Constraints, challenges and prospects of public-private partnership in health-care delivery in a developing economy

Abstract

Background:In Nigeria, concerns on the quality and financing of health-care delivery especially in the public sector have initiated reforms including support for public-private partnerships (PPP) at the Federal Ministry of Health. Likewise, Enugu State has developed a draft policy on PPP since 2005. However, non-validation and non-implementation of this policy might have led to loss of interest in the partnership.Aim:The aim of this study was to provide evidence for planning the implementation of PPP in Enugu State health system via a multi-sectoral identification of challenges, constraints and prospects.Subjects and Methods:Pre-tested questionnaires were administered to 466 respondents (251 health workers and 215 community members), selected by multi-stage sampling method from nine Local Government Areas of Enugu State, Nigeria, over a study period of April 2011 to September 2011. Data from the questionnaires were collated manually and quantitative data analyzed using SPSS version 15 (Chicago, IL, USA).Results:Only 159 (34.1%, 159/466) of all respondents actually understood the meaning of PPP though 251 (53.9%) of them had claimed knowledge of the concept. This actual understanding was higher among health workers (57.8%, 145/251) when compared with the community members (6.5%, 14/215) (P < 0.001). Post-PPP enlightenment reviews showed a more desire for PPP implementation among private health-care workers (89.4%, 101/113) and community leaders/members (55.4%, 119/215).Conclusion:PPP in health-care delivery in Enugu State is feasible with massive awareness, elaborate stakeholder's engagements and well-structured policy before implementation. A critical challenge will be to convince the public sector workers who are the anticipated partners to accept and support private sector participation.

Stakeholder perspectives on public-private partnership in health service delivery in Sindh province of Pakistan: a qualitative study

“…This perception among participants could be attributed to the fact that in Pakistan, existing PPP initiatives started only as a result of poor performance of the government sector. Other researchers have found that overall understanding of PPP is good among public and private sector health workers 23 .…”

“…Resistance against government initiatives that allow increased role of private sector in healthcare provision has been reported in Pakistan 15 and other settings. For example, around 50% public sector health workers opposed the idea of PPP in delivery of healthcare services in Enugu state of Nigeria 23 .…”

“…The semi-structured interview guide was developed based on a tool that sought to explore the views of stakeholders regarding PPP in an earlier study 23 . The flexible interview guide covered aspects such as the participants' understanding and awareness of PPP; the sources where they received the information; their perspectives about the reasons for the provincial government to adopt the PPP policy and the delays in implementation; and the perspectives about the barriers in implementing the policy.…”

Unresolved Challenges in Health Service Delivery in Tanzania under Public Private Partnership: Stakeholders Views from Dar es Salaam Region

“…The rules define private property rights and their allocation; the relationship between participants in the partnership; conventions governing participation such as competition, fair business practices and mutual trust [16,17]. The necessity for ensuring effective institutional arrangements in the context of health service delivery is aimed at implementing strategies to improve the quality of healthcare services, increase universal and equitable access to healthcare service delivery [1,18,19]. The government of Tanzania has therefore, adopted three modes of health service delivery under PPP namely contracting out, offering subsidies and privatisation.…”

“…Overall, the central government is mandated to periodically monitor and supervise activities in line with PPP service agreements with partners. In line with decentralisation guidelines, primary health services are supposed to be monitored by LGAs, while regional hospitals are under the supervision of regional authorities[18,26,30,31,36]. The discussion with government officials revealed that reports from partners were sometimes not submitted, or written and hence, the monitoring team lacked a foundation to assess progress.…”