The responsiveness of a health system as a concept was defined by the World Health Organization (WHO) and leading scientists as the health system’s ability to meet the universal, legitimate expectations of its users (or clients, patients) with regards to non-medical aspects of the way they are treated and the environment (or setting) within which they are treated. This thesis describes how the WHO developed a method to measure the responsiveness concept through assessing the client-experiences of any patient or client in a health care system. The challenge was to achieve universality in measurement feasibility and validity, to enable comparisons of health systems between countries across the globe, and across diverse parts of the health system e.g. mental health care and child birth. A set of 106 WHO household surveys, with approximately 258,000 respondents and 83 countries, analyzed with psychometric and regression methods proved the scientific credibility and viability of this concept and its measurement. With interview questionnaires, the voice of the client or patient can be recorded irrespective of country, culture, or personal education, socio-economic or health background. A secondary finding was that the data show convincingly that inequality of health outcome - known to exist in all developed countries - is paralleled by inequality in the process of care, that is, the degree to which the health system takes care of issues like dignity, communication, confidentiality, prompt attention (access) and basic quality of amenities. The method was valid in specific applications as shown in the Netherlands: a survey could be derived to measure patient experiences in birth care (the “ReproQ”). These findings call for health institutions to take steps to improve their client focus, becoming more responsiveness to the user’s needs for respectful, communicative treatment, with quality amenities and timely responses. As health is a human right, it is the responsibility of the state to develop responsiveness standards and ensure that all providers, public and private, are compliant. Researchers and health authorities should standardise measurement instruments and approaches to ensure that quality of care from the users’ perspective is comparable across different types of private and public sector providers. This will help to ensure greater transparency and accountability of health care insurers and providers to the oversight authorities and to their clients.

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G.J. Bonsel (Gouke)
Erasmus University Rotterdam
Department of Gynaecology & Obstetrics

Valentine, N.B. (2018, December 14). Measuring Client-Centered Health Care Using the Universal World Health Organization Concept of “Health System Responsiveness” : Methods and applications. Erasmus University Rotterdam. Retrieved from