This annex summarises the main project meetings and activities conducted during the development of the HSPA framework for the Slovak Republic, including meetings of the PWG, HLAB, specific Technical Focus Groups and project activities aimed at capacity building. It documents how stakeholders’ proactive input, feedback, technical discussions and international exchanges informed the design and development of the HSPA framework, the selection of its indicators and proposed HSPA governance arrangements, complementing the analytical content presented in the main chapters of this report.
Health System Performance Assessment Framework for the Slovak Republic
The Principal Working Group (PWG) of the Developing the HSPA Framework for the Slovak Republic project was composed of representatives of organisations involved in health system and health data governance and of other health sector stakeholders in the Slovak Republic, including technical experts (see the list of participating organisations in Section 1.2.3).
The 1st Principal Working Group meeting (in-person, September 2024)
This first Principal Working Group (PWG) workshop launched the HSPA development project in the Slovak Republic, bringing together a broad range of stakeholders from across the health system, including central government authorities, statistical bodies, health insurers, providers, academia, employers, and patient organisations. Opened by the Minister of Health, the meeting introduced the concept of HSPA to a national audience, presented the project’s objectives, governance structure and planned activities, and provided a first opportunity for in-person discussion on the potential purpose, scope and boundaries of the Slovak HSPA framework.
The 2nd Principal Working Group meeting (online, November 2024)
The second PWG workshop was held as a joint activity together with stakeholders from Luxembourg, benefitting from the multi-country structure of the project split into individual country workstreams. The aim of the workshop was to share the experience of other countries that have developed and implemented, or were in the process of implementing, their national HSPA frameworks with health system stakeholders in the Slovak Republic and Luxembourg. It focussed on the early stages of HSPA development in other countries and on lessons learnt. The meeting was attended by 36 participants from the Slovak Republic, with a broad representation of stakeholder organisations.
Participants from the Slovak Republic highlighted that defining the purpose of the HSPA is essential for its implementation and governance, including for aligning organisational responsibilities related to health data and indicator custodianship. They emphasised the importance of having comparators for indicators, including international benchmarks and time trends, and of building as much as possible on existing indicators and data rather than focussing primarily on developing new ones. At the same time, participants noted that the HSPA project could help strengthen stakeholder collaboration and support improvements in data collection and international indicator reporting where established methodologies already exist. During the discussion, participants appreciated the opportunity to learn from other countries’ experiences and to draw practical lessons for the design and implementation of the Slovak HSPA.
The 3rd Principal Working Group meeting (online, December 2024)
This workshop aimed to discuss the preliminary findings of the situational analysis on the health data landscape in the Slovak Republic with health system stakeholders. The analysis fed into the Baseline report that provides an overview of health data readiness for HSPA indicators in the Slovak Republic and served as a basis for the following HSPA project phase. The meeting was attended by 39 participants, representing broad stakeholder engagement across the Slovak health system.
The discussion confirmed that the Slovak Republic has a solid foundation of health data sources and custodians on which to build an HSPA, supported by ongoing developments such as the RISEZ project and broader efforts to improve data sharing. Stakeholders highlighted important strengths, including comprehensive administrative data, good population coverage in key datasets, and opportunities to make better use of existing surveys, registers and future clinical registry development. At the same time, the discussion underlined persistent challenges around limited data linkage, poor timeliness, duplicative reporting, and legislative barriers to secondary data use. Participants emphasised that improving linkages across datasets, including with social care and socio‑economic data where feasible, as well as strengthening automation and reducing manual reporting, will be essential to support regular and meaningful HSPA indicator production.
The 4th and 5th Principal Working Group meetings (in-person, January 2025)
These workshops aimed to generate and narrow down potential performance domains and indicator themes for the Slovak national HSPA framework, building on the draft purpose and scope discussed with the PWG and the High-Level Advisory Board during autumn 2024. Over two days, around 35 participants representing a broad range of Slovak health system stakeholders worked together in a highly interactive setting to shape the first draft structure of the Slovak HSPA. The meetings enabled open discussion, collective reflection on national health system priorities, and supported stakeholder ownership of the framework through an in-person consensus-building process. The input generated during the workshops formed the basis of the first draft of the Slovak HSPA framework and contributed initial ideas for potential indicators and indicator themes.
