This section describes the proposed the Czech HSPA governance structure that should ensure a smooth implementation of the newly designed and populated HSPA framework into practice. It starts by briefly presenting the context of the Czech health data custodian landscape (Section 5.1). Section 5.2 presents the proposed the Czech HSPA governance structure, which has been approved by the HLAB at its meeting in January 2023. Further, Section 5.3 links the proposed HSPA activities and outputs to the HSPA framework purpose.
Health System Performance Assessment Framework for the Czech Republic
5. The HSPA governance structure
5.1. Background on health data custodians
There are various institutions that feel a level of ownership of some health data and databases in the Czech Republic. All of them have been involved in the Setting up the Czech HSPA Framework project from the very beginning, both on the level of High-Level Advisory Board, and on the level of the Principal Working Group. Naturally, the HSPA governance structure is proposed to mirror the governance structure of this project, to build up on the established mutual collaboration and on reached HSPA-related agreements.
A background document was produced by the OECD team for one of the HSPA development workshops. The report described in detail the roles of various institutions within the Czech health data landscape and provided lists of currently reported indicators, by the Czech national institutions and in international context. Further, it analysed data flows and sharing between individual stakeholders and mapped the information landscape. For a summary and an overview of the Czech health data custodians, please see Annex E.
In August 2021, a legislation has been passed, amending the Act on Health Services, which introduced the so-called Resort Reference Statistics (RRS). The law mandates the Ministry of Health to define the RRS statistics in an accompanying legislation act and the RRS statistics will be then published by the UZIS. The by-law has not been passed yet (May 2023) and it has been discussed throughout the HSPA project how to link RRS definition and development to the HSPA framework development. As part of the HSPA project discussions, an agreement has been reached between the MoH and UZIS that HSPA indicators in the custody of UZIS would be listed among the Resort Reference Statistics, while the list of these statistics would be broader, covering areas and statistics also out of the scope of the HSPA.
5.2. HSPA governance proposal
The Czech HSPA framework has been designed to improve public reporting and report sharing, accountability of principal stakeholders, and public involvement, and at the same time to allow for reform planning and monitoring. This purpose has shaped the proposal for HSPA governance structures in the Czech Republic. At the same time, institutional continuity of the HSPA framework development project has been observed, which allows to build the HSPA governance on already established collaboration. Likewise, HSPA shall be a continuous activity, so the governance and its structures are designed to work in cycles.
The HSPA governance structure has 3 levels (Figure 5.1). At the top, there is the Executive Steering Board [Rada HSPA]. This body will be established by a Minister’s decree, which is a common legislative practice in the Czech Republic for advisory boards to the Ministers, as well as for steering boards of projects that involve more ministries, experts, and interested stakeholders. The HSPA Executive Steering Board would be designed in a similar manner as for instance the CZ-DRG Steering Board, which has a history of almost 5 years now.
The current members of the HLAB will become members of the HSPA Executive Steering Board. These include senior-level representatives from the Ministry of Health (MoH), Ministry of Finance (MoF), the Institute of Health Information and Statistics (ÚZIS), General Health Insurance Fund (VZP), Association of Health Insurance Funds, the Czech Statistical Office (CZSO), and the National Public Health Institute (SZÚ). The main task of the Executive Steering Board would be to define HSPA outputs and support their dissemination; to oversee HSPA implementation and to advise on targets; and to regularly reassess the HSPA scope and purpose. The last one would happen in parallel to approvals of HSPA indicator changes and refinement proposals by the HSPA Task Force (Figure 5.1).
Figure 5.1. The Czech HSPA governance structure
Source: The Czech HSPA project, HLAB meeting in January 2023.
The HSPA Task Force, located at the Ministry of Health and formed by the MoH core staff, would be the second governance layer of the Czech HSPA governance. It will be tasked by supporting the Executive Steering Board meetings and its decisions (by proposing indicator changes and refinements); reviewing indicator interpretation drafted by the Technical Groups; co‑ordinating the drafting process of the HSPA report and contributing to it; monitoring the national health policy and proposing changes or updates to the HSPA scope and purpose to the Steering Board; and organising the Stakeholder Conferences annually.
The third layer of the Czech HSPA governance structure is formed by the Technical Implementation Groups. There are more of these Groups, formed by the HSPA indicator custodians, de facto forming one Group at each indicator custodian organisation. In terms of number of indicators in its custody, the biggest Technical Implementation Group will be at the UZIS., followed by a group at the national Institute of Public Health (SZU), the Czech Statistical Office (CZSO), Ministry of Health (MoH), and the Health Insurance Bureau (KZP). There may be, however, particular areas of expertise where the Technical Implementation Group may seek expert advice from other stakeholders, such as the HIFs, MoF, or for instance for mental health the National Institute for Mental Health. The Technical Implementation Groups will develop agreed on HSPA outputs by drafting indicators’ technical sheets, calculate the indicators and provide their description, contextualisation and benchmarking, review indicator technical sheets drafted by other Technical Implementation Groups, and possibly also publish updates on the HSPA web platform.
5.3. Linking HSPA governance structures and outputs to the purpose of the HSPA framework
The Czech HSPA framework development process started by defining the national HSPA scope and purpose (see Section 2). To make sure the HSPA is implemented in line with its purpose, and to ensure that this alignment stays in place even during the implementation phase and the subsequent annual and 4‑year cycles, a mapping exercise was performed, linking the HSPA purpose to its governance structures and outputs. Depicted in Figure 5.2, this has been discussed with the HLAB during the January 2023 meeting.
Figure 5.2. The HSPA purpose linked to HSPA governance structures and outputs
Source: The Czech HSPA project, HLAB meeting in January 2023.
For additional information:
Annex E: Overview of the Czech health data custodians.
Policy and health data governance context
Health data infrastructure context