Acceptability of a Healthcare Performance Evaluation System Among Professionals in Rural Areas of Ethiopia, Tanzania, and Uganda Three Years After Its Implementation

The efficacy of healthcare performance evaluation systems depends on their design and implementation, as well as on their perceived value and integration into daily practice. This study explores the acceptability of a healthcare performance evaluation system, used by health and administrative professionals in four rural healthcare settings in Ethiopia, Tanzania, and Uganda, three years after its implementation. In-depth semi-structured interviews were conducted, either in person or via video conference, with 17 professionals involved in system design and implementation. The analysis of qualitative data drew on Sekhon’s Theoretical Framework of Acceptability, using content analysis to identify themes across seven dimensions of acceptability. Key findings show that participants’ perceptions of acceptability of the performance evaluation system are influenced by data disclosure and reputational effect, the system’s understandability, alignment with their mission to improve quality of care, perceived usefulness, experienced opportunity costs, and intervention burden. The key features of the performance evaluation system are the most critical factors contributing to its acceptability, but the administrative burden, which includes professionals’ need to invest more time and change work habits to use the new system, poses some challenges and may hinder the medium- to long-term effectiveness of the intervention.