical depth of HSPA.

At the same time, important structural challenges may affect HSPA work. Data sharing and linkage remain limited, partly due to fragmented governance arrangements and legislative constraints. Healthcare providers report administrative burden and duplication in data submissions, often involving manual processes, which may affect data quality and efficiency. Despite the existence of rich administrative claims data, their full analytical potential has not yet been realised. Strengthening data governance arrangements for the secondary use of health data, improving interoperability between datasets and gradually automating data flows can facilitate more efficient production of HSPA indicators, reduce reporting burden and enable more systematic use of existing data sources for performance analysis. A detailed review of the health data ecosystem and stakeholders, prepared as a baseline report for the Development of the HSPA Framework in the Slovak Republic project, identified several strengths and opportunities for HSPA data and indicator management (OECD, 2025[1]). A summary of the main findings of the report can be also found in Annex B.

5.1.4. Steps to implementing the Slovak HSPA framework

Figure 5.4 presents the broad timeline for the initial implementation of the Slovak HSPA.

In the first half of 2026, example indicator technical sheets will be developed jointly with the OECD and the relevant HSPA custodians. These will serve as templates to guide the preparation of additional technical sheets. In the second half of 2026, HSPA custodians will prepare the remaining technical sheets under their responsibility, building on these templates.

From early 2027 onwards, data collection and analysis will begin to support the preparation of the first HSPA report. The initial report is expected to provide a first overview of health system performance based on the available indicators. Subject to the establishment of detailed timelines during the implementation phase, the objective is to prepare and publish the first Slovak HSPA report by the end of 2027 or early 2028.

Figure 5.4. HSPA implementation timeline for the first report of the Slovak HSPA

5.2. Embedding the HSPA intelligence in the Slovak health policymaking

5.2.1. Clear roles, stakeholder accountability and engagement strengthen use of HSPA in policymaking

Legal foundations play an important role in ensuring stakeholder accountability and in determining how effectively HSPA findings are integrated into policy decisions. The Slovak Republic currently does not have a formal legal mandate anchoring the HSPA in legislation. While this allowed flexibility in shaping the HSPA governance proposal, international experience shows that a clear legal or regulatory basis can significantly strengthen sustainability and stakeholder accountability (OECD, 2026[2]). A formal mandate helps clarify institutional responsibilities, secure predictable resources, and reduce the risk that performance assessment becomes dependent on individual commitment or short-term political priorities. In the absence of such a mandate, there’s a need for building strong accountability through explicit agreements, transparent allocation of roles, and strong co‑ordination mechanisms embedded in the governance structure.

Given that health system data management and policy implementation in the Slovak Republic involve multiple institutions, broad engagement across the system is essential. Inclusive participation fosters ownership and buy-in, enhances credibility, and increases the chance of HSPA findings influencing policy discussions. In this context, a series of bilateral meetings with key stakeholders were organised to clarify responsibilities, particularly for indicator custodianship and analytical tasks. In several cases, joint custodianship arrangements were also assigned. Such arrangements encourage collaboration, combine complementary expertise and strengthen shared ownership of results. At the same time, joint custodianship may also create challenges, including blurred accountability, co‑ordination delays or differing interpretations of findings. To mitigate these risks, there is a need to further define the potential responsibilities that may arise during the process, such as validation of the results, resolution of methodological disagreements and ownership of final outputs. Establishing these arrangements transparently within the agreed governance structure help strengthen the foundations for a sustainable and credible HSPA system in the Slovak Republic, even in the absence of a formal legal mandate.

Another important factor shaping accountability dynamics is the choice of HSPA governance model. In independent models, analytical and commissioning functions are institutionally separated, creating greater distance between performance assessment and political decision making, as seen in Belgium’s and Luxembourg’s HSPA arrangements (OECD, 2026[2]). In the Slovak Republic, the governance model is integrated, with both steering and analytical responsibilities located within or closely linked to the MoH through IZA, similar to the approach in Czechia. This proximity ensures internal accountability and can improve co‑ordination and facilitate the timely use of findings in policymaking. It also creates a clear line of responsibility: the MoH remains accountable for acting upon HSPA findings, rather than assuming subsequent measures are the responsibility of other organisations involved in the HSPA production. At the same time, because analytical functions operate close to political leadership, maintaining transparency, methodological rigour and clear role separation is essential to safeguard credibility and trust in the evaluation process.

