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(1) Background: The aim of this study is to provide a better understanding of the requirements to improve routine health information systems (RHISs) for the management of health systems, including the identification of best practices, opportunities, and challenges in the 53 countries and territories of the WHO European region. (2) Methods: We conducted an overview of systematics reviews and searched the literature in the databases MEDLINE/PubMed, Cochrane, EMBASE, and Web of Science electronic databases. After a meticulous screening, we identified 20 that met the inclusion criteria, and RHIS evaluation results were presented according to the Performance of Routine Information System Management (PRISM) framework. (3) Results: The reviews were published between 2007 and 2020, focusing on the use of different systems or technologies and aimed to analyze interventions on professionals, centers, or patients’ outcomes. All reviews examined showed variability in results in accordance with the variability of interventions and target populations. We have found different areas for improvement for RHISs according to the three determinants of the PRISM framework that influence the configuration of RHISs: technical, organizational, or behavioral elements. (4) Conclusions: RHIS interventions in the European region are promising. However, new global and international strategies and the development of tools and mechanisms should be promoted to highly integrate platforms among European countries.

This article aims to provide information to public agencies and policymakers on the determinants of health systems and their relationships that influence citizens’ health–disease status. A total of 61 indicators for each of 17 Spanish autonomous communities were collected from the Spanish Ministry of Health, Social Services, and Equality between 2008 and 2017. The applied technique was partial least squares structural equation modeling (PLS-SEM). Concerning health–disease status, an influence of sustainability and performance on the health system was hypothesized. The findings revealed that health system sustainability had a negative effect on health–disease status, measured in terms of disease incidence. However, the relationship between health system performance and health–disease status is positive. Furthermore, health system performance mediates the relationship between sustainability and health–disease status. According to our study, if we consider the opposite poles that make up the definition of health–disease status (well-being and disease), this concept is defined more by the incidence of the negative aspect.

Vietnam has achieved impressive improvements in its health outcomes over the last few decades. Life expectancy has increased significantly over the years, and mortality rates have declined substantially. The prevalence of chronic, noncommunicable diseases (NCDs) in Vietnam has also risen sharply. These trends imply a shift in the health needs of Vietnam’s population away from acute episodic care, towards disease management for NCDs. Ensuring that care is appropriate for the changing needs of the population, including older persons, will require a paradigm shift in the way services are delivered. Today, Vietnam’s health service delivery system is hospital-centric, which is both expensive and not well-suited to the management of chronic conditions and NCDs. An important contributor to the persistence of the hospital-centric model of service delivery and hospital overcrowding is a weak primary health care (PHC) system, especially for NCD management. In theory, most patients with NCDs and chronic conditions can be managed in the community, where care is closer to home, more appropriate, and cheaper. Putting this into practice in Vietnam will entail a new orientation in health service delivery - one which focuses on shifting the delivery of low complexity care out of hospitals to PHC and other intermediate units. Globally, there has been a push towards service delivery models which are more responsive to individual health needs and can deliver the right care in appropriate settings. Such service models typically promote a person-centered approach and involve integration of care.

The aim of the article is to compare health system outcomes in the BRICS countries, assess the trends of their changes in 2000-2017, and verify whether they are in any way correlated with the economic context. The indicators considered were: nominal and per capita current health expenditure, government health expenditure, gross domestic product (GDP) per capita, GDP growth, unemployment, inflation, and composition of GDP. The study covered five countries of the BRICS group over a period of 18 years. We decided to characterize countries covered with a dataset of selected indicators describing population health status, namely: life expectancy at birth, level of immunization, infant mortality rate, maternal mortality ratio, and tuberculosis case detection rate. We constructed a unified synthetic measure depicting the performance of individual health systems in terms of their outcomes with a single numerical value. Descriptive statistical analysis of quantitative traits consisted of the arithmetic mean (xsr), standard deviation (SD), and, where needed, the median. The normality of the distribution of variables was tested with the Shapiro-Wilk test. Spearman's rho and Kendall tau rank coefficients were used for correlation analysis between measures. The correlation analyses have been supplemented with factor analysis. We found that the best results in terms of health care system performance were recorded in Russia, China, and Brazil. India and South Africa are noticeably worse. However, the entire group performs visibly worse than the developed countries. The health system outcomes appeared to correlate on a statistically significant scale with health expenditures per capita, governments involvement in health expenditures, GDP per capita, and industry share in GDP; however, these correlations are relatively weak, with the highest strength in the case of government's involvement in health expenditures and GDP per capita. Due to weak correlation with economic background, other factors may play a role in determining health system outcomes in BRICS countries. More research should be recommended to find them and determine to what extent and how exactly they affect health system outcomes.

