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The role of health ministries in their stewardship function is to steer the different factors influencing health so that health systems deliver better health to populations, reduce health inequalities, and ensure that safeguards are in place so that people do not become poor as a result of ill health.

Most countries in the WHO European Region have incorporated elements of health system performance assessment (HSPA) into their oversight. However, only very few have developed systems which have formalized and integrated all of its attributes with the potential to substantially drive performance improvement.

Table 1 presents an overview of the implementation of health system performance assessment in selected countries in the WHO European Region. Consistent with the approach presented above, these statistics review the characteristics of HSPA and identifies strengths and weaknesses in implementation. For example, a “-” score on the “regular, systematic and transparent” scale means that the HSPA is not released regularly or that the results are not shared broadly and transparently with health system stakeholders and the public at large. Conversely, a “+” score on the “link to health system performance management” column means that performance information is clearly linked to strategy, and that processes are in place to ensure that it is used systematically at different stages of the decision-making process, for policy development, resource allocation or accountability decisions. The “+/-” score indicates that the situation is still unclear.

Table 1. Overview of health system performance characteristics across select countries of the WHO European Region