5.2.2. Aligning HSPA reporting with important policy timelines to maximise impact and sustainability

Establishing a clear reporting timeline and cycle for HSPA is a strategic decision that directly affects both the usability of results and the long-term sustainability of the cycles. OECD country experience shows that timing can be instrumental for HSPA findings to inform policy debates: countries that align HSPA cycles with policy planning tend to achieve a greater impact on decision making. Strategic approaches include releasing reports when national health plans are developed, timing assessments to inform budget cycles, and co‑ordinating with electoral timeliness (OECD, 2026[2]).

Completing one HSPA cycle is expected to take at least one year from the finalisation of the indicator list to the publication of the report. During this period, methodological stability is important to ensure consistency in data collection, analysis and interpretation. Introducing changes mid-cycle could undermine comparability and delay delivery. Once the report is published, a deliberate interval between cycles becomes equally important. This period allows time to disseminate findings, agree on improvements to indicators (including addition of new indicators or methodological adjustments), and give governance bodies and contributing institutions space to adjust. It also provides an opportunity to reflect on lessons learned and, where necessary, refine the framework to respond to evolving national priorities. Regular meetings during this phase can help ensure that improvements are structured rather than ad hoc, supporting both continuity and gradual enhancement of the HSPA over time.

Figure 5.5 presents the foreseen HSPA reporting cycle in relation to the Slovak Republic’s national election calendar. The first full HSPA report would be published in either 2027 or 2028, following completion of the methodological report launch and the initial data collection and analysis period. This would place its publication either in the same year as the national elections scheduled for 2027 or shortly thereafter. Subsequent reports, assuming a four‑year cycle, would be released in 2031 and 2035. As a result, future HSPA publications would continue to coincide with or closely follow national electoral cycles, creating recurring windows during which HSPA findings may be available for policy reflection and strategic planning.

Figure 5.5. Possible HSPA timeline and reporting cycles

The timing of HSPA reports in relation to national elections creates both opportunities and constraints. Publishing shortly after elections can help protect the report from being drawn into political debates during campaigns, hence safeguard its technical credibility. It can also provide a useful evidence base for the new government, helping inform priority-setting, reform and strategy planning over the government course. At the same time, once a government programme has already been negotiated, there may be less room to integrate HSPA findings into high-level commitments. During political transitions, ownership of results may also be less clear. Finally, timing alone does not ensure policy impact: even if published at an opportune moment, uptake still depends on institutional capacity and political willingness to embed HSPA in policymaking.

5.2.3. Aligning with strategic priorities to leverage use in policy development

When aligned with national policy priorities, HSPA can contribute to monitoring ongoing reforms and inform the development and refinement of future strategies and decisions. Box 5.1 presents the examples of different ways in which HSPA can be leveraged to support planning and monitoring of national priorities and policymaking, as well as resource allocation.

Box 5.1. From monitoring to action: linking HSPA with strategic priorities and decisions

HSPA can play a role not only in monitoring system performance but also in informing policy and funding discussions. When strategically embedded, HSPA can be systematically used to guide priorities, track progress and support more informed decision making across the health system.

Countries link their HSPA with strategic priorities and reform implementation

One key approach is to align HSPA indicators with national health plans to ensure coherence between monitoring and policy priorities. For example, Estonia links its HSPA framework to multiple strategic documents, including the National Health Plan 2020‑2030, the Cancer Control Plan and the Mental Health Action Plan. Similarly, Belgium is working to align HSPA indicators with inter-federal health objectives, using them alongside other assessment tools to monitor progress against jointly defined priorities.