The main aim of this study was to analyse the association between non-clinical factors and the self-reported experience of people with the main health services of the Spanish public healthcare system. Specifically, we analysed whether factors such as the treatment received from health staff, the confidence transmitted to the patient by the doctor, or waiting time for a diagnostic test had an influence on people reporting a more satisfactory experience with primary, specialised, and hospital care services. We used cross-sectional microdata from the Spanish Healthcare Barometer survey of 2015 comprising a sample of 7800 individuals. We applied a probit-adapted ordinary least squares estimation, which is one of the most widely used methods in recent studies on subjective well-being. Our findings suggest that individuals&rsquo, interaction with non-clinical factors was positively correlated with the overall health services experience. Treatment received from health staff was one of the most relevant factors to ensure that individuals report a more satisfactory experience with primary care. Time devoted by physicians to each patient and waiting time for a non-emergency admission were the most correlated factors in specialised and hospital care services, respectively. This study could have implications for public policies. First, it shows policy-makers the influence of non-clinical factors when individuals rate their overall experience with the main health services in Spain. Second, it identifies the key factors where the health system could reallocate more public resources to improve people&rsquo, s experience and thus the health system responsiveness.

—Health systems are not easy to benchmark, in part because the health sector produces more than one outcome. This article offers two ways of benchmarking the health systems of countries in the Middle East and North Africa (MENA) focusing on two different outcomes, health status and financial protection. The first approach is by measuring the gap between predicted health outcomes based on country socioeconomic status and actual health outcomes. The second approach is by simply comparing the levels of out-of-pocket (OOP) spending in MENA countries. The article offers some interesting findings about the large heterogeneity in both health system outcome achievements despite considerable cultural and linguistic similarities in the region. Moreover, three discrete clusters of countries are found on the health status measure. The findings also give specific health system target outcomes for MENA countries to focus their reform efforts.

Background Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. Method We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. Findings Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR = 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR = 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR = 2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR = 1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII = 7.45 vs 1.64). Conclusion Our findings suggest that urban areas have achieved better prevention and management of non-communicable disease than rural areas, but access to healthcare was equivalent. A better understanding of the causes of the observed variations is needed to develop appropriate policy interventions which address these disparities.

Background Globally, good health system performance has resulted from continuous reform, including adaptation of Decentralisation by Devolution policies, for example, the Direct Health Facility Financing (DHFF). Generally, the role of decentralisation in the health sector is to improve efficiency, to foster innovations and to improve quality, patient experience and accountability. However, such improvements have not been well realised in most low- and middle-income countries, with the main reason cited being the poor mechanism for disbursement of funds, which remain largely centralised. The introduction of the DHFF programme in Tanzania is expected to help improve the quality of health service delivery and increase service utilisation resulting in improved health system performance. This paper describes the protocol, which aims to evaluate the effects of DHFF on health system performance in Tanzania. Methods An evaluation of the effect of the DHFF programme will be carried out as part of a nationwide programme rollout. A before and after non-controlled concurrent mixed methods design study will be employed to examine the effect of the DHFF programme implementation on the structural quality of maternal health, health facility governing committee governance and accountability, and health system responsiveness as perceived by the patients’ experiences. Data will be collected from a nationally representative sample involving 42 health facilities, 422 patient consultations, 54 health workers, and 42 health facility governing committees in seven regions from the seven zones of the Tanzanian mainland. The study is grounded in a conceptual framework centered on the Theory of Change and the Implementation Fidelity Framework. The study will utilise a mixture of quantitative and qualitative data collection tools (questionnaires, focus group discussions, in-depth interviews and documentary review). The study will collect information related to knowledge, acceptability and practice of the programme, fidelity of implementation, structural qualities of maternal and child health services, accountability, governance, and patient perception of health system responsiveness. Discussion This evaluation study will generate evidence on both the process and impact of the DHFF programme implementation, and help to inform policy improvement. The study is expected to inform policy on the implementation of DHFF within decentralised health system government machinery, with particular regard to health system strengthening through quality healthcare delivery. Health system responsiveness assessment, accountability and governance of Health Facility Government Committee should bring autonomy to lower levels and improve patient experiences. A major strength of the proposed study is the use of a mixed methods approach to obtain a more in-depth understanding of factors that may influence the implementation of the DHFF programme. This evaluation has the potential to generate robust data for evidence-based policy decisions in a low-income setting. Electronic supplementary material The online version of this article (10.1186/s12961-018-0400-3) contains supplementary material, which is available to authorized users.

