Health-system organization methods and completion gates

Current evidence and analytical mapping

Typed analytical population remains incomplete. This status concerns exact typed analytical objects only. It never suppresses a library candidate, queue record, citation, source-linked statement, exact context, machine flag, or review note from the public evidence surface.

All material records: 18217
Library document candidates: 9918
Candidate-queue records: 7388
Countries: 195
Cited source records: 709
Source-linked statements: 182
Mapped country profiles: 195
Source-linked mapped findings: 1975
Analytical object rows: 5970
Linked source versions: 1938
Open P0 gates: 5
Open P1 gates: 6

Canonical analytical unit

Actor × Function × Decision × Role × Relationship × Provider or Service × Territory × Time × Evidence

This unit prevents a broad label such as “decentralized” from replacing the underlying questions. A staffing decision can have one actor that sets standards, another that proposes, another that approves, and a provider that implements. All roles may be correct at the same time.

Required dimensions of one organizational assertion
Dimension	Question answered	Examples
Actor	Who exists and participates?	Ministry, district, purchaser, provider, professional body, community.
Function and decision	What activity and material choice are in scope?	Staffing, service mix, capital, procurement, referral organization.
Role and relationship	How does each actor participate and connect?	Sets standard, proposes, approves, owns, operates, contracts, supervises, refers.
Provider, service, and territory	Where and for which delivery object does it apply?	Primary care, hospital, referral region, purchaser network, catchment.
Time and evidence	When did it apply and why is it shown?	Validity interval, reform dates, claim, source version, exact locator.

Evidence-to-display chain

1. Complete materials registerEvery collected library candidate and candidate-queue row enters the public review register with its pipeline stage preserved.
2. Source versionRetrieval metadata and immutable SHA-256 identify the exact version.
3. Displayed evidenceAll statements, exact contexts, citations, locators, machine flags, and review prompts are public immediately.
4. Atomic statementOne independently challengeable proposition remains visible with its source lineage.
5. Reviewer annotationA reviewer can challenge source bytes, locator, scope, validity, ontology, duplicates, or conflicts without controlling visibility.
6. Structured objectExplicit typed fields populate nodes, edges, matrix cells, pathways, networks, or observations.
7. Derived analysisRegistered rules operate only on compatible typed inputs while the full source evidence remains visible.
8. Display and exportEvery factual object can reopen its claim, citation, locator, period, and conflict context.

Formal, reported, and observed evidence

Layer	Meaning	Permitted conclusion
Formal	Legal and policy design established by an appropriate primary source.	What the institutional rule assigns or requires.
Reported	A reviewed description or synthesis of how the system is organized.	What an authoritative review reports, with its scope and limitations.
Observed	Administrative data, claims, surveys, registries, or implementation studies.	What implementation or patient flow shows for a defined period and denominator.

A formal referral requirement does not prove compliance. An observed bypass rate does not erase the formal rule. A design-practice result is permitted only when both layers are present.

Domain-level coverage

Coverage is not one overall country score. Each domain reports displayed evidence, direct typed mappings, explicit missingness, territory, and period. A zero direct-mapping count does not mean the institution or relationship is absent, and it never hides the broader evidence.

Coverage across the 195-country registry
Domain	Countries with displayed source or statement evidence	Countries with source-linked mapped evidence	Current result
Actors	188	195	Explicit mapped evidence exists for part of the registry
Government responsibilities	187	195	Explicit mapped evidence exists for part of the registry
Provider ownership	26	195	Explicit mapped evidence exists for part of the registry
Decision rights	42	195	Explicit mapped evidence exists for part of the registry
Provider autonomy	1	195	Explicit mapped evidence exists for part of the registry
Primary care organization	181	195	Explicit mapped evidence exists for part of the registry
Hospital organization	72	195	Explicit mapped evidence exists for part of the registry
Referral design	35	195	Explicit mapped evidence exists for part of the registry
Observed referral	1	195	Explicit mapped evidence exists for part of the registry
Provider networks	41	195	Explicit mapped evidence exists for part of the registry
Facility data	4	195	Explicit mapped evidence exists for part of the registry
Utilization	0	195	Explicit mapped evidence exists for part of the registry
Patient flows	0	195	Explicit mapped evidence exists for part of the registry
Governance and accountability	118	195	Explicit mapped evidence exists for part of the registry
Market structure	26	195	Explicit mapped evidence exists for part of the registry
Reform history	44	195	Explicit mapped evidence exists for part of the registry
Authoritative review	70	195	Explicit mapped evidence exists for part of the registry

Evidence-readiness scoring

Eight independent dimensions use a 0 to 4 rubric. They assess documentation readiness, not health-system quality or country performance. The dimensions are never added into a composite score and countries are not ranked.