HSPA can also serve as a tool to monitor and steer reform implementation. In Ireland, HSPA was initially developed in alignment with the Sláintecare reform programme launched in 2017, aiming to use the framework to measure, monitor and evaluate priority areas of the reform and to inform policy cycles. As the framework evolved, it incorporated additional priorities from the Programme for government, the Health Service Executive Corporate Plan and ministerial agendas. Latvia further extends this approach by using its HSPA framework to benchmark assessments at international, regional, municipal and even health service provider level, depending on the indicator.

Linking HSPA to financing and accountability mechanisms can also inform budget decisions

HSPAs may also inform discussions on financing in parliament, including on budget setting, tracking money on activity and flagging sectors where key performance indicators have unwanted variation. In Belgium, HSPA findings are presented in parliamentary budget discussions, giving legislators evidence‑based insights into system performance that can inform funding priorities. In Italy, the New Guarantee System (NGS), embedded within its HSPA framework, links performance to financial incentives and oversight: regions meeting minimum service standards receive additional funding, while persistent underperformance can trigger increased national supervision or financial penalties.

Source: OECD (2026[2]), Learning Through national Health System Performance Assessment (HSPA): Emerging findings from OECD Countries, https://doi.org/10.1787/2fa1314a-en.

A mapping exercise to understand the Slovak HSPA linkage to national health policy strategies shows HSPA’s strong potential for policy use in the Slovak Republic

To strengthen the usability and long-term sustainability of the HSPA, it is important to understand how the framework can support existing national health strategies and plans. To assess the alignment between HSPA and national strategies in the Slovak context, a systematic mapping exercise was conducted between the Slovak Republic’s national health plans and programmes and the HSPA indicator set.

This exercise showed that the Slovak HSPA holds strong potential to support national policymaking and monitoring, with substantial alignment between HSPA indicators and national health priorities. The final Slovak HSPA comprises 110 indicators, many of which are already reflected (either directly or conceptually) in existing strategic documents. Overall, about 80% (86 out of 110) of HSPA indicators show alignment with national strategies, either as “fit-for-use” indicators that measure the same areas of performance as existing national indicators, or as “fit-for-purpose” indicators that correspond to national priorities at a thematic level but differ in their precise definition or measurement (see Table 5.3 and its footnote for definitions).

Table 5.3. Degree of alignment between Slovak national health strategies and HSPA indicators

Name of the document	Type of document	Latest update	Health-related indicators in the document	Fit-for-use matches of HSPA indicators	Fit-for-purpose matches of HSPA indicators
Strategic Framework for Healthcare for the years 2014-2030	S	2022	50	32	16
Spending Review on Healthcare	S/A	2022	39	2	7
Recovery and Resilience plan	S	2023	5	2	6
National Programme for Active Ageing 2021-2030	S	2021	19
National Tobacco Control Programme	S		9
National Action Plan for Tobacco and Related Products 2023-2030	A	2022	7	2
National Action Plan on Alcohol Problems 2021-2030	A	2021	20	1
National Action Plan for the Prevention of Obesity 2015-2025	A	2015	7
National Action Plan for the Promotion of Physical Activity 2024-2030	A	2024	17	1	2
National Action Plan of National Oncology Programme 2021- 2025	A	2021	16	3	1
Food and Nutrition Action Plan 2017-2025	A	2017	16	1	1
Action Plans for the Roma Equality, Inclusion and Participation 2030	A	2022	14	1
National Drugs Strategy for the period 2021-2025	S	2021	22
National Mental Health Programme	S	2024	7	2
Action Plan of the National Mental Health Programme for 2024-2030	A	2024	9		2
Long-term care strategy in the Slovak Republic	S	2021	22	1
National Health Promotion Programme	S	2022	22	1	2

Note: Type of a document: S – mainly strategic with macro goals and objectives, A – action plan, usually linked to an overarching strategic document, but with extra details and goals. Fit-for-use match: indicators that measure the same area of performance as existing national indicators. Differences may exist in wording, minor methodological details, analytical focus or depth. Fit-for-purpose match: indicators aligned with national documents at a thematic level, but differing substantially in definition or measurement. Where multiple strategic documents overlapped in indicator ownership, the most relevant overarching document was selected for this mapping exercise.

