Population assessment of health system performance in 16 countries

Authors

Margaret E. Kruk, Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA).
Shalom Sabwa, Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA).
Todd P. Lewis, Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA).
Ifeyinwa Aniebo, Ministry of Health and Social Welfare of Nigeria, Abuja, Nigeria.
Catherine Arsenault, Milken Institute School of Public Health, George Washington University, WashingtonDC, USA.
Susanne Carai, WHO Office on Quality of Care and Patient Safety, Athens, Greece.
Patricia J. Garcia, School of Public Health, Cayetano Heredia University, Lima, Peru.
Ezequiel Garcia-Elorrio, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
Günther Fink, University of Basel and Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
Munir Kassa, Ministry of Health, Addis Ababa, Ethiopia.
Sailesh Mohan, Public Health Foundation of India, New Delhi, India.
Mosa Moshabela, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Juhwan Oh, Seoul National University College of Medicine, Seoul, Republic of Korea.
Muhammad Ali Pate, Ministry of Health and Social Welfare of Nigeria, Abuja, Nigeria.
Jacinta Nzinga, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.

Document Type

Journal Article

Publication Date

7-1-2024

Journal

Bulletin of the World Health Organization

Volume

102

Issue

7

DOI

10.2471/BLT.23.291184

Abstract

OBJECTIVE: To demonstrate how the new internationally comparable instrument, the People's Voice Survey, can be used to contribute the perspective of the population in assessing health system performance in countries of all levels of income. METHODS: We surveyed representative samples of populations in 16 low-, middle- and high-income countries on health-care utilization, experience and confidence during 2022-2023. We summarized and visualized data corresponding to the key domains of the World Health Organization universal health coverage framework for health system performance assessment. We examined correlation with per capita health spending by calculating Pearson coefficients, and within-country income-based inequities using the slope index of inequality. FINDINGS: In the domain of care effectiveness, we found major gaps in health screenings and endorsement of public primary care. Only one in three respondents reported very good user experience during health visits, with lower proportions in low-income countries. Access to health care was rated highest of all domains; however, only half of the populations felt secure that they could access and afford high-quality care if they became ill. Populations rated the quality of private health systems higher than that of public health systems in most countries. Only half of respondents felt involved in decision-making (less in high-income countries). Within countries, we found statistically significant pro-rich inequalities across many indicators. CONCLUSION: Populations can provide vital information about the real-world function of health systems, complementing other system performance metrics. Population-wide surveys such as the People's Voice Survey should become part of regular health system performance assessments.

APA Citation

Kruk, Margaret E.; Sabwa, Shalom; Lewis, Todd P.; Aniebo, Ifeyinwa; Arsenault, Catherine; Carai, Susanne; Garcia, Patricia J.; Garcia-Elorrio, Ezequiel; Fink, Günther; Kassa, Munir; Mohan, Sailesh; Moshabela, Mosa; Oh, Juhwan; Pate, Muhammad Ali; and Nzinga, Jacinta, "Population assessment of health system performance in 16 countries" (2024). GW Authored Works. Paper 5363.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5363

Department

Global Health