Decision-makers in countries around the world face a series of common problems as they aim to make appropriate choices to improve the performance of their health systems. With eight per cent of the world’s economic output invested in health systems, the way these systems are organized to collect resources and transform them into services for people in need can profoundly influence health outcomes for populations. Yet the scientific evidence-base to inform critical health system decisions is much weaker than the evidence-base to inform individual clinical decisions. Policy advice on health system development has, until recently, been based on case-studies and, sometimes, ideology. Case-studies can be useful partly because health systems and cultures all differ in many ways. There is a great deal of knowledge, however, to be gained from the experiences of groups of countries taken together, learning from common experience.
This volume reports on a large body of work led by the World Health Organization that is intended to strengthen the foundations for evidence-based policies aimed at health systems development. This has included work to develop a common conceptual framework for health systems performance assessment, to encourage the development of tools to measure its components, and to collaborate with countries in applying these tools to measure and then to improve health systems performance. It began with the enunciation of a framework that specified a parsimonious set of key goals to which health systems contribute, and the first set of figures on goal attainment and health system efficiency in countries that were Members of the Organization was published in The World Health Report 2000.
This book provides a uniquely comprehensive exploration of many different facets of health systems performance assessment. It will be relevant for researchers, students and decision-makers seeking a more detailed understanding of concepts, methods and the latest empirical findings. While most authors in this volume take a global perspective, the findings have important implications for the development of national performance frameworks and the creation of a culture of accountability.
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