In today’s health care arena, a number of issues are being raised that have received more attention either from the health care consumers or the media. The 1990s can easily be dubbed the period of “performance measurement”. Whether as a provider, a consumer or a purchaser, each was looking for ways to satisfy the other through measuring and reporting on care outcomes. Accountability was at stake in that period. Several third-party organizations attempted to produce certain measure to report on these care outcomes. A number of “indicators” were developed and measured and “report cards” were assembled. All of these activities were done in the effort to measure performance. WHO organized and facilitated a number of activities related to quality assessment, performance improvement and outcome measurement. A large number of countries and institutions participated in these activities and initiatives. And at the end, all agreed there had to be an organized mechanism to account for quality, continuous measurement and improved performance in health care organizations. In order to do this, a mechanism for certification, licensure or accreditation should be put in place. This trend continued in the 2000’s and until now where performance measurements and improvement as on the top of the agenda of any healthcare organization and country healthcare system. Related to performance is accountability. In particular professional accountability both at the individual and the institutional levels became extremely important when dealing with issues related to performance.