Health System Performance Assessment


Health System Performance Assessment (HSPA) frameworks have been developed and used increasingly across countries and regions, as a way to bring together stakeholders in the health sector to share common health system objectives and to support their work towards better health system performance.

An effective HSPA framework should be comprehensive, encompassing all aspects of a health system and its performance. It should incorporate both quantitative and qualitative indicators and should be able to serve as a basis for comparison and benchmarking with other countries, as well as for monitoring regional and socio economic differences. The framework should also be flexible enough to adapt to changing circumstances, such as changing policy priorities, developments in strategic policy objectives and plans, and developments in the health system itself, such as technological advances and changing population and health needs.


The national HSPA frameworks should reflect national priorities and thus each national HSPA is unique. The OECD is supporting countries to set up their national HSPAs tailored to their health policy needs and priorities.


Funded by the EU

The Health Division of the OECD and the DG REFORM of the European Commission are cooperating in providing technical support to countries to establish Health System Performance Assessment (HSPA) programs:
  • Health System Performance Assessment Framework for Estonia

The Health System Performance Assessment (HSPA) framework for Estonia acts as a tool for stakeholders and policy makers to guide health reforms in an evidence-based and targeted manner. This report outlines the Estonian HSPA framework and documents its development through a highly inclusive and consultative process. It also reports on indicators that were selected to populate the first Estonian HSPA report, their selection criteria and core methodologies, and describes the HSPA governance structure, implementation plan, and HSPA capacity building. The report provides a guideline to embed the HSPA in Estonian governance processes in a sustainable manner. Implementing the HSPA will improve systematised public reporting on the health system performance in Estonia, thus increasing transparency and accountability of stakeholders and public awareness and involvement in the health system policy making. 

As part of the project, the OECD carried out a series of workshops and focus group discussions, as well as supported local capacity-building to support the sustainability of the HSPA process. The project resulted in a report assessing the state of the national health information infrastructure and governance. This work was used to inform the development of the Estonian HSPA Framework, Methodology, and Governance plan, delivered at the end of the project (see above)

  • Health System Performance Assessment Framework for the Czech Republic

In mid-2021, the EU-supported project on development of HSPA framework for the Czech Republic was launched. The action was funded by the European Union via the Technical Support Instrument, and implemented by the OECD, in co-operation with the Directorate-General for Structural Reform Support of the European Commission. The present report is one of the key outputs of the Setting up a Framework for Health System Performance Assessment in the Czech Republic project. It describes in detail the final project version of the Czech HSPA framework, its domains and subdomains, and the indicators that were selected for the implementation of the first the Czech HSPA, which should follow up on this project. In addition, the report outlines the HSPA governance structure, agreed on by the main stakeholders, and details out the next steps in the HSPA implementation roadmap. Finally, the report takes stock of the Czech framework development process and the indicator selection process, which all contributed to the necessary HSPA capacity building in the country.

The Health Division of the OECD is also supporting the Dubai Health Authority in developing and implementing a new HSPA framework.

Dubai-HSPA-Framework Establishing a Health System Performance Assessment Framework for Dubai

The Dubai Health Authority of the United Arab Emirates requested technical assistance from the OECD to assess the state of the health information infrastructure and support the creation and implementation of a Health System Performance Assessment Framework. The initial project consisted of four parts: 1) the development of an HSPA framework for Dubai, 2) assessment of the health data infrastructure, 3) the selection of indicators, and 4) analysis and reporting of the first HSPA report.



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