Targets as a tool in health policy. Part I: Lessons learned

This article reviews the start of the use of targets as a tool in health policy, summarises the fruitful uses and frequently-heard objections, and proposes some conditions for successful health target setting. Targets as tool in health policy are based on the 'management by objectives' approach (1954). The use in health policy was possible due to advances in the use of epidemiology for public health purposes. It provisionally ends with the new health targets adopted by WHO in 1998. The setting and monitoring of health targets is one way in which a government can provide leadership, guidance and strategic direction for the health sector. These benefits, and others, will also be reviewed. Drawbacks - such as political accountability and the limited malleability of society - will also be discussed. To overcome most of the objections, the article ends with some SMART conditions for successful health target setting: specific, measurable, achievable, realistic and time-bound. When SMART conditions are met, political will and daring are the recipe for a successful health target approach.