Health System Performance Assessment (HSPA) frameworks have been developed and used increasingly across countries and regions, as a way to bring together stakeholders in the health sector to share common objectives and to support their work towards better health system performance. In 2021, the Ministry of Social Affairs of Estonia requested technical assistance from the European Commission and the OECD to support the process of developing a national HSPA framework, which would enable national authorities in Estonia to have a clear health information system governance and an agreement on a systematised list of health system monitoring indicators and objectives.
An effective Health System Performance Assessment (HSPA) framework should be comprehensive, encompassing all aspects of the system and its performance. It should incorporate both quantitative and qualitative indicators and should be able to serve as a basis for comparison and benchmarking with other countries, as well as for monitoring regional differences and inequalities. The framework should also be flexible enough to adapt to changing circumstances, such as technological advances and changing population and health needs.
A national HSPA framework should also be regularly updated to reflect the latest research, data and methodology, which requires an iterative process to ensure the right indicators are reported, in a manner that is accessible and useful to multiple stakeholders. Furthermore, the framework should be implemented in an objective, transparent, and consistent manner, and include quality assurance mechanisms, such as stakeholder review and consultation. Finally, an HSPA framework needs to be tailored to the needs of the specific country where it is implemented, so that the framework is relevant and meaningful for national priorities.
The health system performance assessment framework for Estonia is an important initiative that has been developed by the Estonian Ministry of Social Affairs alongside representatives from key stakeholders within the Estonian health system, with the OECD, and supported by the European Commission. The developed framework provides a multifunctional tool that allows monitoring of health system performance, transformation, and data to support decision making.