Health system performance assessment in the WHO European Region: which domains and indicators have been used by Member States for its measurement?

The practice of health systems performance assessment (HSPA) varies across the WHO European Region. Consequently, there is a need for baseline information about HSPA across Member States. This review summarises HSPA domains and indicators used by Member States in their HSPA or health system-related reports. The evidence for this review was extracted through a purposive scoping analysis of online and publicly available health systems documents (e.g. national strategic plans for health or health systems, national HSPA reports, national health target reports) published in English by WHO European Region Member States from 2002 to 2015. Each document was reviewed to extract instances on the use of HSPA indicators and to analyse these in terms of the 14 domains of the WHO 2007 health system framework. Findings may be useful to identify similarities and differences in HSPA priorities across the Region, inform future comparative assessments of health systems and provide preliminary information for potential areas that WHO may need to further support to strengthen health systems at both national and regional levels. The efficacy and accessibility of an HSPA for health system partners and citizens will be increased if it is robust with well-defined indicators that can be used for comparisons with other systems. Decision-makers responsible for overseeing HSPA management will benefit from this synthesis to further strengthen existing practices.