Source: Based on national health strategy documents of the Slovak Republic.

In total, 49 indicators can be classified as “fit-for-use” for monitoring and guiding national health policy priorities. The largest concentration of such matches is found in the updated Strategic Framework for Healthcare for the years 2014-2030, from which 32 indicators originate. Additional fit-for-use indicators appear in documents such as the National Action Plan of the National Oncology Programme 2021-2025, the National Action Plan for Tobacco and Related Products 2023-2030, and the Food and Nutrition Action Plan 2017-2025. Of the 49 indicators, 22 are near-exact matches, differing only in units or minor technical details. The remaining 27 differ in aggregation level, population coverage, time horizon or analytical depth, but still measure the same underlying construct and are broadly comparable. For example, the HSPA indicator “All-bed occupancy rate in inpatient healthcare facilities by specialisation” corresponds closely to the Strategic Framework for Healthcare for the years 2014-2030 indicator “Bed utilisation, acute wards, % of beds occupied”. While the latter does not disaggregate by specialisation and is therefore not an exact match, it remains operationally aligned. Most approximate matches (14 of 27) are concentrated in the Strategic Framework, reflecting its broad thematic coverage across access, workforce, financing, health outcomes and service utilisation. Smaller numbers of approximate matches are also found in documents such as the Spending Review on Healthcare, the Recovery and Resilience Plan, the National Mental Health Programme, the National Oncology Action Plan.

A third group of 37 HSPA indicators demonstrates “fit-for-purpose” alignment with existing national strategic documents due to thematic alignment. These indicators address similar policy areas or strategic objectives but differ substantially in conceptual approach, level of detail, analytical perspective or data availability. Unlike fit-for-use matches, these indicators are not directly comparable. They may capture the same issue from a different analytical angle (e.g. process- versus outcome‑based measures), operate at a different level of granularity (system-level versus patient-level indicators), or relate to emerging policy areas where robust measures are not yet embedded in national strategies.

For example, the HSPA indicator “Share of patients on waiting lists waiting above the legislative waiting time limits” reflects a more recent data development and is not explicitly included in current strategic documents. While the Strategic Framework for Healthcare for the years 2014-2030 includes indicators related to access (such as unmet needs), these do not measure waiting time compliance and therefore cannot be classified as a “fit-for-use” match. Instead, they demonstrate thematic correspondence. Most “fit-for-purpose” indicators are again found in the Strategic Framework for Healthcare for the years 2014-2030, reflecting its broad policy coverage. Within the HSPA structure, these indicators are most frequently located in the access domain, care co‑ordination general health outcomes.

5.2.4. Effective dissemination to foster HSPA intelligence use and impact on shaping policies

In the Slovak Republic, strengthening the impact of HSPA requires embedding dissemination within the governance structure itself. Real-world impact of HSPA findings depends on whether findings are strategically endorsed, communicated and acted upon across institutions (OECD, 2026[2]).

The HSPA Committee in the Slovak Republic can play a critical role in this regard. By bringing together senior-level representatives of the MoH, Ministry of Finance, NCZI, ÚVZ, ŠÚ SR, AZP and ÚDZS, the Committee provides the organisational mandate that enables system-wide uptake. Its responsibility extends beyond approving the scope and validating final outputs; it ensures that HSPA findings are embedded within institutional decision making processes and disseminated across the health sector. Without such high-level ownership, HSPA risks remaining a technical exercise with limited influence on reform, planning or resource allocation.

