World Health Report 2000: a step towards evidence-based health policy.

the policy message in the World Health Report 2000 as “healthcare à la Karl Marx”, whereas Vicente Navarro described it as the mouthpiece of “US financial and political circles”. This contrast in opinions illustrates how discussions of health policy or health system reform often become ideological debates that are fuelled by anecdotes or, at best, by non-comparable results from studies in which differing methods were used. The WHO Framework on Health Systems Performance Assessment is an attempt to accelerate the development of an evidence base on the outcomes of health systems, and of the determinants of these outcomes. Without comparable information about the achievements and organisation of different systems, transcendence of purely ideological debates will be difficult. Clinical practice in many countries is being transformed by evidence-based medicine, and a similar transformation in assessment of health system performance is desperately needed. We hope that the World Health Report 2000 is a step in that direction. Navarro seems to have misinterpreted the fundamental principles of the WHO Framework, which are: to clarify the boundaries of health systems; to assess how health and other systems interact to achieve key social goals; to define and measure health, responsiveness, and fairness in financial contribution; and, ultimately, to show the importance of transparency and accountability for the world’s health systems.