Health Policy and Planning - September 2010; Vol. 25, No. 5
Commentaries
The World Health Report 2000: expanding the horizon of health system performance
Julio Frenk, Dean, Harvard School of Public Health, Boston, MA - USA.
Health Policy Plan. 2010 25: 343-345; doi:10.1093/heapol/czq034.
URL: http://heapol.oxfordjournals.org/cgi/content/full/25/5/343?etoc
“……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:
(1) What are the boundaries of the health system?
(2) What are health systems for?
(3) What is the architecture of a health system in terms of its functions?
(4) How good is a health system in terms of its performance?
(5) How can we relate health system architecture to performance?............”
The World Health Report 2000: 10 years on
Martin McKee, Professor of European Public Health, London School of Hygiene and Tropical Medicine, London, UK
Health Policy Plan. 2010 25: 346-348; doi:10.1093/heapol/czq032.
URL: http://heapol.oxfordjournals.org/cgi/content/full/25/5/346?etoc
“…..In this commentary I focus on the rankings of health system performance contained in the report’s statistical annex. The framework for understanding health systems employed in the main text has proven uncontroversial and is now used widely, while the accompanying text is an extremely valuable source of material for scholars of health systems.
In contrast, the country rankings have attracted considerable comment from researchers and politicians, much of it critical. Some, such as Navarro (2001), focused on what they perceived as an underlying pro-market ideology in many of the solutions proposed and the language used to justify them, in particular a seeming conflation of tax-funded national health services with the discredited Soviet system (perhaps anticipating the neo-liberal critiques of President Obama’s health care reforms a decade later).
He and others (Almeida et al. 2001) criticized what they saw as an unjustified dismissal of the primary care model set out at Alma Ata, which they attribute to the authors’ ideological opposition to an active role of government in funding and delivering health care. However, this view was not universal, with one commentator, writing in the Wall Street Journal, accusing the WHO of adopting a Marxist stance by arguing for any more than a token role for the state in providing health care (Helms 2000). Reflecting this diversity, Williams (2001) asked whether there are, in fact, universally agreed goals for health systems….”
WHR 2000 to WHR 2010: what progress in health care financing?
Di McIntyre, Professor and South African Research Chair in ‘Health and Wealth’, Health Economics Unit, University of Cape Town
Health Policy Plan. 2010 25: 349-351; doi:10.1093/heapol/czq033.
URL: http://heapol.oxfordjournals.org/cgi/content/full/25/5/349?etoc
“…..The World Health Report 2000 (WHR 2000) is probably best remembered for trying to stack the health systems of different countries up against each other using a uniform set of measures (WHO 2000). Certainly, senior health officials in my own country (South Africa) repeatedly referred to our ranking of 175 out of 191 countries, in terms of overall health system performance, to highlight our plight. The problem is that nothing was done to improve our performance (Coovadia et al. 2009).
Simply knowing the ranking of individual countries’ health systems is of very little value to policy makers and health managers within these countries. Instead, what is required is clear guidance on the principles that should underlie our health systems, conceptual frameworks for approaching efforts to improve their performance and integrated analyses of key lessons from international experience.
Indeed, these issues were dealt with in the WHR 2000, but the related messages were not disseminated or received by policy makers as forcefully as the performance index ranking was. This commentary focuses on some of the useful conceptual frameworks and guidance on potentially fruitful directions for health system performance improvements in the WHR 2000, with reference to the issue of health care financing………..”.
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