JavaScript Required

The P4H website is designed to perform best with Javascript enabled. Please enable it in your browser. If you need help with this, check out

Health System Performance Assessment Framework in Estonia as part of Structural Reforms - P4H Network

Health System Performance Assessment Framework in Estonia as part of Structural Reforms

Since 2017, the European Commission has provided expertise to help design over 1000 reform projects in 27 Member States through the Structural Reform Support Programme. As of 2021, the Technical Support Instrument (TSI), its successor, continues to support reforms with an emphasis on the green and digital transitions. The TSI can also support the preparation and implementation of Member States’ Recovery and Resilience Plans.

New projects adopted include “Developing a performance assessment framework for the health system” among others.

Estonia has so far benefited from 25 projects financed under the predecessor of the TSI, the Structural Reform Support Programme (SRSP). This support has addressed a broad range of policy areas, including capital markets, public financial management, digitalisation, cybercrime, small and medium-sized enterprises, healthcare, aging population, green transition, climate neutral electricity as well as transport and mobility. A particular focus has been on the digitalisation of the public administration and the reform of education. To date, 7 projects have been successfully concluded.

Past project examples:

Developing an integrated hospital master plan

The European Commission supported Estonia in developing a new hospital master plan, to organise patient-centred provision of hospital care. To define the masterplan, the programme helped to map the current hospital system and to develop a prediction model to consider the future development in the demand and supply of care. The ultimate goal of the project is to build a system that provides the right care in the right place at the right time.

Enhancing budget responsibility through spending reviews

The European Commission supports Estonia in increasing the effectiveness of public spending by strengthening the capability to conduct spending reviews and helping to anchor spending reviews as an integral part of the budget process. Spending reviews help to improve the quality of allocation of public funding and enhance budget responsibility. The support measures will build the administrative capacity and strengthen the knowledge within the Estonian administration in this area.

It is interesting to see how the performance assessment framework for the health system is developed and implemented from the point of its value to other countries who could learn from the Estonian example.


Photo of Tallinn, the capital of Estonia, Euronews. Copyright Unsplash