Applying WHO's health systems performance assessment in Pakistan: critical reflections

The World Health Organization (WHO) proposed a health systems performance assessment framework in 2000, which met with quick and often severe criticisms in terms of process, methods and utility. However, a country specific reflection for the potential application of this framework has not been published to-date from South Asia. This paper reviews the recent literature and critiques and analyzes the potential for applying the framework in Pakistan. Deconstruction of the framework into its five component parts--health (level, distribution), responsiveness (level, distribution) and fair financing--allows an assessment of data needs for generation of specific indicators. This paper proposes that three of the five components may be attempted in Pakistan due to the availability of specific data; however the two components of responsiveness will require the collection of new primary data and present a considerable challenge. The conduct of a burden of disease study, assessment of health expenditures using household consumption surveys, and use of numerous national surveys will allow for optimal utilization of available information in Pakistan. The assimilation and analysis of available data will also be critical in informing national health decision-making.