5.1 - Targets and performance measurement

Summary

Introduction

Targets are a tool designed to improve health and health system performance. They can facilitate the achievement of health policy by expressing a clear commitment to achieve specified results in a defined time period and facilitating the monitoring of progress towards the achievement of broader goals and objectives. They may be quantitative (e.g. x% increase in the immunization rate) or qualitative (e.g. introduction of national screening programme); based on health outcomes (e.g. reduction in mortality) or processes (e.g. reduction of waiting time). The introduction of the concept of targets into the health sector is often traced to the 1981 publication of WHO's Health for All strategy which presented targets as a tool with which to improve health policy (WHO Regional Office for Europe 2005).

Earlier chapters of this book discuss the manifest need for tools designed to improve performance and accountability. Thus it is not surprising that targets' role in health policy has grown and an increasing number of countries and/or regions now use them as tools to improve performance. Various mapping exercises have documented growing and sustained interest in health targets among governments and international organizations (Busse & Wismar 2002; Ritsatakis et al. 2000; van de Water & van Herten 1998). The 2005 update of the WHO European Health for All policies reported that forty-one of the (then) fifty-two Member States of the Region had either adopted or drafted policies which included health targets (WHO Regional Office for Europe 2005). Most recently, Wismar et al. (2008) offered many national and sub-national examples from Europe, primarily in population health. The Millennium Development Goals introduced important health targets at the international level.