Health system responsiveness

Programmatic Milestones

  • Identified as a key goal of health systems in the 2000 World Health Report
  • Endorsed by the Scientific Peer Review Group
  • Group of experts produce technical report evaluating responsiveness concept and tools
  • A responsiveness survey module is part of the Multi-Country Survey Study
  • A responsiveness survey module is part of the World Health Survey
  • Responsiveness work merged with the Equity Team

The 2000 World Health Report.This report proposed a new framework for evaluating health systems performance. The framework conceptualized performance as being assessed by the extent to which certain “goals” were achieved. One of these goals was “responsiveness”. This referred to the goal of having a system that was responsive to people’s needs to be treated humanely, with dignity, and to be accommodated with comforts and conveniences, within reason and to the extent possible. An indicator for the average level of responsiveness in a country’s population, and its distribution were estimated for all 191 countries and formed part of a controversial overall performance index, that was used to rank health systems of the world. The indicator was based on "scores" calculated for each responsiveness domain, which were conceived as aspects of health related activities that affect a person’s experience of health care.

The Scientific Peer Review Group (SPRG). The SPRG was appointed by the Director-General as an advisory group in response to an Executive Board Resolution in January 2001 [107th Session, EB107.R8, 15-22 January 2001], to initiate a scientific peer review of health systems performance methodology. In EB109.R1 [109th Session, 14-21 January 2002], the board noted with satisfaction the steps undertaken by the DG to appoint this advisory group. The EB accepted the suggestions of this advisory group. They decided that the next statistical annex reporting on the performance of countries’ health systems would be published, after consultation, later in 2003, and requested that the report to the health authorities of Member States be provided 15 days before the intended date of publication.

The Multi-Country Survey Study on Health and Health System Responsiveness. WHO launched the Multi-country Survey Study on Health and Health System's Responsiveness (MCSS) in 2000–2001 in order to develop various methods of comparable data collection on health and health system responsiveness. This study has used a common survey instrument in nationally representative populations with modular structure for assessing health of individuals in various domains, health system responsiveness, household health care expenditures and additional modules in other areas such as adult mortality and health state valuations. WHO contracted out the surveys to two types of survey operators: multi-country survey and single country survey operators. The multi-country survey operators were international commercial survey companies INRA and GALLUP. Independent survey operators covered a single country each and were from universities, private commercial survey companies, governmental central statistical offices and government health departments. The study was implemented in 61 countries completing 71 surveys. Two different questionnaire modes were intentionally used for comparison purposes in 10 countries. This has allowed the data from the different modes to be compared in order to estimate the effect of the mode of the survey. Surveys were conducted in different modes: in-person household interviews in 14 countries, brief face-to-face interviews in 27 countries, computerized telephone interviews in 2 countries and postal surveys in 28 countries.

The World Health Survey. This survey was implemented in 2002-2004. It contained a responsiveness module that also included more detailed questions on self-reported utilization of health services and barriers to care. The survey was implemented in 73 countries. Country reports on utilization, barriers to care, satisfaction and responsiveness are currently being prepared.

Joining the Equity Team. In 2004, the work on responsiveness became part of the Equity Team's work. As part of the equity program, several new analyses were developed to draw out comparisons between different groups in society. These analyses can be seen in the MCSS and WHS reports, as well as in the Analytical Guidelines, which were developed for advising survey analysts on how to analyze data on responsiveness.

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