Health systems responsiveness: A measure of the acceptability of health-care processes and systems from the user’s perspective

Introduction The World Health Organization (WHO) developed and proposed the concept of responsiveness, defining it as aspects of the way individuals are treated and the environment in which they are treated during health system interactions (Valentine et al. 2003). The concept covers a set of non-clinical and non-financial dimensions of quality of care that reflect respect for human dignity and interpersonal aspects of the care process, which Donabedian (1980) describes as “the vehicle by which technical care is implemented and on which its success depends”. Eight dimensions (or domains) are collectively described as goals for health-care processes and systems (along with the goals of higher average health and lower health inequalities; and non-impoverishment - as measured through other indicators): (i) dignity, (ii) autonomy, (iii) confidentiality, (iv) communication, (v) prompt attention, (vi) quality (of) basic amenities, (vii) access to social support networks during treatment (social support), and (viii) choice (of health-care providers). Building on extensive previous work, this chapter directs the conceptual and methodological aspects of the responsiveness work in three new directions. First, the given and defined domains (Valentine et al. 2007) are used to link responsiveness (conceptually and empirically) to the increasingly important health system concepts of access to care and equity in access. The concept of equity used in this chapter was defined by a WHO working group with experts on human rights, ethics and equity. It is defined as the absence of avoidable or remediable differences among populations or groups defined socially, economically, demographically or geographically (WHO 2005).