**7. References**


The following draws on the research reviewed to describe a series of steps which is likely to

1. Create a structure which includes key stakeholders to formulate a service-strengthening

2. Combine actions to strengthen delivery of disease specific programmes with actions to

3. Use the constraints-based list below to guide national and local information gathering on the nature, severity and possible solutions for national and local constraints to:

Management development and management system development especially for

4. Consider from this report and others which evidence about constraint-reduction actions

5. Combine this information with the national information described above to formulate sub-strategies to reduce each of the constraints. Consider which actions would produce

6. Consider which actions in each sub-strategy are the same or similar and then prioritise

7. Sequence the strategy in relation to priorities, funding availability and your assessment

8. Create a structure for implementation involving stakeholders, and with systems to allocate the resources to each sub strategy, and to monitor and to regularly review the

This report was commissioned by the MoPHP, Primary Health Care Sector to help inform future strategy to strengthen health services and health systems in Yemen. The grant is from

Al Serouri, A.W. (2004). Towards Quality Health Care In Yemen Republic: I- Quality

Cooley, L., Kohl, R. (2005). *Scaling-up – a conceptual and operational framework.* Washington

from Clients' perspective. The Yemeni Journal of Medical and health Research, 2004,

D.C., In: *Management Services International,* accessed 30 March 2010, Available from: <http://www.vibrantcommunities.ca/downloads/SSI\_downloads/kohl\_scaleup.pdf>

**5.5 Practical steps for developing a strategy** 

strategy for the country and each region

 Necessary changes to organisation Drug supply and better prescribing

management information and use

these in the overall strengthening strategy.

GAVI for Health System Strengthening (HSS).

strategy.

**7. References** 

3: 1-6.

**6. Acknowledgment** 

Finance for health services

result in an effective strengthening strategy which is implementable:

strengthen health services and the health system overall.

Human resources and management and planning

Employee and provider motivation and payment systems

Cross-sector interventions which strengthen health services

significant short term results and which are longer term actions.

of the absorptive- and change-coping capacity of the system.

is most applicable to your country, and the strength of the evidence.

Quality and performance improvement programmes and methods

Good governance including community participation in health services


**17** 

*Italy* 

**Performance Measurement Features of the** 

A growing number of factors among which rising costs, technological advancements, aging population, health market failure and medical errors, led many industrialized countries to manage their health services and goals through performance measurement (Arah et al, 2003; Kelley & Hurst., 2006; Smith, 2002). In this context it became a commonplace for countries to formally assess the performance of their healthcare system (Mc Loughlin et al., 2001). Since the 1980s the introduction of "New Public Management" (NPM) principles has promoted a number of reforms in order to drive a more efficient, effective and accountable public sector (Hood, 1995a; Lapsley, 1999; Saltman et al. 2007). OECD countries have

Among the NPM principles, the one asking the public sector to adopt more explicit and measurable standards of performance measurement, has motivated countries to create

In the Italian health sector, the development of PMS can be traced back to the 90s reforms that introduced managerial tools and devolved the organization and assessment of healthcare services to Regions. This devolution, enforced by the recent federalist reform of 2009, has led Regions to shape their own organizational structures and relationships among health system actors (Censis, 2008; Formez, 2007). As a consequence of these reforms, Italy

On the basis of these considerations the Italian health sector provides with an interesting scenario in order to detect and analyze the differences and similarities in PMS adopted by

This chapter attempts to provide a cross sectional analysis of the Italian Regional PMS

As a consequence of NPM reforms, especially those concerning PMS, academics and international organizations such as the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD) developed conceptual frameworks and models in order to help countries in building effective tools (Arah et al.,

applied these principles in different ways with different emphasis (Hood 1995b).

has now 21 Regional Health Systems with significant differences from each other.

characteristics using evidences of an empirical study carried out in 2008-2009.

2006; Kelley et al., 2006; Murray & Evans, 2003; Smith, 2002; Veillard et al., 2005).

different performance measurement systems (PMS).

**1. Introduction** 

the Regional governments.

**2. Theoretical frameworks** 

**Italian Regional Healthcare Systems:** 

*Istituto di Management - Laboratorio Management & Sanità,* 

**Differences and Similarities** 

Milena Vainieri and Sabina Nuti

*Scuola Superiore Sant'Anna, Pisa* 