Specifically, during Workshop 4, two interactive sessions engaged participants in identifying possible HSPA domain themes, which were subsequently clustered by the OECD and the Institute for Health Analyses into emerging domain topics. In total, 195 ideas were generated and initially grouped into 31 domain themes, of which 19 were prioritised by stakeholder sub-groups based on their role in the health system (see Figure 2.4 in Section 2.3). Stakeholders highlighted in particular the importance of prevention and efficiency, which were reflected as distinct building blocks in the first draft of the Slovak HSPA framework. Building on these results, the first proposal for the draft framework was presented and discussed during Workshop 5 the following day, alongside an interactive session to generate ideas and initial reflections on indicators and indicator themes that could be used to assess performance across domains.
The 6th Principal Working Group meeting (online, September 2025)
The meeting was held to update Slovak stakeholders on the progress made since the previous PWG meeting, provide an update on the then-current version of the Slovak HSPA framework, and share next steps and details on the PWG’s involvement in the upcoming indicator scoring process. It was attended by 33 participants representing a broad range of Slovak health system stakeholders.
The Slovak PMT presented refinements to the draft HSPA framework developed following the January workshops, Technical Focus Groups, and additional expert input. These refinements aimed to strengthen the framework’s structural coherence by reducing the number of domains, redistributing overlapping topics, and clarifying domain content and descriptions. The August 2025 draft framework was presented in detail (see Figure A A.1), highlighting its structure around five main areas: Resources, Prevention and Risk Factors, Outcomes, Healthcare Services, and Efficiency, with efficiency positioned as a cross-cutting area and linkages across the framework made explicit. Participants welcomed the refined framework, appreciated the progress made, and acknowledged that stakeholder and expert feedback had been appropriately reflected.
The OECD and the PMT also presented the indicator repository developed for the Slovak Republic project, drawing on national and international databases, other countries’ HSPAs, and expert discussions. These indicators had been mapped to the draft framework domains, with work underway to consolidate the original repository into a shorter list for stakeholder voting. The next phase of the project was outlined, focussing on selecting a feasible number of relevant indicators to populate the framework. The methodology for the indicator selection process was presented, highlighting the central role of PWG members in voting for the short-listed indicators based on their relevance, comprehensiveness, and significance for the purpose of the Slovak HSPA.
The 7th and 8th Principal Working Group meetings (on-line, November 2025)
These meetings aimed to review the results of stakeholders’ voting of HSPA indicators for the Slovak Republic and to agree on a final set of indicators, taking into account both the scoring results and the meetings’ discussions to ensure that the selected indicators are fit for the purpose of the HSPA and provide comprehensive coverage of the framework domains. Ahead of the meetings, PWG members received an Excel file with a summary of the indicator voting results, structured in the same way as the voting file used for stakeholders’ indicator contribution.
Around 34 participants representing a broad range of Slovak health system stakeholders attended the two meetings, which took place over two consecutive days. During the sessions, voting results were presented by domain by the PMT and the OECD teams, together with proposals for the final indicator selection and additional considerations based on written stakeholder comments. Each domain presentation was followed by a group discussion, during which PWG members provided feedback, expressed agreement, or suggested refinements. Considerations related to data availability and the existence of international benchmarks were also taken into account in the group decision making on inclusion or exclusion of indicators. Overall, the discussions resulted in a mutually agreed set of indicators populating the Slovak HSPA framework, with technical follow-up to be pursued with relevant data and indicator custodians and the final list to be shared with the High-Level Advisory Board.
The High Level Advisory Board (HLAB) of the Developing the HSPA Framework for the Slovak Republic project was composed of representatives of the core organisations that would be involved in national HSPA governance once the HSPA is set up. The HLAB regularly followed the progress of the project, provided organisational perspectives and inputs on the developed materials and outputs, and served as liaisons with respective organisations (for list of participating organisations, see Section 1.2.3).
The 1st High-Level Advisory Board meeting (in-person, September 2024)
The first meeting of the HLAB provided information on the project rationale, objectives, governance structure and timeline, and clarified the role of the HLAB in guiding the process and providing strategic oversight for the development of the HSPA in the Slovak Republic.
