The World Health Report 2000 is an expert analysis of the
increasingly important influence of health systems in the daily
lives of people worldwide. To an unprecedented degree it takes
account of the role of people as providers and consumers of health
services, as financial contributors to health systems, as workers
within them, and as citizens engaged in their responsible
management, or stewardship. Health systems provide the critical
interface between life-saving, life-enhancing interventions and the
people who need them. If health systems are weak, the power of
these interventions is likewise weakened, or even lost. Health
systems thus deserve the highest priority in any efforts to improve
health or ensure that resources are wisely used. In recent decades,
health systems have contributed enormously to better health for
most of the global population. As the new century begins, they have
the potential to achieve further improvements in human wellbeing,
especially for the poor. But very little has yet been done to
unravel the complex factors which explain good or bad performance
by individual health systems. Given equal resources, why do some
succeed where others fail? Is performance simply driven by the laws
of supply and demand, or does another logic apply? Why is
dissatisfaction with services so widespread, even in wealthy
countries offering the latest interventions? If systems need
improvement, what tools exist to measure performance and outcomes?
These are some of the many questions addressed in this report.
Drawing upon a range of experiences and analytical tools, the
report traces the evolution of health systems, explores their
diverse characteristics, and uncovers a unifying framework of
shared goals and functions. Using this as a basis for analysis, the
report breaks new ground in presenting an index of health system
performance based on three fundamental goals: improving the level
and distribution of health, enhancing the responsiveness of the
system to the legitimate expectations of the population, and
assuring fair financial contributions. As the report convincingly
argues, good performance depends critically on the delivery of
high-quality services. But it relies on more than that. Health
systems must also protect citizens from the financial risks of
illness and meet their expectations with dignified care. The report
goes on to show how the achievement of these goals depends on the
ability of each system to carry out four main functions: service
provision, resource generation, financing, and stewardship.
Chapters devoted to each function offer new conceptual insights and
practical advice on how to assess performance and achieve
improvements with available resources. In doing so, The World
Health Report 2000 aims to stimulate a vigorous debate about better
ways of measuring health system performance and thus finding a
successful new direction for health systems to follow. By shedding
new light on what makes health systems behave in certain ways, WHO
also hopes to help policy-makers understand the many complex issues
involved, weigh their options, and make wise choices.
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