Engaging citizens in the development of a health system performance assessment framework: a case study in Ireland

Background The launch in 2017 of the Irish 10-year reform programme Sláintecare represents a key commitment in the future of the health system. An important component of the programme was the development of a health system performance assessment (HSPA) framework. In 2019, the Department of Health of Ireland (DoH) and Health Service Executive (HSE) commissioned the technical support of researchers to develop an outcome-oriented HSPA framework which should reflect the shared priorities of multiple stakeholders, including citizens. This study describes the method applied in the Irish context and reflects on the added value of using a citizen panel in the development of an HSPA framework. Methods A panel of 15 citizens was convened, recruited by a third-party company using a sampling strategy to achieve a balanced mix representing the Irish society. Panellists received lay-language preparatory materials before the meeting. Panellists used a three-colour scheme to signal the importance of performance measures. An exit questionnaire was administered to understand how participants experienced being part of the panel. The citizen panel was the first in a series of three panels towards the development of the HSPA framework, followed by panels including representatives of the DoH and HSE, and representatives from professional associations and special interest groups. Results The citizen panel generated 249 health performance measures ranging across 13 domains. Top-ranking domains to the citizen panel (people-centredness, coordination of care, and coverage) were less prioritized by the other panels; domains less prioritized by the citizen panel, such as accessibility, responsiveness, efficiency, and effectiveness, were of higher priority in the other panels. Citizen panellists shared a similar understanding of what a citizen panel involves and described their experience at the panel as enjoyable, interesting, and informative. Conclusions The priorities of the citizen panel were accounted for during all phases of developing the HSPA framework. This was possible by adopting an inclusive development process and by engaging citizens early on. Citizen engagement in HSPA development is essential for realizing citizen-driven healthcare system performance and generating trust and ownership in performance intelligence. Future research could expand the use of citizen panels to assess, monitor, and report on the performance of healthcare systems.

Framework for assessing the performance of the Ghanaian health system: study protocol

Background Assessing the performance of health systems through quantitative and qualitative methods is recognized as an effective approach to strengthening national health systems. However, while many high-income countries have institutionalized health system performance assessment (HSPA) as an integral component of their respective health systems, few studies on HSPA have been documented in low- and middle-income countries, including Ghana. This study aims at providing a comprehensive framework for periodic assessment of the performance of the entire health system in Ghana. Methods The study will have four work packages. First, a structured review will be conducted to identify both international and national HSPA frameworks that could be applied to the Ghanaian context. Second, based on the structured review, an assessment framework tailored to the Ghanaian health system context will be developed. Third, the draft framework will be presented and discussed with experts and stakeholders for its appropriateness, feasibility and acceptability. Finally, the framework will be piloted to assess its effectiveness and suitability for full-scale implementation. Discussion Currently, Ghana does not have a full-fledged HSPA tool that provides a holistic health sector-wide approach to assessing health system performance. Thus, developing this HSPA framework for the country will provide a tool for periodic and comprehensive assessment of the performance of the health system, which can be compared with that of other countries. Such a comparison will offer the opportunity for mutual learning and for exploring new options for formulating more effective national health policies. As this is expected to be the first attempt to develop a comprehensive HSPA framework in Ghana, this study will provide a basis for future discussions on how to further develop and implement HSPA programmes in the country.

Inter-state Disparities of Efficiency in Foreshortening Under-five Mortality Rate in Rural India

The present study aims to assess the efficiency of the rural health system to foreshorten the under-five (U5) mortality rates across Indian states. The study further attempts to pinpoint the factors responsible for state-level inefficiency of the rural health system performance. The empirical results reveal that among the Indian states, Kerala is the most-efficient in foreshortening the U5 mortality rate. The results convey that the states with better health indicators may not have efficient health systems. The study concludes that along with investment in the health sector, efficient management of the investment is intrinsic to better health outcomes.