Most HLAB member organisations and governmental bodies attended the meeting, represented by senior officials from key health system and data institutions in the Slovak Republic. HLAB members welcomed the initiative and underlined the importance of involving the right technical experts in the PWG, while ensuring strategic guidance at high level on HSPA governance and its embedding in national health policymaking. Discussions highlighted the value of a clear project timeline, strong collaboration across health sector stakeholders and data custodians, and the potential of the HSPA to support health system monitoring, evidence‑based policymaking, and improved use of health data. Members also noted possible synergies with wider developments in secondary health data use, including the European Health Data Space.
The 2nd High-Level Advisory Board meeting (in-person, January 2025)
The second HLAB meeting reviewed progress in the project, with a particular focus on the previous PWG workshops, the preparation of the Baseline Report, and the January 2025 draft framework sessions. The PMT presented the draft purpose and scope of the HSPA for the Slovak Republic, which emphasises improving public reporting and informing policy and decision makers, while enabling monitoring of regional differences, time trends, international comparisons, and health system quality. The scope was confirmed as covering the whole population, with specific attention to marginalised and disadvantaged communities.
Most HLAB member organisations and governmental bodies were represented at the meeting by senior officials. Participants welcomed the progress made so far and highlighted the value of the project’s participatory approach and strong stakeholder engagement. Several members stressed the importance of making better use of existing data, improving data linkage and secondary use for policymaking, and strengthening co‑ordination across data custodians. Suggestions for further consideration included maintaining broad stakeholder mobilisation, drawing on other countries’ experience, and using the project to support longer-term improvements in data culture, collaboration, and country ownership of the HSPA process.
The 3rd High-Level Advisory Board meeting (online, September 2025)
The third HLAB meeting reviewed project progress, presented the August 2025 draft of the HSPA framework for the Slovak Republic, and gathered strategic feedback from HLAB members. The PMT outlined the main refinements made since the January draft, incorporating inputs from Technical Focus Groups to improve structural coherence, streamline the organisation of domains, and clarify domain content and links across the framework. Members welcomed the progress and confirmed that the framework remained a draft, to be further refined based on indicator votings and stakeholder feedback.
The meeting convened most HLAB member organisations and governmental bodies, represented by senior officials from key health system and data institutions in the Slovak Republic. The OECD and the PMT also outlined next steps, focussing on populating the framework with a feasible and policy-relevant set of indicators through a stakeholder voting process led by PWG members. HLAB members broadly supported the approach, welcomed the strong engagement of their organisations’ experts in the project, and emphasised the importance of long-term sustainability, flexibility, and effective use of existing data. Members agreed to reconvene in November to review the final indicator set and discuss governance arrangements related to the selected indicators.
The 4th High-Level Advisory Board meeting (online, November 2025)
The fourth HLAB meeting focussed on reviewing the list of indicators selected by the PWG to populate the HSPA framework for the Slovak Republic. The PMT summarised the indicator selection process, which took place between September and November 2025 and resulted in a final set of 110 indicators. This set was considered to strike an appropriate balance between technical feasibility and comprehensive coverage of health system performance.
The meeting brought together most HLAB member organisations and governmental bodies, represented by senior officials from key health system and data institutions in the Slovak Republic. The PMT and the OECD presented the selected indicators structured along the HSPA framework areas, highlighting domain coverage, data sources, data availability, placeholder indicators, and the scope for international benchmarking. The meeting also included discussion of a proposed governance structure for implementation of the HSPA in the Slovak Republic, building on the project’s existing governance arrangements. HLAB members welcomed the final indicator set, agreed that it should be considered final, and expressed broad support for the proposed governance approach, while underlining the importance of continued technical work with data custodians and of maintaining flexibility as data availability and infrastructure evolve.
The OECD organised four technical focus group (TFC) meetings to explore themes that had been highly prioritised by stakeholders during the 4th and 5th PWG meetings in January 2025. These meetings aimed to identify potential indicators to cover the priority themes and areas of improvement for indicator measurement by bringing together relevant stakeholders from across the Slovak health system, with representatives spanning from patient organisations to research bodies.
