Defining the purpose and scope at the start of an HSPA framework setting project is crucial to set clear objectives and boundaries, align stakeholders and ensure there is a common understanding of the HSPA aims. Section 2.1 outlines the process that led to the definition of the purpose and scope of the Estonian HSPA and its adoption by all stakeholders. Section 2.2 presents the Estonian HSPA purpose and scope and Section 2.3 outlines HSPA linkages with national strategies and health policy priorities.
Health System Performance Assessment Framework for Estonia
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2. The purpose and scope of the HSPA in Estonia
2.1. The process
The purpose and scope of the HSPA in Estonia were developed in consultation with the members of the project’s Principal Working Group and High-Level Advisory Board (HLAB). Discussions were opened at the project launch event on 21 October 2021, followed by various meetings and workshops held in Autumn 2021 to further elaborate on the purpose and scope definition (see Section 1.1). A dedicated exchange was held in January 2022 in the HLAB meeting to reach consensus on the final refinements to the purpose and scope. These were presented and discussed and endorsed by the principal working group at the framework development workshops held in Tallinn on 24‑25 May 2022. The purpose and scope of the Estonian HSPA were adopted to guide the development of the framework and select indicators, and to steer the implementation of the first round of the Estonian HSPA. During the HSPA framework development, extensive reference was made to the defined purpose and linkages to national health policy priorities (Section 2.3).
2.2. The defined purpose and scope of the HSPA in Estonia
The adopted purpose of the HSPA in Estonia is depicted in Figure 2.1. The HSPA aims to support stakeholders in achieving better health outcomes for the Estonian population, including increases in life expectancy, healthy life expectancy, and reductions in inequalities. These objectives are specified in the NHP 2020‑30 (Ministry of Social Affairs, 2021[4]) and are further elaborated in Annex B of this report. The Estonian HSPA aims to guide the establishment of common objectives between stakeholders, to allow for targeted and evidence‑based change management, and to improve the collection and utilisation of health data. As a result of HSPA reporting, public awareness of the population health status will improve, the health system will be more transparent while accountability of the stakeholders will increase.
The scope of the HSPA in Estonia mirrors the scope of the National Health Plan 2020‑30, the core document for strategy that covers the whole health system. Beyond healthcare (primary care, secondary care, long-term care etc.), health determinants such as healthy choices, health supportive environment and health literacy were considered within the scope of the assessment of Estonia’s health system.
Figure 2.1. The purpose of the Estonian HSPA
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Source: The Estonian HSPA framework project.
2.3. Linkage of the Estonian HSPA with key policy priorities
Strategic alignment between the purpose and scope of the HSPA and key policy priorities ensures its perception and use as a tool to enable better governance decisions, rather than a standalone technical exercise. Annex B discusses Estonia’s policy priorities outlined, including those outlined in the National Health Plan 2020‑30. The defined purpose and scope of the Estonian HSPA are linked to priorities and practical applications in governance, reporting, and impact assessment (see Table 2.1). Stakeholders with specific roles in working toward each of the objectives throughout the implementation cycles of the HSPA are specified in Section 4.2.
The Estonian HSPA addresses the need to monitor specific policy objectives and strategic goals outlined in various strategies to improve the health status of the population. The HSPA must be useful and operable, serving the purposes it was developed for, and thus the core objectives were kept in mind throughout the selection process of the indicators (see Section 3.3).
Table 2.1. Practical applications of the Estonian HSPA purpose and scope
Purpose and Scope |
Practical application |
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Common objectives |
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Change management |
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Public awareness |
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Transparency and accountability |
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Targeted data use |
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For additional information:
Annex B: Policy context and health system governance structures relevant to the Estonian HSPA
OECD (2022[2]), Situational Analysis Report: The Development of the Estonian Health System Performance Assessment Framework, https://www.oecd.org/health/Development-of-Estonian-Health-System-Performance-Assessment-Framework.pdf