Investigation of the frequency of rabies in EMRO countries: A review study

Objective: Rabies is a dangerous zoonotic infectious disease. Dog bites cause 99% of all human deaths from rabies. In Europe and North America, however, with the successful control of rabies in dogs, the wild cycle of rabies is the major and dominant cycle of disease. According to the WHO classification, the Eastern Mediterranean Regional Office (EMRO) countries are divided into population health laws, health system performance, and health spending levels. This review aimed to evaluate the epidemiology of rabies in the EMRO countries in these three categories. Methods: In this study, using some search engines (PubMed, Scopus, and Google Scholar) were searched about the frequency of rabies in EMRO countries without considering the time and related content. Results: In some parts of the world, including most countries in the region, EMRO, rabies is endemic and a serious problem for human and animal health. Conclusions: According to the global strategic plan to end human deaths from rabies by 2030, all the countries in the EMRO region and the international organizations such as WHO, OIE, etc., must take the necessary measures to control this disease. Regional and global cooperation, and comprehensive and effective policies, are required to solve this issue. Keywords: rabies; surveillance; epidemiology.

9.I. Workshop: Health systems performance – making the links between what we do and what we want to achieve

In this session, WHO together with the UHC2030 Technical Working Group on Health System Assessment and the European Observatory on Health Systems and Policies discuss the main elements of their joint approach to HSPA. The workshop intends to propose a common and practical framework that links descriptive health system analysis with evaluation, focussing on health system outcomes. The framework's approach to uncovering health system challenges and bottlenecks and the sources of variation will be discussed - showcasing how Health System Performance Assessment can be used as a means to uncover sources of health system inefficiencies and inequities. The workshop intends to identify the links between intermediate and ultimate goals and relate these to specific actions and actors within a health system, thus providing policy makers with an actionable tool to assess performance. The session is structured into two parts. In the first part the process of developing the HSPA framework and the framework itself will be introduced. The presentation will provide insights into the joint framework based on health system functions and emphasise the links to the intermediate and final goals of the HSPA framework. This will be followed by four short case studies pertaining to the four functions - governance, financing, resource generation and service delivery - and linking specific assessment areas to intermediate and final goals. The second part is an interactive discussion, to be kicked off by the input of Kanitsorn Sumriddetchkajorn and moderated by Josep Figueras, to jointly identify the strengths and weaknesses in performance of a given health system. Key messages Health Systems Performance Assessments should focus on what health systems do and how well, rather than on what they are. Health System Performance Assessment should focus on performance and use their evaluative angle to get to the root causes of not achieving final health system goals.

How would the HSPA framework play out in practice? ‘Cross-sectoral collaboration (Governance)'

The presentation will discuss housing as a social determinant of health. It will highlight how housing links to health system performance and thus demonstrate how contextual factors, usually placed outside the health system's boundaries, impact on intermediate outcomes and final goals.

Engaging citizens in the co-production of a health system performance assessment framework: a case study in Ireland

Background The launch in 2017 of the Irish 10-year reform programme Sláintecare represents a key commitment in the future of the health system. An important component of the programme was the development of a health system performance assessment (HSPA) framework. In 2019, the Department of Health of Ireland (DoH) and Health Service Executive (HSE) commissioned the technical support of researchers to develop an outcome-oriented HSPA framework, which should reflect the shared priorities of multiple stakeholders, including citizens. This study describes the method applied in the Irish context and reflects on the added value of using a citizen panel in the co-production of an HSPA framework. Methods A panel of 15 citizens was convened, recruited by a third-party company using a sampling strategy to achieve a balanced mix representing the Irish society. Panelists received lay-language preparatory materials prior to the meeting. Panelists used a three-color scheme to signal the inclusion and importance of performance measures. An exit questionnaire was administered to understand how participants experienced being part of the panel. The citizen panel was the first in a series of three panels towards the development of the HSPA framework, followed by panels including representatives of the DoH and HSE, and representatives from professional associations and special interest groups. Results The citizen panel generated 249 health performance measures ranging across 13 domains. Domains assessed as the most important included people-centeredness, coordination of care, and coverage. Prioritization of domains differed between panels. Citizen panelists shared a similar understanding of what a citizen panel involves and described their experience at the panel as enjoyable, interesting, and informative. Conclusions The engagement of citizens early on in the co-production process of the HSPA framework shaped the processes that followed, with the restating of priorities of the citizen panel informing decision-making throughout. Citizen engagement in HSPA development is essential for realizing value-based people-centered health systems and assuring an inclusive process that helps to generate trust and ownership of performance intelligence. Future research could expand on how citizen panels could be further engaged in co-creating mechanisms to assess, monitor, and report on the performance of health care systems.