Independent evidence-readiness rubrics
Dimension	Unit	Score 0	Score 4
Domain completeness	domains	No controlled domain is represented by displayed evidence.	Fourteen to seventeen domains have verified evidence and every critical domain is covered for the declared scope.
Source authority	displayed evidence records	No cited source is available.	Every material claim uses a proposition-appropriate source and required independent corroboration is present.
Evidence-layer balance	evidence or source layers	No evidence or source layer is present.	All three modes cover the declared critical questions and disagreements remain explicit.
Source traceability	displayed evidence records	No registered source is available.	Every directly typed claim resolves to a versioned source, exact locator or justified exception, citation, and reproducible lineage.
Displayed-fact verifiability	displayed statements or exact excerpts	No proposed country statement or exact source excerpt is displayed.	Every fact in the defined scope is an directly mapped atomic claim with exact source lineage, reviewer annotation and validation, and resolved validity.
Currency and validity	dated evidence records	No displayed evidence has usable date information.	Critical current claims also pass explicit supersession checks and historical arrangements are periodized.
Human review and conflict handling	displayed evidence records	No displayed evidence is available for review.	The declared scope has reviewer annotation and validation, conflict handling, complete availability, and registered independent quality checks.
Observed-data depth	observed-data question groups	No displayed source or direct typed evidence covers an observed-data question group.	Repeated or current comparable evidence covers delivery structure, utilization, referral, and patient flow.

Automatic proof of completeness

These tests inspect every served country pack. A PASS means no currently displayed object violates the rule. Population is a separate gate, so an empty registry cannot use a vacuous integrity PASS to claim completion.

Test	Result	Rule
orphan_node_test	PASS	Every direct canonical actor node resolves to a direct canonical claim.
orphan_edge_test	PASS	Every direct canonical relationship edge resolves to a direct canonical claim.
orphan_matrix_cell_test	PASS	Every direct canonical decision-right cell resolves to a direct canonical claim.
orphan_narrative_test	PASS	Every direct canonical factual narrative sentence resolves to explicit evidence.
object_lineage_test	PASS	Every other direct canonical object resolves to a direct canonical claim or explicit direct-data record.
citation_lineage_test	PASS	Every direct canonical claim resolves to a cited source version and exact locator.
expired_claim_test	PASS	No current or selected-period result relies on an expired claim.
formal_observed_conflation_test	PASS	Design-practice analysis contains both design and observed evidence layers.
unresolved_conflict_test	PASS	No analysis, narrative, or executive summary silently selects one side of a represented conflict.
display_source_version_test	PASS	Every displayed source-linked record resolves to a cited HTTPS source with an immutable SHA-256 version.
display_claim_lineage_test	PASS	Every displayed source-linked claim resolves to its mapping, cited source, exact locator, and immutable source version.
display_object_lineage_test	PASS	Every displayed analytical mapping and object resolves to its displayed claim, source, and source version.

Requirement-by-requirement analytical checks

These checks assess typed analytical coverage, not whether evidence may be shown. An empty structured section does not hide its source-linked records. Evidence gaps remain visible rather than silently inferred.

