The value of scoring and ranking
Scoring is an intuitive method of summarising complex health system capacities across diverse contexts, monitoring longitudinal and cross-sectional trends and advocating for needed policy change. Scoring is also used widely across many areas of global health, economic, policy and development research, as well as in established health security evaluation tools like the JEE.7–10
In general, scoring is an effective method for measuring, motivating and monitoring efforts to strengthen infectious disease management capacities across high-income, middle-income and low-income settings alike. The Africa Leaders Malaria Alliance, for example, produces scorecards that track country progress in improving financing, capacity-building and increasing coverage of health services for malaria, neglected tropical diseases and malnutrition.11 And, between 2012 and 2016, publication of scores from the Nuclear Security Index (produced by the Nuclear Threat Initiative and developed with EIU) encouraged 10 countries to remove or dispose of highly enriched uranium within their territories.12 The Human Development Index has similarly emerged as a valuable tool for guiding decision making and monitoring policymaking at both national and subnational levels in many countries.8
In this vein, the GHS Index provides high-level composite scores for each country and offers considerable granularity and transparency in scoring justifications at the indicator and sub-indicator levels, with the aim of helping decision makers pinpoint discrete capacities that require strengthening. Notably, GHS Index scores have been used by some countries to create new metrics of health security. For example, Malaysia’s Ministry of Science, Technology and Innovation—in collaboration with PEMANDU Associates and the Sunway Group—has developed a Global COVID-19 Recovery Index (GCI). GCI Scores are calculated from dynamic estimates of confirmed cases and death rates by country (which receive a weight of 70%), along with static measures of prevention capacities (GHS Index, category 1) and public health vulnerability (GHS Index, Indicator 6.5), which receive a weight of 30%.13
Like scoring, ranking is an effective way to galvanise change in low-performing countries and identify outliers, such as countries that score unexpectedly well despite limited resources, or those that rank poorly despite undertaking capacity-building efforts. Outliers, in turn, should prompt deeper analyses of such findings.14 Morse writes, too, that ‘the ‘league table’ style of presenting rankings is…meant to be picked up by the media, and through them the public, non-government organisations, pressure groups, aid agencies and so on, and ultimately provide pressure on decision makers to bring about positive change.’15 Regardless of their overall score and rank, all countries—including high-performing states—should examine specific GHS Index indicators closely as a means of identifying critical weaknesses to address through capacity-building, funding, legislation or other approaches (see the Considerations for GHS Index users section).