Effective dissemination further depends on the operational role of the HSPA Core Team. As the “engine room” of each cycle, the Core Team not only consolidates analysis and drafts the report but also co‑ordinates communication throughout the process. By regularly reporting progress to the Committee, organising consultations, and publishing validated outputs, the Core Team ensures transparency and continuity. Importantly, dissemination is not confined to the final publication stage: structured communication during the cycle can help align expectations and prepare institutions for the interpretation and use of results. This continuous engagement strengthens trust in the analytical process and increases the likelihood that findings inform strategic and operational decisions.

Stakeholders constitute the third pillar of effective dissemination in the Slovak HSPA governance. They represent institutions that rely on HSPA outputs for planning, monitoring and decision making and form an extended community of practice around health system performance. Through stakeholder forums organised by the Core Team, these organisations feedback on report structure, priority areas and usability, ensuring that outputs remain relevant to system needs. After publication, stakeholders disseminate findings within their organisations and contribute reflections that inform subsequent cycles. This iterative feedback loop strengthens institutional learning and helps anchor HSPA within routine governance processes.

A structured dissemination infrastructure can further reinforce impact. Beyond the periodic publication of comprehensive HSPA reports, the Slovak HSPA could benefit from consolidating validated indicators and methodological documentation in a dedicated and easily accessible reference space. Such an approach would enhance visibility, reduce fragmentation of performance information across institutions and provide a stable reference point for monitoring progress over time. Where data maturity allows, selected indicators could be updated between reporting cycles, supporting more timely performance dialogue and strengthening the role of HSPA as a living monitoring framework rather than a static reporting exercise.

The dissemination and use of HSPA results can be further supported through knowledge translation activities. Targeted initiatives (such as seminars, training sessions or collaboration with higher education institutions) can help strengthen analytical literacy and promote the practical use of HSPA findings in decision making. From a longer perspective, embedding HSPA concepts and results into professional training, policy discussions and organisational processes reinforces institutional memory, continuity and sustained demand for health system performance assessment and evidence‑based policy.

5.3. The HSPA methodological report as a blueprint to support the HSPA implementation

The Slovak HSPA framework presented in this report represents a milestone in the transition from conceptual design to HSPA operational implementation. The framework reflects a collaborative effort among national institutions, data custodians and sector stakeholders. Through structured consultations, technical exchanges and iterative validation of indicators, the national purpose, scope and architecture of the Slovak HSPA were progressively refined. Beyond defining the indicator set, this process contributed to strengthening institutional dialogue and fostering a shared understanding of how health system performance should be assessed in the Slovak Republic.

The next phase focusses on operationalising the framework through the production of the first national HSPA report. The overarching objective is to establish HSPA as a sustainable instrument that embeds performance intelligence into routine governance and decision making processes. Effective HSPA governance arrangements, technical work and continued stakeholder engagement are all instrumental for the ability to translate HSPA results into policy-relevant insights. The strong alignment between the Slovak Republic’s national health policy strategies and the HSPA framework further consolidates its use and maximises its potential to inform policymaking and sustainability. As the HSPA implementation moves forward, the OECD team will continue to support the Slovak Republic in 2026, providing guidance on HSPA implementation, including indicator production and data interpretation.

This methodological report therefore serves not only as a technical reference, but as a roadmap for sustained implementation. By formalising the HSPA framework and related responsibilities, production processes and dissemination arrangements, it lays the institutional foundations for continuity across future HSPA cycles. Its ultimate ambition is to support a system in which HSPA is not a one‑off reporting exercise, but a stable and evolving framework that informs policy debates, supports accountability and promotes continuous improvement in the Slovak health system.

References

[2] OECD (2026), “Learning through national Health System Performance Assessment (HSPA): Emerging findings from OECD countries”, OECD Publishing, Paris, https://doi.org/10.1787/2fa1314a-en.

[1] OECD (2025), Situational analysis of Slovakia’s health data infrastructure for HSPA purposes, OECD Publishing, https://www.oecd.org/content/dam/oecd/en/about/projects/the-oecd-technical-support-to-national-hspa-development/Slovakia-Health-data-HSPA.pdf.