What can people expect from their health system?

Shot of a doctor showing a patient some information on a digital tablet

As constraints around the availability and accessibility of health services are increasingly loosened in low-and middle-income countries, it is important to understand what people from across the social spectrum expect from their health systems.

It has been argued that since expectations can be limitless, and since expectations quickly change and rise as they are met, it is important to have a realistic understanding of, and agreement about what citizens can reasonably and legitimately expect from their health systems. In fact, in 2000, the World Health Organisation codified the notion of ‘legitimate expectations’ by including it in its definition of what makes a responsive health system. While the definition has stood the test of time so far, little attention has been paid to the notion of ‘legitimacy’ of expectations, and to, how to go about establishing ‘legitimate’ expectations in particular health system contexts?

Our recently published paper, ‘What can one legitimately expect from a health system? A conceptual analysis and a proposal for research and action', tackled this question. We unpack the concept of legitimacy of expectations using insights from different disciplines. We argue that there is a need for the creation of regularised ‘invited spaces which allow citizens to negotiate and contest the standards that can define ‘legitimate’ expectations. We contend that in establishing such spaces, “it is vital that healthcare institutions create the conditions for equivalence to strengthen the participation of marginalised groups.”

We call upon researchers, as key health system actors, to pave the way ahead – to trigger the processes for equitable and meaningful participation and contestation of entrenched health system norms.

We welcome your feedback on our paper: What can one legitimately expect from a health system? A conceptual analysis and a proposal for research and action | BMJ Global Health

Ms Kimberly Lakin, is a PhD Scholar at the Nossal Institute; Professor Sumit Kane is Kimberly’s supervisor.

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Professor Sumit Kane


  • health services
  • legitimate expectations
  • Responsiveness