Health Systems Responsiveness - a measure of the acceptability of health care processes and systems

WHO developed and proposed the concept of responsiveness, defining it as aspects of the way individuals are treated and the environment in which they are treated during health system interactions (Valentine et al. 2003). The concept covers a set of non-clinical and non-financial dimensions of quality of care that reflect respect for human dignity and interpersonal aspects of the care process, which Donabedian (1980) describes as ‘the vehicle by which technical care is implemented and on which its success depends’. Eight dimensions (or domains) are collectively described as goals for health-care processes and systems (along with the goals of higher average health and lower health inequalities; and non-impoverishment – as measured through other indicators): (i) dignity, (ii) autonomy, (iii) confidentiality, (iv) communication, (v) prompt attention, (vi) quality (of) basic amenities, (vii) access to social support networks during treatment (social support), and (viii) choice (of health-care providers). Building on extensive previous work, this chapter directs the conceptual and methodological aspects of the responsiveness work in three new directions. First, the given and defined domains (Valentine et al. 2007) are used to link responsiveness (conceptually and empirically) to the increasingly important health system concepts of access to care and equity in access. The concept of equity used in this chapter was defined by a WHO working group with experts on human rights, ethics and equity. It is defined as the absence of avoidable or remediable differences among populations or groups defined socially, economically, demographically or geographically (WHO 2005). Health inequities involve more than inequality – whether in health determinants or outcomes, or in access to the resources needed to improve and maintain health. They also represent a failure to avoid or overcome such inequality which infringes human rights norms or is otherwise unfair. Second, it expands on the issue of measurement strategies. Third, the psychometric results of the responsiveness module from the WHS are compared with its survey instrument predecessor in the Multi-country Survey (MCS) Study. The chapter concludes with analysis of the most recent results for responsiveness from the WHS for ambulatory and inpatient healthcare services for sixty-five countries (with special reference to subsets of European countries) to see how European countries’ health-care systems perform with respect to responsiveness.