The purpose of this paper is to explore stakeholder expectations of performance within public healthcare services from a less-developed economic context – Zambia in this case. The study emerges from extant literature indicating potential variations in stakeholder conceptions and expectations of performance within public services.
The paper draws on institutional and structuration theories to investigate cross-sectional stakeholder expectations of performance together with power relations embedded within public healthcare performance expectations. Empirical data are drawn from semi-structured interviews with 33 stakeholders including legislators, policymakers, regulators of health services, healthcare professionals and health facility managers.
The findings not only reiterate the constructed and multi-dimensional nature of performance but also highlight the hierarchical configuration of stakeholder expectations linking macro-level health outcomes with micro facility-level service delivery processes.
The study points towards the need of harmonising the national performance measurement (PM) framework to ensure that macro-level goals are suitably cascaded and translated into micro-level service delivery processes through bottom-up structuration linkages.
In addition to filling the gap of explicating public healthcare PM practices in a less-developed economic context, the paper integrates insights from institutional and structuration theories to depict stakeholder expectations of performance through a multi-level and hierarchical framework.
