EDITORIAL

World Health Report 2000:
Health system

performance
T he World Health Report 2000 is a review by the WHO of the world's health systems

performance.' It makes sobering reading for South Africans'
South Africa's overall health system performance was ranked 175 out of 191 countries. The

best country was France, the UK was 18 and the USA stood at 37 on the list. The worst country
was Sierra Leone at 191. What is surprising is how badly South Africa performed in this global

competition. Most African countries were in the last quarter of the list.
Performance was measured in two ways: on the functions of service delivery,

MBChB, FFRad(D)SA, FRCR, M Med(UCT) the creation of resources (investment and training), stewardship and financing
(collecting, pooling and purchasing), and on the objectives of responsiveness by
the health care system to people's expectations, fair financial contribution and
good health of the population.

South Africa's health system measured poorly in the following areas of responsiveness to
people's expectations: promptness of service delivery, choice of service provider, respect of
patients and institutional autonomy.

For radiologists, an interesting comparison was the health care input mix in middle-income
. countries like South Africa, Thailand, Mexico and Egypt. Health care input mix is a measure of

the financial resources invested in high technology such as MR and CT scanners, finance spent
on hospital beds and finance spent on training of physicians and nurses. The authors' comment

. on South Africa is that it is "at the maximum of the group of middle income countries for
. expenditure on health care, nurses, hospital beds and MR scanners, while it is the furthest from
the maximum for drugs and physicians".

What does this all mean in a global perspective? We are classified by the World Bank as a
middle-income country. Our gross national product per capita in 1998 was USD3 310, making
us the 83rd richest country in the worldl-We spend close to 8,5% of our gross domestic product

. (GDP) on health care, which compares well with other middle-income countries: 6% in Hungary,
3% in Malaysia and 4,7% in Chile, all of which have better performing health systems.'

What is apparent is that we are not getting value for money in our health care system
investment in South Africa. Now that our health system performance has been measured for
the first time using international norms, we know where we stand in the international rankings.
We also know we have to do better.

Peter Corr

Head: Department of Radiology,
University of Natal

Peter Corr
Editor

References
l . World Health Report 2000. Health systems: Improving performance. Geneva: WHO, 2000 (www.who.org).
2. World Bank Atlas 2000. Washington: World Bank (www.worldbank.org).
3. McIntyre D, Bloom G, Doherty J, Brijlal P. Health expenditure and finance in South Africa. Durban: Health

Systems Trust & World Bank, 1993 (www.hst.org.za/pubs/hstefsa/heftoc.htm).

3 SAJOURNAL OF RADIOLOGY· October 2000