World Health Report 2000: expanding the horizon of health system performance
Author(s)/Editor(s): Frenk J
Publisher/Organizer: Health Policy and Planning
Publication date: September 2010; Vol. 25, No. 5
“Anniversaries offer the opportunity to revisit events that have been enriched by the passage of time. They help to balance disagreements, create new consensuses and re-launch promising discussions. The decennial of the World Health Report 2000 (WHR 2000) may be such an auspicious occasion (WHO 2000).
There are two aspects of the WHR 2000 that are worth considering: the context and the content. The key event regarding the context of the report was the election in 1998 of a new Director General for the World Health Organization (WHO), which took place in the midst of a leadership crisis. For the first time in the history of this organization, a former head of government, Gro Harlem Brundtland, was elected to the top position. In this role she had the vision to firmly place health at the centre of the development agenda, the ability to reposition WHO in the global health arena, the skill to transform an agency mostly focused on providing technical assistance to developing countries into an institution relevant to the entire world, and the commitment to promote evidence-based health policy.
This last pledge was expressed in the creation of a new Cluster on Evidence and Information for Policy, a unit explicitly charged with developing a scientific foundation for decision making and undoubtedly one of the most important initiatives during Brundtland’s tenure.
The first major product of this unit was precisely the WHR 2000, an ambitious undertaking aimed at transforming the way we think about, measure and compare health systems performance assessment. On the conceptual front, the report proposed a comprehensive framework to expand the view on health systems by addressing five fundamental questions:
- What are the boundaries of the health system?
- What are health systems for?
- What is the architecture of a health system in terms of its functions?
- How good is a health system in terms of its performance?
- How can we relate health system architecture to performance?............”