Peru was not an exception, because up until recently it did not monitor the main indicators on preparation, provision and effect of safe and affordable surgical and anaesthesia care for the population. 2,3 In 2012, 312.9 million surgical procedures were carried out in the world 4 however, information regarding frequency and safety of this care was severely limited by the lack of national data, considering that 70% of countries had no information on their national surgery volumes, and practically none attempted to value the allocation of surgical resources or the results. Although they have been recognised as a costly component, surgeries are performed in both affluent and precarious economic contexts alike. Surgical services are integral components of the public health system because they are part of the continuous primary care process. However, as a result of the increase in LE in the world, as well as the drop in MM and IM rates, other measurements such as surgical care have gained important when it comes to evaluating the health system. Maternal mortality (MM), infant mortality (IM) and life expectancy (LE) rates have been important indicators for measuring the effectiveness of healthcare services over a considerable time period. Will HSI’s cut the mustard? Time will tell.Surveillance in public health has used standardised measurements designed to quantify the cost of disease in a population, monitor mortality rates, and provide guidance to health systems. Workforce wellbeing as an indicator of sector performance has not been included.
Yet, the acute workforce shortage faced by the sector has not been addressed, despite having a detrimental effect across the health system and fatiguing health professionals who are the prime driver of health system improvement. The health system relies on people to keep it going and deliver timely and accessible healthcare.
The indicators will be publicly reported on every three monthsīut there are glaring omissions. The emphasis is on continuous improvement at a local level, rather than focusing attention on achieving nationally set performance targets. Advocates claim that it is good to have indicators that will make the health sector look outside the hospital walls to see what changes can be made in the community that will make a true difference to New Zealand’s health outcomes. It is good that their scope is widened beyond what can be counted. These indicators are a mature improvement on the former targets. But they will still report the actual performance, such as the percentage of two-year-olds who have been fully immunised. In contrast to the targets, the indicators don’t have a set percentage of compliance to aim for. They will tell us whether the health system overall is working to improve the health of all New Zealanders, and what we need to do to make it better. HSIs hope to perform a different function.
There are several conditions affecting New Zealanders’ health, including heart disease, strokes, diabetes and cancers, that are measured and monitored. It was found that the previous health targets have led to "perverse" outcomes as some hospitals were only driven to meet them without actually providing services that the people needed or wanted. The HSI framework has been developed by the MoH and HQSC. It builds on the System Level Measures programme and include 12 indicators based on the Government’s six priorities for health: improving child wellbeing, improving mental wellbeing, improving wellbeing through preventative measures, creating a strong and equitable public health system, better primary healthcare and a financially sustainable health system. These targets have now been replaced by the Health System Indicators (HSI). However, health targets have had their share of criticism of never being a reliable assessment of how well health services are performing.
Health targets were a set of national performance measures in place from 2007 to 2020, designed to improve the performance of health services. By the 2000s, it became emergency department waiting. In the 1990s, it was elective surgery access. The focus of our attention has changed over time. The performance of New Zealand’s health system has always been measured.