Technical Focus Group 1: Integrated care (online, June 2025)
Participants from the National Health Information Centre, health insurance companies, the Healthcare Supervisory Authority, patient organisations, hospital associations, self-governing regions, the MoH, and the OECD attended the first Technical Focus Group meeting for the Slovak Republic. The session began with presentations by the IZA and OECD teams on integrated care, drawing on national and international perspectives and highlighting existing indicator approaches and measurement practices.
The discussion confirmed integrated care as a priority area within the HSPA framework for the Slovak Republic, while also underlining that the concept still lacks a sufficiently clear and shared definition. There was broad agreement on the need to develop indicators related to treatment adherence, care co‑ordination, patient pathways, and the use of digital tools such as eHealth, eReferrals and eLabs. Health insurance companies highlighted their capacity to generate indicators on chronic disease management and polypharmacy, while patient representatives stressed gaps in continuity of care and the need for measures related to adherence to care guidelines and referral follow-through. Providers and regional representatives also pointed to weaknesses in data connectivity across providers and levels of care, with implications for prevention, efficiency and continuity. Overall, participants supported further development of integrated care indicators, while recognising that some would require additional methodological work and would initially need to be treated as placeholder indicators.
Technical Focus Group 2: Workforce (online, June 2025)
The focus group brought together a broad range of stakeholders involved in health workforce monitoring in the Slovak Republic, including representatives from the National Health Information Centre, the Statistical Office of the Slovak Republic, the Institute for Health Analyses, self-governing regions, hospital associations, academia, and the OECD. The session began with presentations by the IZA and OECD teams on international approaches to measuring human resources for health, relevant OECD concepts and definitions, and potential workforce indicators and data sources already available in the Slovak Republic.
The discussion highlighted workforce as a strategically important area within the HSPA framework, while also revealing important weaknesses in the national data infrastructure. Participants pointed in particular to gaps in data on workforce outflows, transition from graduation into active practice, working conditions, and future workforce demand. Existing registers provide a basis for measuring workforce stocks and selected characteristics, but challenges remain around data standardisation, coding, completeness, and linkages across institutions. Participants discussed a broad set of possible indicators, including numbers of doctors and nurses by region and demographic characteristics, doctor-to-nurse ratios, overtime and workload measures, and indicators on graduates and entry into practice. Representatives also stressed the importance of linking education and employment data to improve long-term workforce planning, while noting that several potentially important indicators would initially need to remain placeholders due to missing or fragmented data. Overall, the session confirmed the relevance of workforce measurement for the HSPA and underlined the need for stronger data linkages and better visibility of workforce dynamics and working conditions.
Technical Focus Group 3: Cost monitoring and efficiency (online, July 2025)
The session brought together stakeholders involved in health financing, data, service delivery and analysis in the Slovak Republic, including representatives from the Ministry of Finance, the National Health Information Centre, the Statistical Office of the Slovak Republic, health insurance companies, hospital associations, the Institute for Health Analyses, and the OECD. The meeting began with presentations by the IZA and OECD teams on value‑based healthcare and efficiency from an international and OECD perspective, as well as on relevant indicators already used in the Slovak Republic and the historical development of efficiency measurement in the health system.
The discussion confirmed efficiency as a priority area within the HSPA framework for the Slovak Republic and emphasised the importance of focussing not only on expenditure levels, but also on patterns of healthcare use and their relationship to quality and outcomes. Participants highlighted in particular the relevance of indicators on hospitalisations by disease group, avoidable hospitalisations, adherence to evidence‑based prescribing, antibiotic consumption, hospital cost structures, and human resource costs in relation to revenue. Stakeholders also discussed opportunities to monitor the effectiveness of new technologies and medicines, especially for small populations and rare diseases, as well as possible future indicators on cancer treatment stages, programme decree impacts, and nosocomial infections. While some indicators are already available and regularly measured, others would require further methodological development, improved coding or better data quality, and would therefore need to be treated as placeholder indicators. Overall, the session reinforced strong support for developing efficiency metrics that are grounded in quality, appropriateness and system performance rather than cost alone.
