T03P11 - Bringing Politics to the Analysis of Performance Measurement Programs: Case and Comparative Studies in Health Policy

Topic : Policy and Politics sponsored by Policy & Politics Journal

Panel Chair : Fabiana C Saddi - fasaddi@usp.br

Panel Second Chair : Stephen Peckham - s.peckham@kent.ac.uk

Panel Third Chair : Nick Turnbull - nick.turnbull@manchester.ac.uk

Objectives and Scientific Relevance of the panel

In this panel a selection of papers may be considered for the Policy & Politics journal.



Co-organized by Fabiana C. Saddi, Stephen Peckham, Nick Turnbull and Matthew J. Harris.

The objective is to gather political-realistic studies focusing on either or both policymaking and implementation processes of performance measurement (PM) programs in health policy in developed and/or developing counties, as a case or comparative study.

PM programs have been adopted in countries with distinct levels of development, and tend to continue to play an important role in policymaking. In this process, the adoption of PM has revealed some challenges during implementation and has therefore, though in different rhythm between countries, been accompanied by the valorization of political-realistic or more post-positivist type of analyses. Those programs are constructed and implemented in political and social environments with distinct organizational capacity and where people hold values and interests that can influence the implementation of rational-based PM programs. This is why concerns based on who are involved in its elaboration and implementation, as well as on where/how those processes have been realized, have recently contributed to enhance the importance of taking the politics, the cognitive/subjective (“alternative logics”) and work task and organizational aspects of PM programs into account. They have also contributed to better understand and unfold some dynamics and regularities that go beyond rational-based concerns. This literature emphasizes aspects such as political system, organizational culture, participation of staff in the implementation, appropriateness of the design, the possibilities of gaming (Bevan and Hood) and cheating and symbolic uses. Also, concerns and consequences regarding performance measurement programs have been categorized as “performance alternative logics” (Pollitt), as the “politics of performance” (Lewis) and as “performance paradox”, as examples. 

When applied to middle and low income countries, studies have given emphases not only to front line staff’s involvement (Songstad et al.) (Chimhutu et al.) (Ssengooba F et al.), but especially to organizational constraints (Olafsdottir et al.), given the fact that the policies still face some contradictory organizational problems (Saddi and Harris et al.). Those works are considered important for having enhanced the knowledge on motivation and impact regarding front line workers in contradictory or problematic contexts, as well as for shedding lights on how to enable the creation of a culture of evaluation in diverse and not always favorable organizational and political environments.

From the policy diffusion perspective, however, we still know little comparatively about the distinctive and politically significant challenges involved in the implementation of PM programs not only across health unities with different configurations in each country, but also across countries with distinctive and similar levels of development. 

If those issues constitute a significant lacuna in the knowledge of comparative health policy and politics, shouldn’t we develop comparative political analyses evaluating how PM have been designed and implemented? What methods could be used to develop meaningful comparisons across countries, taking each reality into account? Could differences be explained in terms of institutional heritages, or by means of using a comprehensive and long-term political analysis? What lessons could be partially and meaningfully transferred from developed to developing countries and vice versa?

Call for papers

Co-organizers and chairs: Fabiana C. Saddi (Federal University of Goias, Brazi - fasaddi@usp.br), Stephen Peckham (London School of Hygiene and Tropical Medicine and University of Kent - s.peckham@kent.ac.uk), Nick Turnbull (University of Manchester, nick.turnbull@manchester.ac.uk), Matthew J. Harris (Imperial College London - m.harris@imperial.ac.uk ).


This panel welcomes papers focusing on either or both the policymaking and implementation process(es) of performance measurement programs (PM) adopted in health policy in distinct countries in the last years. We expect papers to take into account the actors, ideas and interests involved in the policymaking and/or implementation phases in diverse institutional setting(s) and macro/micro political context(s). Papers can be applied to either primary health care or specialized health care policies. Analyses should focus on political or political-realistic aspects of policy-making and/or implementation processes, or establish politically significant relationships between both processes. We welcome studies that consider policymaking from the view point of social learning (Hall), policy transfer (Dunlop), feedback (Jacobs), policy regime change (May), state capacity, performance regimes and system of performance (Talbot) and/or as communicative practice (Fischer) (Turnbull) or from other interactive perspective. Implementation analyses that have applied surveys, semi-structured and open interviews, as well as developed focus groups or policy dialogues with front line health workers are highly encouraged. Papers highlighting the inherent problems of measuring performance in health care delivery when comparing those interventions where the medical intervention and professional practice has only a partial effect and where self-care and informal care may play a larger role in success (Peckham) are welcome. Country analyses of PM programs and comparisons across countries employing mixed-methods, qualitative and long-term analyses, as well as political-sociological and institutional type of policy analyses will also be considered. Papers that deal with the theme of this panel in innovative and politically and policy relevant ways will be highly appreciated.

Export PDF