Measuring Health System Performance Globally by highlighting the Indicators, Frameworks, and Challenges
DOI:
https://doi.org/10.65329/wjeb.v6.01.03Keywords:
Health system; Frameworks; WHO; Global challenges; Low-income countries.Abstract
Evaluating the performance of the health system is important for anyone who wants to improve population health. In response to this challenge, the World Health Organization (WHO) introduced its first formal health system performance assessment framework in 1999–2000. From that time, a variety of additional conceptual frameworks, monitoring tools, and indicators have been developed to help describe, measure, and compare health systems internationally. This article focuses on four interconnected streams of literature related to the WHO Health System Performance Framework and the controversies that have arisen from it. The subsequent WHO Health Systems Building Blocks framework, along with the degree to which it has been adopted globally to strengthen health systems. The key tools for evaluating health systems and the indicators currently used to monitor and assess health system inputs, processes, outputs, and outcomes, including those for universal health coverage. This manuscript deals with the continuing methodological hurdles that researchers continue to face as they attempt to assess health system performance, e.g. the poor data infrastructures that exist in low and middle-income countries; the technical complexity of effectively linking health systems performance outputs to specific health service system inputs; the possibility that if separate performance measures for the different health systems functions are not developed. The integration of these functions may lead to poor evaluation processes and the fragmentation of interdependent functions into separate data, as well as ongoing debates about how to weight and sum multiple performance indicators into a composite performance measure for any specific health system. No single framework or tool is sufficient, but the complementary use of conceptual frameworks, facility-based assessment tools, and routine information systems offers the most realistic path toward solidifying an accountable, evidence-based health system.
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