Responsiveness

Responsiveness in this context is a measure of how the system performs relative to non-health aspects, meeting or not meeting people’s expectations of how they should be treated by providers of prevention, care or non-personal services (like vector control, for instance).

This general sense of responsiveness can be further decomposed into two broad elements:

• Respect for human beings as persons (largely subjective and judged by the patient), and
• Orientation of health systems to common concerns of patients and their families as clients (more objective)

The above two broad elements further include the following:

Respect for persons includes:

• Respect for the dignity of the person (in general, not humiliating or demeaning patients)
• Confidentiality (the right to determine who has access to one’s health information)
• Autonomy (to participate in choices about one’s own health)

Greater autonomy can mean a conflict between individual freedom to choose a service/ intervention (like immunization), and public health objectives of ensuring good health for as many as possible.

Client orientation includes:

• Prompt attention: immediate attention in emergencies, and reasonable waiting times for non-emergencies
• Amenities of adequate quality (like cleanliness, hospital food, and space)
• Access to social support networks (family and friends) for those receiving care
• Choice of provider: freedom to choose which individual or organization delivers one’s care

Generally, responsiveness promotes service utilization, but not if some people are treated with courtesy while others are humiliated. A perfectly fair health system would make no such distinctions and would receive the same rating of responsiveness on every element, for every group in the population. Sadly, poor are identified as the main disadvantaged group in almost every country.

It generally costs more to assure quick attention and to offer high quality food, more space and well-kept facilities. Cost control is made harder if people are allowed to choose their providers, and costs differ among them. In contrast, elements of respect for people can be costless apart from training of providers and administrators. Respect for dignity, autonomy, and confidentiality show no relation to health system spending. There is potential for improving health system performance in these respects without taking any resources away from the primary objective of better health.