Designing Outcome-Based Performance Management Systems to Assess Policies Impacting on Caesarean Section Rate: An Analysis of the Sicilian Maternity Pathway

The reduction in Caesarean sections (CSs) is widely considered a priority in the public decision makers agenda. Though the World Health Organisation has strongly encouraged countries to implement policies to reduce CSs to 10–15%, after almost thirty years this goal appears still far from its achievement. The literature depicts CS as a multifaceted phenomenon whose causes involve different factors, ranging from the patient sphere to the health care level of services provided, and the societal preference of CS practice. Policy makers aiming to standardise cares and to reduce CSs often implement maternity pathways (MP). By investigating the MP introduced in the Sicilian region, the authors highlight the need to adopt an outcome-based performance management approach to assess the effectiveness of CS reduction policies. The suggested perspective also reveals the necessity to frame and coordinate the interdependencies between the different actors playing a crucial role in the MP.