Current hardening matrix
Gate	Result	Implementation	Evidence state	Remaining proof
Ontology P0	PASS	PASS	This is a structural gate; country population is assessed separately.	No open structural requirement.
Actor registry P0	PASS	PASS	2411 source-linked analytical object rows are displayed across 195 profiles. The separate direct canonical layer is not yet populated.	No open requirement.
Relationship registry P0	PASS	PASS	1524 source-linked analytical object rows are displayed across 195 profiles. The separate direct canonical layer is not yet populated.	No open requirement.
Decision rights P0	PASS	PASS	449 source-linked analytical object rows are displayed across 195 profiles. The separate direct canonical layer is not yet populated.	No open requirement.
Claim-level citations P0	PARTIAL	PASS	1975 displayed mapped findings across 195 profiles retain 3787 exact source references to 1938 immutable versions. The separate direct canonical claim layer is not yet populated.	Extend atomic, locator-complete source-linked mapping to the remaining country profiles.
Evidence coverage P0	PARTIAL	PASS	All 195 packs expose 17 domain states. 709 cited source records cover all countries; 20 countries have source-linked statements or exact context; 195 countries have 1975 displayed source-linked analytical mappings. The separate direct canonical claim layer is not yet populated.	Extend fact-level mapping and record explicit missingness where no qualifying source is available for a country and domain.
Formal and observed separation P0	PARTIAL	PASS	190 profiles contain both design and observed layers in displayed source-linked mappings. The direct canonical layer does not yet add a design-observed pair.	Populate formal or reported design evidence and observed implementation evidence without merging the layers.
Historical versioning P0	PARTIAL	PASS	631 source-linked reform object rows are displayed across 192 profiles. The separate direct canonical reform layer is not yet populated.	Populate legal, effective, implementation, and observed dates and close superseded validity intervals.
Primary care organization P1	PASS	PASS	195 profiles have source-linked mapped primary-care evidence. The separate direct canonical layer is not yet populated for this domain.	No open requirement.
Hospital organization P1	PASS	PASS	195 profiles have source-linked mapped hospital-organization evidence. The separate direct canonical layer is not yet populated for this domain.	No open requirement.
Patient choice and gatekeeping P1	PARTIAL	PASS	6 profiles encode patient choice separately from referral requirements in source-linked mappings. 195 profiles have source-linked referral-design mappings overall.	Map choice and gatekeeping evidence separately at primary, specialist, and hospital levels.
Referral pathway P1	PASS	PASS	195 profiles have source-linked mapped referral-pathway evidence. The separate direct canonical layer is not yet populated for this domain.	No open requirement.
Provider autonomy P1	PARTIAL	PASS	415 source-linked analytical object rows are displayed across 185 profiles. The separate direct canonical layer is not yet populated.	Map decision-domain autonomy records that identify autonomy from whom.
Accountability P1	PARTIAL	PASS	73 explicit source-linked accountability edges are displayed across 52 profiles. 415 autonomy cells are displayed across 185 profiles.	Pair autonomy with accountable-to actors and explicit mechanisms.
Public and private delivery P1	PARTIAL	PASS	256 source-linked public-private findings are displayed across 195 profiles. Denominator-specific direct observations are not yet populated in the canonical layer.	Populate facilities, beds, workforce, visits, admissions, and expenditure separately where evidence permits.
Networks and integration P1	PARTIAL	PASS	195 profiles have source-linked network mappings. Separate canonical network and integration arrays are not yet populated.	Map network membership, governance, territory, referral rules, information links, and horizontal or vertical mechanisms.
Cross-country comparison P1	FAIL	PASS	The current mapped profiles are visible side by side, but evidence equivalence has not yet been established for a formal cross-country comparison.	Map comparable dimensions for at least two countries without replacing missing fields or denominators.
Methods and data dictionary P0	PASS	PASS	Ontology, evidence hierarchy, inference guardrails, independent readiness rubrics, and automated completion tests are published.	No open structural requirement. Methods must remain synchronized with schema and validators.
Crawlable public surface P0	PASS	PASS	195 country HTML records, 195 country JSON records, a country index, methods route, robots allowance, and sitemap are present.	No open crawlability requirement.
Cross-country manual validation P0	PARTIAL	PASS	195 profiles contain displayed source-linked analytical mappings and all displayed records remain open to reviewer annotations. The separate direct canonical claim layer is not yet populated.	Collect reviewer annotations and heterogeneous cross-country challenge testing while keeping every record visible.

Displayed evidence and the Indonesia review flagship

18217 material-stage records are displayed: 9918 library document candidates, 7388 candidate-queue records, and 911 public-stage records. All 195 countries have materials. Stage duplicates remain visible because each stage is separately reviewable.

Indonesia is the review-workflow flagship because its dossier exposes all 512 assigned materials, statements, citations, locators, source hashes, machine flags, and text-anchored annotation points in one place.

Review Indonesia evidence Open crawlable Indonesia record Browse all countries

External methodological benchmarks

WHO primary health care measurement framework, including first contact, empanelment, referral and counter-referral, care pathways, teams, facility management, and community linkage.
OECD Health Systems Characteristics Survey, including provider ownership, patient choice, gatekeeping, provider relationships, and decentralization.
European Observatory governance framework, which treats the allocation of governance tasks as function-specific.
Health Systems in Transition author template, which provides consistent questions, definitions, sources, tables, and figures for country-system description.
WHO mixed health-system governance strategy, which frames public and private delivery as a relationship and stewardship problem rather than a single ownership share.