Measuring Health System Performance: A Critique, with Proposals for Improving on the WHO “Building Blocks Framework”

Abstract

Attempts have been made to measure overall national health system performance and, more controversially, rank national health systems in terms of their relative performance. The World Health Organization made such an attempt in 2000. The resulting rankings generated criticism and controversy and was not repeated. Any attempt to measure overall national health system performance for the purpose of comparison is fraught with challenges and unlikely to be productive. In this critique (opinion piece), I argue that instead of measuring and ranking in terms of relative performance (such as “responsiveness of health system” and “fairness of contribution to the health system”), it would be relatively easier and less controversial to change the metrics and focus only on which components of a national health system are not meeting specific standards of minimal requirements (i.e. using benchmarks associated with the WHO “Building Blocks Framework”) and ought to be improved through public policy intervention. The WHO Building Blocks Framework has shortcomings and omissions. Some suggestions for its improvement are proposed.