Analysis of health system characteristics needed before performance assessment.

To assess the performance of a health system, understanding its structures and functions is necessary. This understanding requires an in-depth description and analysis of the health system, which can be facilitated using standardized assessment templates. While many national and international actors work on health systems strengthening, they often struggle to find reliable systematic information on the design and functioning of a health system. At the same time, national policy-makers might seek to learn from experiences from other systems and contexts, but do not always find comparable information on other countries’ health systems. Using a standardized guide or template when describing and assessing how a health system functions can support cross-country comparisons because the structured nature of a template simplifies the extraction of comparable information.(1,2) Several international agencies, including the World Health Organization (WHO), the Organisation for Economic Co-operation and Development (OECD), the United States Agency for International Development (USAID), the European Union (EU) and the Commonwealth Fund have developed such templates. We have reviewed 12 of these templates (Waitzberg R, Berlin University of Technology, unpublished material, 2024) and believe that there is much scope for improvement and harmonization (Box 1). Templates were defined as having an overall framework, a list of indicators or topics and instructions for users, while covering the entire health system and the design of the health system, as well as including an assessment of health system performance.