A Critique of the World Health Organisation's Evaluation of Health System Performance

The World Health Organisation (WHO) approach to the measurement of health system efficiency is briefly described. The article then focuses upon four issues. First, it is argued that the choice of objectives gives undue prominence to the equity of financing and, more generally, inappropriately imposes a particular set of values upon all countries. Secondly, the importance weights attached to the objectives are somewhat misleading as an indication of the importance of the dimensions in the country rankings. Depending upon WHO objectives they are an also an incorrect measure of system performance. Thirdly, the model for combining the different objectives into a single index of system performance is problematical and alternative models are shown to alter system rankings. Fourthly, the econometric modelling of system performance does not provide a reliable basis for the evaluation of efficiency and the ranking of system performance. It is concluded that, despite these problems, the study is a landmark in the evolution of system evaluation, but one which requires significant revision.