ABSTRACT
Health systems in some countries perform well. Others perform poorly. An accumulation of applied research efforts and practical experience now suggests some reasons for these differences. Countries differ, of course, and lessons that are useful to one country may have little value to others. Furthermore, evidence about what has worked – and what has not – constitutes only one of several factors influencing the decisions that shape health systems. That said, for many government officials, as for many clinicians, evidence does matter. But clearly, for national purposes, only national officials can judge the relevance and political feasibility of using evidence generated from other countries and other times. [. . .]
Before turning to the evidence, it is worth listing the goals of health systems – as WHO sees them. Goals can be phrased in many ways, and each goal may have different relevance in different contexts. Yet the following core list of goals for health system development is likely to elicit broad agreement:
• improving health status; • reducing health inequalities; • enhancing responsiveness to legitimate expectations; • increasing efficiency; • protecting individuals, families and communities from financial loss; • enhancing fairness in the financing and delivery of health care.
