Hospital Public–Private Partnerships in Low Resource Settings: Perceptions of How the Lesotho PPP Transformed Management Systems and Performance

Abstract

Public-private partnerships (PPPs) seek to expand access to quality health services in ways that best leverage the capacities and resources of both sectors. There are few examples of PPPs in the hospital sector in developing countries, and little is known about how the involvement of the private sector transforms the delivery of health services in this context. In 2006, the government of Lesotho adopted a PPP approach for the health sector, contracting out to design, build, and operate a hospital network in its capital district. This case study examines differences between a government-run hospital and the PPP-run hospital that replaced it, using in-depth interviews with key informants, observation of management systems, and document review. Key informants emphasized changes in infrastructure, communication, human resource management, and organizational culture that improved quality and demand for services. Important drivers of improved performance included better defined policies and procedures, empowerment and training of managers and staff, and increased accountability. Well-functioning support systems kept the hospital clean and equipment functioning, reduced stock-outs, and allowed staff to do the jobs they were trained to do. The Lesotho PPP model provides insight into the mechanisms by which publicprivate partnerships may increase access and quality of care.

The Private Scope in Public–Private Collaborations: An Institutional and Capability-Based Perspective

“…In this paper, we focus on the determinants of private scope in public-private collaborations, with the notion of the private scope referring to the extent to which private actors are investing and participating in multiple, successive (functional) activities along the collaborative project's value chain (Kwak et al 2009). Specifically, the notion of private scope in PPPs considers the structure and division of resource allocation and production activities along the various stages of the value chain, and the associated interdependencies between different sets of activities (Jacobides, 2006 in this case is expected to lead to expanded access to services along with more efficient asset management and higher quality care (Vian et al 2015).…”

A Framework of Output Specifications and Evaluation Method for Hospital PPP Projects

“…As is shown in Table 3, this section evaluates hospital operation and maintenance of hospital PPP projects from the perspective of third-party regulatory agencies [4]. When the social capital party participates in the construction and design of the hospital PPP project, it is mainly responsible for providing the repair and maintenance of the building during the operation period.…”

A mixed-method pilot study to improve patient satisfaction in rural Uganda

“…In low-income settings, much attention has been given to the importance of increasing the availability and accessibility of health services, but insufficient focus has been paid to assessing their quality (Batbaatar et al 2015). Only recently has patient satisfaction with healthcare interactions been conceptualised as a factor influencing confidence and future care-seeking behaviours (Andaleeb 2011; Svoronos, Macauley, and Kruk 2014;Vian et al 2015).…”

“…Monitoring the association between satisfaction, health outcomes, and changes in clinical care is important yet the evidence base for the mechanism through which patient perspectives causes change must be more clearly conceptualised and evaluated (Dang et al 2013). After collecting baseline data on satisfaction, patients in Lesotho reported improvements in care and decreased waiting times for treatment (Vian et al 2015). There is, however, concern within the medical community that focusing on patient-identifiable issues decreases the attention to clinic care and safety, which may be more difficult, if not impossible, for the patient to comment on (Black 2013).…”