New HEN report emphasizes importance of indicators for assessing health system performance

A new Health Evidence Network (HEN) report was recently published to support decision-making for improved health system performance assessment (HSPA) in the WHO European Region. The report, entitled “Health system performance assessment in the WHO European Region: which domains and indicators have been used by Member States for its measurement?”, summarizes HSPA domains and indicators used by 30 Member States in their HSPA or health system-related reports. It serves as a tool for supporting WHO’s commitment to strengthening the foundations for evidence-informed policies aimed at health system development.

A great part of the world’s economic output is invested in health systems – in 2014, this amounted to approximately 10% of the world’s gross domestic product. Considering the role that health systems play in population health, decision-making that optimizes health system performance is crucial.

WHO’s work in this area has included the development of a common conceptual framework for HSPA to encourage the development of tools to measure its components, and to enhance collaboration between countries to facilitate mutual learning for improving the performance of health systems.

WHO/Europe has been supporting Member States in publishing their own HSPA reports, with 17 documented in 2016, and supports local capacity-building efforts with an HSPA manual for national and subnational analyses.

The new HEN report sheds light on current measurement practices in the Region. It identifies significant heterogeneity in the number of indicators reported per country, which range from 9 to 146. The domains most frequently covered by the indicators include service delivery and improved health, while only 20–30% of identified documents covered indicators in the domains of safety, efficiency, coverage or responsiveness.

Key considerations to strengthen the measurement of health system performance

To support health policy decision-makers across the Region to identify indicators and domains when carrying out HSPA, the authors outline the following policy considerations:

  • further clarity of the scope and function of HSPA domains could help in more effectively placing indicators that cut across domains (for example, finance, coverage or social and financial risk protection);
  • existing financing indicators could be expanded to cover issues within domains of access and coverage and improved efficiency;
  • the performance of services as related to the performance of the health system as a whole could be clearly conceptualized within HSPA frameworks, domains and indicators;
  • intermediary domains of access, coverage, quality and safety require appropriate and sufficient indicators to describe how performance of input and output of services are realized as intermediary outcomes;
  • safety could be conceptualized as a dimension of quality;
  • outcome measurement could be broadened from mortality towards quality of life and well-being (that is, patient-reported outcome measures); and
  • the domain of responsiveness could be operationalized in a more comprehensive/standardized manner and might be linked to the need for policies on citizen involvement and empowerment.

Relevance to evidence-informed policy-making

HSPA is critical in monitoring health system developments and providing data to improve accountability, equity and efficiency within health systems. Recognizing the importance of the use of evidence in health system development and health policy decision-making, Member States adopted the Action plan to strengthen the use of evidence, information, and research for policy-making in the WHO European Region in 2017.

In support of the Action plan and to improve international comparability and health system accountability and transparency, the knowledge management, evidence and research for policy-making programme (where the HEN Secretariat is located) in WHO/Europe’s Division of Information, Evidence, Research and Innovation commissioned and developed the latest HEN report.