The World Health Report the goals of health systems and relating them to the essential functions, the framework is meant to help Member States measure their own performance, understand the factors that contribute to it, improve it, and respond better to the needs and expectations of the people they serve and represent The analysis and synthesis of a wealth of information is summa- rized by a measure of overall achievement and by a performance index which should lead to much new research and policy development. The index will be a regular feature of forth coming World health reports and will be improved and updated every year. The framework was the basis for round table discussions entitled"Addressing the major health system challenges"among Ministers of Health at the 53rd World Health Assembly in Geneva in May 2000. The subject of these discussions is reflected throughout the report, and the outcome of the discussions will help orient future work on the framework. Policy-makers need to know why health systems perform in certain ways and what they can do to improve the situation. All health systems carry out the functions of providing or delivering personal and non-personal health services; generating the necessary human and physical resources to make that possible; raising and pooling the revenues used to the overall stewards of the tions entrusted to them Comparing the way these functions are actually carried out provides a basis for under- standing performance variations over time and among countries. Undoubtedly, many of the concepts and measures used in the report will require refinement. There is an impor tant agenda of developing more and better data on goal attainment and on health system functions. Yet much can be learned from existing information. The report presents the best available evidence to date. In doing so, it seeks to push forward national and global devel opment of the skills and information required to build a solid body of evidence on the level and determinants of performance, as a basis for improving how systems work. Improving performance"are therefore the key words and the raison d'etre of this report The overall mission of WHO is the attainment by all people of the highest possible level of countries. The Or- ganization,'s ability to fulfil this mission depends greatly on the effectiveness of health sys- tems in Member States-and strengthening those systems is one of WHOs four strategic directions. It connects very well with the other three: reducing the excess mortality of poor and marginalized populations; dealing effectively with the leading risk factors; and placing health at the centre of the broader development agenda. pregnancy are all WHO priorities. But the Organization will have very little impact in these and other battlegrounds unless it is equally concerned to strengthen the health systems through which the ammunition of life-saving and life-enhancing interventions are deliv- This report asserts that the differing degrees of efficiency with which health system organize and finance themselves, and react to the needs of their populations, explain much of the widening gap in death rates between the rich and poor, in countries and between countries, around the world. Even among countries with similar income levels, there are unacceptably large variations in health outcomes. The report finds that inequalities in life expectancy persist, and are strongly associated with socioeconomic class, even in countries that enjoy an average of quite good health. Furthermore the gap between rich and poor ectancy is divided into years in good health effect, the poor not only have shorter lives than the non-poor, a bigger part of their lifetime is surrendered to disabilityxii The World Health Report 2000 the goals of health systems and relating them to the essential functions, the framework is meant to help Member States measure their own performance, understand the factors that contribute to it, improve it, and respond better to the needs and expectations of the people they serve and represent. The analysis and synthesis of a wealth of information is summa￾rized by a measure of overall achievement and by a performance index which should lead to much new research and policy development. The index will be a regular feature of forth￾coming World health reports and will be improved and updated every year. The framework was the basis for round table discussions entitled “Addressing the major health system challenges” among Ministers of Health at the 53rd World Health Assembly in Geneva in May 2000. The subject of these discussions is reflected throughout the report, and the outcome of the discussions will help orient future work on the framework. Policy-makers need to know why health systems perform in certain ways and what they can do to improve the situation. All health systems carry out the functions of providing or delivering personal and non-personal health services; generating the necessary human and physical resources to make that possible; raising and pooling the revenues used to purchase services; and acting as the overall stewards of the resources, powers and expecta￾tions entrusted to them. Comparing the way these functions are actually carried out provides a basis for under￾standing performance variations over time and among countries. Undoubtedly, many of the concepts and measures used in the report will require refinement. There is an impor￾tant agenda of developing more and better data on goal attainment and on health system functions. Yet much can be learned from existing information. The report presents the best available evidence to date. In doing so, it seeks to push forward national and global devel￾opment of the skills and information required to build a solid body of evidence on the level and determinants of performance, as a basis for improving how systems work. “Improving performance” are therefore the key words and the raison d’être of this report. The overall mission of WHO is the attainment by all people of the highest possible level of health, with special emphasis on closing the gaps within and among countries. The Or￾ganization’s ability to fulfil this mission depends greatly on the effectiveness of health sys￾tems in Member States – and strengthening those systems is one of WHO’s four strategic directions. It connects very well with the other three: reducing the excess mortality of poor and marginalized populations; dealing effectively with the leading risk factors; and placing health at the centre of the broader development agenda. Combating disease epidemics, striving to reduce infant mortality, and fighting for safer pregnancy are all WHO priorities. But the Organization will have very little impact in these and other battlegrounds unless it is equally concerned to strengthen the health systems through which the ammunition of life-saving and life-enhancing interventions are deliv￾ered to the front line. This report asserts that the differing degrees of efficiency with which health systems organize and finance themselves, and react to the needs of their populations, explain much of the widening gap in death rates between the rich and poor, in countries and between countries, around the world. Even among countries with similar income levels, there are unacceptably large variations in health outcomes. The report finds that inequalities in life expectancy persist, and are strongly associated with socioeconomic class, even in countries that enjoy an average of quite good health. Furthermore the gap between rich and poor widens when life expectancy is divided into years in good health and years of disability. In effect, the poor not only have shorter lives than the non-poor, a bigger part of their lifetime is surrendered to disability