This will allow the health sector to detect, understand, influence, anticipate, and possibly even alter the health impacts of decisions in other sectors. In order to be comprehensive and efficient, health performance frameworks and associated monitoring should track trends in these broader determinants.

Yet social and environmental factors may give rise to additional problems with access to health services, thus modifying or even augmenting their direct effects on population health. As Hippocrates observed, social and environmental factors affect health directly. This implies augmentation of the original WHO frameworks mentioned above to include causal pathways beyond service coverage. From the leading nineteenth century German doctor, Rudolf Virchow, to the present-day discussions on sustainable development, there is general recognition that average levels of population health and health inequities arise from factors beyond health care and the health systems’ direct control. We focus on two areas for improvement for the purposes of this paper.Ī first area for improvement in these frameworks is to address the neglect of the critical role of determinants beyond the health sector on population health. When considering these frameworks and the associated monitoring approaches they have generated in the context of the sustainable development goals (SDGs) ( 5, 6), one can make several observations concerning potential areas for improvement. The final goals are improvements in: population health levels, population health equity, levels of health systems’ responsiveness to the legitimate expectations of the population, responsiveness equity, and fairness in financial contributions.

According to these frameworks, different combinations of health systems’ functions such as stewardship, financing, or service delivery can be evaluated based on how well they improve the intermediate and final goals. These frameworks refer to five health system goals that are achieved through the intermediate goal of coverage of the population with needed health services. In the first decade of the twenty-first century, the World Health Organization (WHO) played a leading role in harmonizing health systems’ performance assessment approaches through the development of relevant conceptual frameworks ( 1– 4).

Responsiveness health system indicators