Background: Quality indicators are quality assurance instruments for the evaluation of mental healthcare systems. Quality indicators can be used to measure the effectiveness of mental healthcare structure and process reforms. This project aims to develop quality indicators for mental healthcare systems in Bulgaria, the Czech Republic, Hungary and Serbia to provide monitoring instruments for the transformation of mental healthcare systems in these countries. Methods: Quality indicators for mental healthcare systems were developed in a systematic, multidisciplinary approach. A systematic literature study was conducted to identify quality indicators that are used internationally in mental healthcare. Retrieved quality indicators were systematically selected by means of defined inclusion and exclusion criteria. Quality indicators were subsequently rated in a two-stage Delphi study for relevance, validity and feasibility (data availability and data collection effort). The Delphi panel included 22 individuals in the first round, and 18 individuals in the second and final round. Results: Overall, mental healthcare quality indicators were rated higher in relevance than in validity (Mean relevance=7.6, SD=0.8; Mean validity=7.1, SD=0.7). There was no statistically significant difference in scores between the four countries for relevance (X2(3)=3.581, p=0.310) and validity (X2(3)=1.145, p=0.766). For data availability, the appraisal of “YES” (data are available) ranged from 6% for “assisted housing” to 94% for “total beds for mental healthcare per 100,000 population” and “availability of mental health service facilities”. Conclusion: Quality indicators were developed in a systematic and multidisciplinary development process. There was a broad consensus among mental healthcare experts from the participating countries in terms of relevance and validity of the proposed quality indicators. In a next step, the feasibility of these twenty-two indicators will be evaluated in a pilot study in the participating countries.

Insufficient growth during childhood is associated with poor health outcomes and an increased risk of death. Between 2000 and 2015, nearly all African countries demonstrated improvements for children under 5 years old for stunting, wasting, and underweight, the core components of child growth failure. Here we show that striking subnational heterogeneity in levels and trends of child growth remains. If current rates of progress are sustained, many areas of Africa will meet the World Health Organization Global Targets 2025 to improve maternal, infant and young child nutrition, but high levels of growth failure will persist across the Sahel. At these rates, much, if not all of the continent will fail to meet the Sustainable Development Goal target—to end malnutrition by 2030. Geospatial estimates of child growth failure provide a baseline for measuring progress as well as a precision public health platform to target interventions to those populations with the greatest need, in order to reduce health disparities and accelerate progress., Geospatial estimates of child growth failure in Africa provide a baseline for measuring progress and a precision public health platform to target interventions to those populations with the greatest need.

A growing body of research suggests that the quantity and quality of structural inputs of education and healthcare services such as infrastructure, classroom and medical supplies, and even teacher and medical training are largely irrelevant if teachers and healthcare providers do not exert the requisite effort to translate these inputs into effective teaching and medical service. To exert adquate effort, providers must feel they are accountable for the quality of service they provide. Yet a sense of accountability among providers does not necessarily occur naturally, often requiring mechanisms to monitor and incentivize provider effort. The literature on improving provider accountability has under-emphasized the role of monitoring practices by school principals and chief medical officers. This study begins to fill this gap by investigating the role of within-facility accountability mechanisms in the education and health sectors of Jordan. To do this, an analysis of existing and original data from these sectors was conducted in which the association of within-facility monitoring and provider effort was quantified. The results indicate that within-facility monitoring is underutilized in both sectors and is a consistent predictor of higher provider effort.

Objective Health data constitute a significant resource in most OECD countries that could be used to improve health system performance. Well-intended policies to allay concerns about breaches of confidentiality and to reduce potential misuse of personal health information may be limiting data use. A survey of 20 OECD countries explored the extent to which countries have developed and use personal health data and the reasons why data use may be problematic in some. Results Countries are divided, with one-half engaged regularly in national data linkage studies to monitor health care quality. Country variation is linked to risk management in granting an exemption to patient consent requirements; in sharing identifiable data among government authorities; and in project approvals and granting access to data. The resources required to comply with data protection requirements is a secondary problem. The sharing of person-level data across borders for international comparisons is rarely reported and there were few examples of studies of health system performance. Discussion Laws and policies enabling data sharing and data linkage are needed to strengthen national information infrastructure. To develop international studies comparing health care quality and health system performance, actions are needed to address heterogeneity in data protection practices.

