WHO Health Systems Performance Assessment^[1]

The term health system performance assessment describes a series of activities including:

• Measuring the health system’s contribution to socially desirable goals;
• Measuring the health system and non-health system resources used to achieve these outcomes;
• Estimating the efficiency with which the resources are used to attain these outcomes;
• Evaluating the way the functions of the system influence observed levels of attainment and efficiency;
• Designing and implementing policies to improve attainment and efficiency and monitoring the effect.

It is important to be able to measure and compare performance over time in order for countries to monitor their own performance and to modify their policies as necessary. To enable countries to learn from the experience of others, it is necessary to be able to compare performance across settings thereby identifying what types of policies have been associated with high performance.

Performance assessment and comparison is not new. Countries and international agencies routinely report estimates of life expectancy, GDP and health expenditures, for example. The World Health Report 2000 presented a new framework for assessing health system performance, but the approach builds on the work of many other people and agencies, and existing reporting exercises.

With the framework, WHO is trying to set out a more comprehensive, explicit and systematic basis for making comparisons over time within a country and across settings.

World Bank: Health Sector Review
 Accessing individual country health sector assessments requires accessing each country’s website separately. Search by country and “health system” in the World Bank search bar.

As part of its Flagship Course on Health Sector Reform and Sustainable Financing, the World Bank Institute presented a Discussion Paper at a Special Lunch Session “Health System Analysis: Lessons from Recent World Bank Experience” by Ricardo Bitran, Bitran y Associados and Peter Berman, Lead Economist, HDNHE.

This presentation shared results of a recent review of the Bank’s experience with comprehensive analysis of health systems, which looked at frameworks, methods, results, and how results were used by countries and development partners. “Health System Analysis” could be an important step for countries to develop strategies for health system strengthening^[2].

PAHO: Health Systems Profiles^[3]
Until 1998, a report on the health system of each country of the Region of the Americas that systematically provided a succinct and analytical description of the structure and dynamics of each country’ s health system was not available. The countries of the Region expressed the need to have methodological guidelines that would facilitate the preparation and periodic updating as well as to monitor and evaluate health sector reform processes. (CD41.R12)

The following Health Systems Profiles have resulted from the application by the country technical levels of the Guidelines for the Preparation of Health Systems Profiles for the Countries of the Region. The Profile does not contain an exhaustive analysis of all possible subjects or of all the subjects it deals with. It refers only to the relevant aspects of selected subjects considered indispensable by the countries.

Detailed analyses of the subjects included (or of others not included) are possible and, in many cases, necessary, and they can be addressed subsequently by the countries. The concise nature and periodic updating of the Profile has made the Health Systems Profile a valuable tool for decision-makers at the national, sub-national, and international level. This is particularly relevant at a time when the strengthening of the steering role of the ministries of health has become an important item in the countries health agenda.

Association of Public Health Observatories
The Association of Public Health Observatories (APHO) represents and co-ordinates a network of 12 public health observatories (PHOs) working across the five nations of England, Scotland, Wales, Northern Ireland and the Republic of Ireland. APHO looks at indicators of public health in the English regions:

• population health status,
• priority public health interventions,
• effectiveness of partnerships,
• risk factors and determinants,
• public health capacity.

Includes a lot of statistical analysis with confidence intervals and adjusting for confounders such as deprivation.

The European Observatory on Health Systems and Policies
The European Observatory on Health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of the dynamics of health care systems in Europe^[4].

They produce HiTs, Health System Country profiles. HiTs are country-based reports that provide a detailed description of each health care system and of reform and policy initiatives in progress or under development. Each profile is produced by country experts in collaboration with the Observatory’s research directors and staff. In order to facilitate comparisons between countries, the profiles are based on a template, which is revised periodically.