Abstract
Issue/problem
Health system performance assessment (HSPA) frameworks only deliver policy value if they provide actionable information for the institutions they are meant to support. Top-down HSPA development may struggle to gain stakeholder acceptance and miss relevant health system priorities, limiting real-world impact, highlighting the need to involve health system stakeholders in the development process. Luxembourg developed its national HSPA framework with stakeholders at the centre of the process.
Description of the problem
In 2024, Luxembourg’s National Health Observatory (ObSanté) initiated development of a national HSPA framework, with OECD and European Commission support. A participatory process spanning 2024–2026 involved three governance bodies: a High-Level Advisory Board of senior institutional leaders, a Project Management Team, and a Principal Working Group of 30+ stakeholders broadly representing Luxembourg’s health system organisations, including key governmental bodies, agencies, patients and provider representatives. Several workshops addressed scope definition, the health data landscape, framework development, indicator selection and prioritisation, and governance planning.
Results
A framework reflecting health system priorities and needs was developed comprising 12 domains, 30 subdomains, and 105 indicators, structured around outcomes, processes, inputs, and the cross-cutting topics of equity, sustainability and health determinants. Stakeholder co-ownership was secured through their constant involvement and ensured the development of a framework of local relevance.
Lessons
Multi-stakeholder processes are essential for the development of tailored HSPA frameworks and build the ownership necessary for their sustained implementation. Combining international technical support with inclusive national processes is a transferable approach for other countries.
Key messages
• Participatory co-design with 30+ stakeholders produced Luxembourg’s first national HSPA framework: 12 domains, 30 subdomains, 105 indicators, with broad institutional ownership.
• Countries can build evidence-based health system accountability through inclusive, internationally supported HSPA development.