Objective: To improve previous approaches to health system goals valuation. Methods: We reviewed literature on health system performance and previous comparative performance assessments, and combined this with literature on process utility to create a theoretical foundation for health system goals. We used a discrete choice experiment to elicit goal weights. To obtain social justice weights respondents were placed behind a 'veil of ignorance'. To ensure that respondents understood their task, we instructed them in a classroom setting. Results: We identified five health system goals. All five goals significantly affected choice behavior. An equitable distribution of health obtained the highest weight (0.34), followed by average level of health (0.29) and financial fairness (0.24). Both process outcomes (utility derived from the process and its distribution) received much lower weights (0.07 and 0.06, respectively). Conclusions: Our framework adds to that of the World Health Organization. We demonstrated the feasibility of measuring societal valuation of health system goals with a multi-attribute technique based on trade-offs. Our weights placed much greater emphasis on health and health inequality than on process outcomes. Our study improves the methodology of international health system performance comparison and thereby enhances global evidence-based health policy information. © 2013 The Authors.

OBJECTIVE: Avoidable mortality trends over the period 1994-2009 were calculated to evaluate health intervention by the health system of Umbria, a region of central Italy. MATERIALS AND METHODS: Mortality data were supplied by the regional causes of death registry. Rates were standardized to the 2001 census Italian population. Joinpoint regression was used to analyze the trends. RESULTS: Overall avoidable mortality rates decreased significantly both in males (-3.9% per year) and in females (-3.6% per year). Mortality rates from ischemic heart and cerebrovascular disease about halved in the study period in both sexes. Avoidable mortality increased slightly only for a few causes (e.g. lung cancer in females). CONCLUSION: The overall trend of avoidable mortality indicates that the regional health/ preventive system is performing well.

Este artigo apresenta uma revisão da Matriz de Dimensões da Avaliação do Sistema de Saúde no Brasil desenvolvida em 2003, e uma atualização conceitual de parte das subdimensões de avaliação do desempenho dos serviços de saúde: efetividade, acesso, eficiência e adequação. Descreve o processo de seleção dos indicadores utilizados e uma síntese dos resultados para cada subdimensão do desempenho. O comportamento dos indicadores utilizados para avaliar o desempenho dos serviços de saúde no Brasil, no que se refere às quatro subdimensões selecionadas, não é uniforme e as melhorias mais acentuadas são observadas naquelas influenciadas pela atuação dos serviços no campo da atenção primária, as melhorias mais significativas foram observadas nas Efetividade e Acesso. Em relação à Eficiência dos serviços de saúde coexistem situações de alta eficiência com outras de baixo desempenho. A atuação dos serviços de saúde na subdimensão Adequação foi pior do que nas demais apresentadas.This paper presents a review of the Dimension Matrix for Evaluation of the Brazilian Health System that was initially developed in 2003, as well as a conceptual update of some of the sub-dimensions for the evaluation of health service performance, namely effectiveness, access, efficiency and appropriateness of health care. It also describes the indicator selection process as well as the results obtained in each performance dimension. The behavior of the indicators used to assess the performance of health services in Brazil, with respect to each sub-dimension, was not uniform. Areas of marked improvement were found in indicators that are influenced by activities in the field of primary care. The most significant improvements were seen in the sub-dimensions of Effectiveness and Access. With respect to the Efficiency of health services, situations of high efficiency coexist with others with substandard performance. The performance of health services in the sub-dimension of Appropriateness of Health Care was the lowest of all indicators.

Summary The paper explores the use of anchoring vignettes as a means to adjust survey reports of health system performance for differential reporting behaviour by using data contained within the World Health Survey. Survey respondents are asked to rate their experiences of health systems across a number of domains on a five-point categorical scale. Using data provided through a set of vignettes we investigate variations in reporting of interactions with health services across both sociodemographic groups and countries. We show how the method of anchoring vignettes can be used to enhance cross-country comparability of performance. Our results show large changes in the rankings of country performance once adjustment for systematic country level reporting behaviour has been undertaken compared with a ranking based on raw unadjusted data.

Conference paper published at the proceedings of the4th International Conference on Disaster Management and Human Health.

Relative to other comparable income and health spending countries, Bulgaria has more physicians per capita. Bulgaria’s physician to population ratio increased from 2.5 in 1980 to 3.8 physicians per 1000 population in 2011. The physician to population ratio is comparable to the EU-12 average of 3.8 physicians per 1000 population in 2012 but is higher than the EU-15 average of 3.1 physicians per 1000 population in 2012. Bulgaria has achieved significant improvements in health outcomes over time but is still falling behind most EU countries on key health indicators. Infant mortality decreased from 24.5 in 1980 to 10.5 per 1,000 live births in 2012 (Figure 5). Infant mortality in Bulgaria is slightly lower relative to other comparable income and health spending countries. Despite the significant reduction, however, Bulgaria’s infant mortality rate is still more than three times higher than the EU-15 average of 3.2 infant deaths per 1000 live births and almost twice as high as the EU-12 average of 5.5 infant deaths per 1000 live births. More significant improvements were achieved in reducing maternal mortality, which fell from 24 deaths per 100,000 live births in 1990 to 8 deaths per 100,000 live births in 2010. The maternal mortality ratio in Bulgaria is low compared to the global averages relative to income and health spending. Bulgaria has surpassed the EU-12 average of 11.3 deaths per 100,000 live births and is approaching the EU-15 average of 7.6 deaths per 100,000 live births.

