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Tesi etd-10112021-113253

Type of thesis
Dottorato
Author
BELARDI, PAOLO
URN
etd-10112021-113253
Title
Evaluating Healthcare Performance in Low-and-Middle-Income Countries: Lessons Learned from a Bottom-Up and Integrated Approach
Scientific disciplinary sector
SECS-P/08
Course
Istituto di Management - MANAGEMENT
Committee
relatore Prof.ssa NUTI, SABINA
Membro Prof. Pier Luigi Lopalco
Relatore Prof.ssa VAINIERI, MILENA
Membro Prof. BELLE', NICOLA
Membro Dott.ssa MURANTE, ANNA MARIA
Keywords
  • Africa
  • healthcare
  • low-and-middle-income countries
  • performance evaluation
Exam session start date
16/12/2021;
Availability
completa
Abstract
This doctoral research is a compilation of three articles that seek to illustrate a comprehensive analysis of how and what features and principles of healthcare performance measurement and evaluation in High-Income Countries (HIC) can be used and adopted when developing a bottom-up and integrated Performance Evaluation System (PES) in Low-and-Middle-Income Countries (LMIC). <br>The Introduction outlines the theoretical framework, by providing an overview of performance measurement in healthcare. Particularly, the first part of this section describes the core components of performance measurement in HICs, its evolution and the key features of an “integrated” performance measurement system. The second presents the main initiatives that have been carried out in the same field in LMICs, with a particular focus on the Sub-Saharan African region. Finally, this section defines the research questions and summarises the research design and outputs. <br>Following the introduction, the research includes three chapters. The First Chapter synthesizes the evidence from the current scientific literature regarding the relationship between benchmarking and quality of care. The findings demonstrate that benchmarking practice may foster quality improvement, but the effects of its systematic use remain a field that need to be further explored, especially in LMICs. The Second Chapter reports the experience of adapting a Performance Evaluation System (PES) designed and implemented in several HICs to four different contexts located in three Sub-Saharan Africa Countries, namely Ethiopia, Tanzania, and Uganda. This chapter illustrates how the system can be a useful framework to be shared with actors and professionals involved in the design, implementation, and use of PESs in LMICs. The Third Chapter investigates the importance of using an integrated and innovative approach when measuring and evaluating the performance of what is relevant to the context of reference. More particularly, this chapter describes the development process of a PES aimed at evaluating the health services provision related to three common communicable diseases, namely Tuberculosis, Gastroenteritis, and HIV. Final remarks and references are presented in the Conclusions.<br>
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