Health system performance assessment (HSPA) plays an integral role in ensuring that health systems are high-performing and delivering quality care to their patients. It is a critical tool for healthcare policy makers and is used to ensure that services are meeting the needs of the population, patients, and healthcare providers. The Czech Republic lacked a HSPA framework, and national authorities regarded its development as a valuable approach for measuring and evaluating their health system. The project “Setting up a Framework for Health System Performance Assessment in the Czech Republic” fills this gap by developing a country specific HSPA framework, tailored to the Czech Republic needs and recognised by all health system stakeholders.
The HSPA framework for the Czech Republic is designed to help the Czech health system improve policy planning, monitoring, and decision taking. It resulted from close co‑operation between the Czech authorities and health system stakeholders, supported by the technical assistance of the OECD and funded by the European Commission. This report describes the HSPA framework for the Czech Republic, its development process, governance structure and implementation roadmap. It further provides details on the Czech HSPA framework domains, populated by indicators selected through a comprehensive and stakeholder-inclusive review process.
The purpose of the Czech HSPA is to enable the assessment of strengths and weaknesses of the Czech health system, also in the context of international comparisons, and to assess progress made over time. Its implementation will increase the accountability of national authorities and main health system stakeholders, improving public involvement, facilitating the flow of information across the health sector, and allowing reform planning and monitoring. A high-level advisory board, composed of main Czech health system stakeholders, regularly took note of the development of the HSPA framework, and approved its final version and related governance structures and implementation roadmap.
The Czech HSPA framework is composed of 12 domains grouped into 4 areas: Outcomes, Outputs, Processes, and Structures. The domains are further detailed into 28 subdomains, covering different aspects of the Czech health system to align with the defined HSPA purpose and scope. In total, there are 122 indicators populating the Czech HSPA framework, which were selected via a comprehensive multi-stage selection procedure and further clarified with health system stakeholders and health data custodians through written procedure and individual consultations. Most of the indicators are existing and often reported to international databases; there are some further 30 placeholders in different stages of development, missing either a developed methodology, or relevant national data, or both.
The selection process of indicators assessed both their fitness-for-use (data availability and readiness), and fitness-for-purpose (meaningfulness in terms of HSPA framework), along with their benchmarking possibilities for international comparison, regional comparison, and/or time series availability. Considering national health objectives and policy priorities, some HSPA indicators are directly related to strategic priority monitoring.
A governance structure for HSPA was designed to facilitate the co‑operation of stakeholders beyond the initial project that designed the framework. The implementation and daily use of the HSPA will be followed by three governance levels, with the Executive Steering Board on the top, formalised through a decree from the Ministry of Health and involving main health system stakeholders and data custodians. The co‑ordination body at the Ministry of Health will be complemented by technical groups established at the HSPA indicator custodian institutions. Annual stakeholder conferences should then ensure the continuous involvement of all health sector stakeholders in the HSPA.
The HSPA implementation roadmap is designed for the first 1.5 years of the implementation process, leading to the launch of the first full Czech HSPA report in January 2025, and for subsequent 4‑year cycles. The continuity of HSPA has been stressed in its design, allowing for activities taking place regularly. Sustainability of the HSPA process is to be achieved via regularly provided feedback and further HSPA framework refinement to respond to changing policy priorities.
The list of indicators selected in the comprehensive process during the Setting up of the Czech HSPA Framework project shall serve as an input for the HSPA implementation phase. Therefore, this is to serve as a reference guide, providing detailed information on each indicator’s possible data disaggregation, benchmarking, methodology, primary data source, data custodian, and indicator custodian, accompanied by identifications of areas where further discussion is needed. Further discussions among HSPA stakeholders are foreseen to develop detailed indicator technical sheets during the implementation phase.
In its effort to establish a national HSPA, the Czech Republic is joining other countries which have been using, or are developing, their own HSPA frameworks. Due to the decentralised nature of the Czech health system, a broad stakeholder involvement in the framework development process was identified as a critical success factor. The report thus takes stock of the Czech framework development and the indicator selection process, which all contributed to the necessary HSPA capacity building in the Czech Republic.
