Measures of goal attainment and performance in the World Health Report 2000: a brief, critical consumer guide.

The World Health Report 2000 presents a set of indicators and global indices by which different countries' goal attainment and performance in health care may be compared. The paper explains the methods employed in some detail and raises a number of critical points. The WHO has gone too far in compressing the results of potentially useful primary measurements in summary indices with unclear meaning, dubious validity and little practical relevance to decision makers facing specific tasks and problems. The WHO has also gone too far in applying the same measuring rods to countries with different histories and values and different stages of development, and in encouraging international comparisons that are of little use to policy makers. The WHO needs to add an indicator of equality in access to its present indicator of fairness in financing.