Technical Focus Group 4: Governance (online, July 2025)
This meeting brought together stakeholders from key health system, financing and statistical institutions in the Slovak Republic to discuss governance‑related indicators within the HSPA framework, including representatives from the National Health Information Centre, the Statistical Office of the Slovak Republic, health insurance companies, the Ministry of Finance, the Public Health Authority, AmCham, the MoH, and the OECD. The session began with presentations by the IZA and OECD teams on governance in HSPA, international approaches to its measurement, and examples of governance‑related indicators used in other countries, including Estonia and Belgium.
The discussion confirmed governance as an important dimension of the HSPA for the Slovak Republic, while also highlighting that no institution currently collects a regular set of governance‑specific indicators. Participants discussed system satisfaction, trust and preparedness as particularly relevant themes, and noted that some proxy measures already exist, including patient satisfaction surveys conducted by insurers and selected survey modules on unmet needs. Stakeholders also identified several possible indicators for future development, including crisis response time, satisfaction with and trust in the health system, and measures of system stability such as the average tenure of leadership positions. The discussion underlined that new primary data collection would likely be needed to support a robust governance measurement framework, while also pointing to international surveys as a possible interim source for selected indicators. Overall, participants agreed that governance is strategically important for the HSPA and that developing meaningful indicators in this area should remain a priority.
As part of the project’s capacity-building activities, a joint visit to the OECD headquarters in France and a study visit to Estonia were organised to support participating institutions in preparing for HSPA implementation and reporting. Both activities were also designed to promote shared learning, knowledge exchange between two countries, and expose national teams to practical experiences from OECD work and peer countries that have already progressed further in their HSPA journey.
Joint capacity building visit to the OECD (March 2025)
The joint visit to the OECD, held in March 2025, served as a capacity building and knowledge‑exchange activity for the Slovak and Luxembourgish teams. Reflecting the multi-country nature of the project, teams from both countries participated together in a structured programme of sessions with OECD experts. This joint format was intended to foster mutual learning, encourage exchange of perspectives and approaches to HSPA. The programme aimed to strengthen the countries’ understanding of OECD data, methodologies and indicators relevant to HSPA, the capacity of the participating countries in data analysis, visualisation, and indicator interpretation for policy use.
The 6 participants from the Slovak Republic represented the General Health Insurance Company, the Public Health Authority, the National Health Information Centre and the Institute for Health Analyses of the MoH.
The programme covered a broad range of policy-relevant areas underpinning HSPA, including health data collections and metadata standards, public health modelling, mental health performance assessment, data visualisation, health workforce statistics, patient-reported outcomes and experiences, long-term and integrated care, patient safety, climate change and health, digital health, and data governance. Through thematic sessions and practical examples, participants explored how OECD indicators, benchmarking tools and analytical models can support evidence‑based policymaking, improve measurement of outcomes and equity, and address emerging challenges such as workforce shortages, digital transformation and climate‑related health risks.
Throughout the visit, structured discussions and daily debriefs helped participants reflect on how OECD tools and approaches could be applied to their national HSPA frameworks. The final wrap-up highlighted key takeaways, areas for further work and the value of continued co‑operation between Luxembourg, the Slovak Republic and the OECD.
Study visit to Belgium
The study visit to Belgium served as a practical learning and peer-exchange activity, allowing stakeholders from the Slovak Republic to draw lessons from a country with a well-established HSPA system. The visit aimed to provide first-hand insight into how HSPA governance and implementation operate in practice, including how responsibilities are organised across institutions, how indicators and reports are produced and maintained over time, and how HSPA findings are communicated to policymakers and other stakeholders.
The Slovak delegation included representatives from the MoH, the National Health Information Centre, health insurers, and the Public Health Authority. During the visit, the delegation engaged in focussed discussions with Belgian counterparts from the Belgian Healthcare Knowledge Centre, the National Institute for Health and Disability Insurance, the federal MoH, Sciensano, and the European Commission. These exchanges covered the functioning and governance of the Belgian HSPA, stakeholder engagement, the development of a shared vision for HSPA, and the processes leading to the regular production and communication of HSPA reports. The visit provided Slovak participants with practical lessons for both framework development and future implementation, and helped build a shared understanding of how HSPA governance could be institutionalised in the Slovak Republic.