This policy note summarizes the central health sector trends and challenges in the Gulf Cooperation Council (GCC) countries of the Middle East and North Africa region (MENA). These countries are Saudi Arabia, Kuwait, Bahrain, the United Arab Emirates (UAE), Oman, and Qatar. The note also provides an overview of the GCC country context, discussing the commonalities between the six member states, and the major areas of engagement by the health, nutrition, and population (HNP) global practice of the World Bank in support of the health sector reform priorities of these countries. The areas of engagement focus on three main clusters of work: (i) developing multi-layered solutions for improving non-communicable disease and road safety outcomes; (ii) health system strengthening; and (iii) integrating health policy solutions within the wider institutional and policy frameworks in the GCC countries. The note builds on an earlier HNP regional strategy prepared by the World Bank in 2013 focusing on the concepts of fairness and accountability. The strategy highlighted the importance of improvements in health system performance in MENA countries from an equity, accountability, and fiscal sustainability perspective. The framework of the strategy covers equity in health status, financial protection and responsiveness, and the accountability of populations, payers, and health service providers interacting within the health system.

Diagnosis-Related Group (DRG) systems across Europe are very heterogeneous, in particular because of different classification variables and algorithms as well as costing methodologies. But, given the challenge of increasing patient mobility within Europe, health systems are forced to incorporate a common patient classification language in order to compare and identify similar patients e.g. for reimbursement purposes. Beside the national adoption of DRGs for a wide range of purposes (measuring hospital activity vs. paying hospitals), a common DRG system can serve as an international communication basis among health administrators and can reduce the national development efforts as it is demonstrated by the NordDRG consortium.

Este artigo é uma síntese de alguns dos principais resultados das discussões realizadas ao longo de 18 meses entre pesquisadores de diversas instituições, afiliadas à Abrasco, e procura contribuir para a formulação de uma metodologia que permita: a) compreender quais são e como se inter-relacionam os fatores que influenciam a eficiência, a efetividade e a eqüidade no desempenho do SUS; b) melhorar a formulação de políticas e c) monitorar as desigualdades no acesso e na qualidade dos serviços recebidos pelos diferentes grupos sociais no Brasil. A metodologia desenvolvida nutre-se de elementos utilizados nas propostas de avaliação de desempenho dos sistemas de saúde canadense, australiano, inglês e a da OPS e tem o formato de um painel de controle (dashboard), onde podem ser visualizadas simultaneamente diferentes dimensões da avaliação. O artigo descreve a experiência na adaptação e desenvolvimento da metodologia e fornece sugestões no sentido de aplicá-la para melhorar a formulação da política de saúde no Brasil.This paper is the result of a Brazilian multidisciplinary public health working group and consists of a methodology developed to: a) identify the factors that influence the efficiency, effectiveness, and equity of the Brazilian public health system and understand how these factors function; b) improve the formulation of health policies; and c) monitor inequalities in access to and quality of health services among different population groups in Brazil. The methodology developed here is based on Australian and Canadian and PAHO proposals that use a "dashboard" approach, allowing one to examine and evaluate simultaneously multiple dimensions of health system performance. This article describes the experience of adapting and developing the methodology and provides suggestions on how such a system might be employed to improve health policy-making in Brazil.

We aimed to relate the percentages of encountered epilepsy-related stigma in people with epilepsy with quantitative indicators of the quality of health systems and quality of life by country in Europe. The epilepsy-related stigma percentages were obtained from the largest population-based study in people with epilepsy available. We correlated percentages of people with perceived stigma per European country with data on the country's overall health system performance, health expenditure per capita in international dollars, and the Economist Intelligence Unit's quality-of-life index. Wefound a nonsignificant trend towards negative correlation between the epilepsy-related stigma percentage and the overall health system performance (r=-0.16; p= 0.57), the health expenditure per capita in international dollars (r = -0.24; p = 0.4), and the Economist Intelligence Unit's quality-of-life index (r = -0.33; p = 0.91). Living in a European country with a better health system performance and higher health expenditure per capita does not necessarily lead to a reduction in perceived epilepsy-related discrimination, unless the public health system invests on awareness programs to increase public knowledge and reduce stigma. (C) 2014 Elsevier Inc. All rights reserved.