Models of public–private engagement for health services delivery and financing in Southern Africa: a systematic review

Abstract

In low- and middle-income countries (LMICs), the private sector-including international donors, non-governmental organizations, for-profit providers and traditional healers-plays a significant role in health financing and delivery. The use of the private sector in furthering public health goals is increasingly common. By working with the private sector through public -: private engagement (PPE), states can harness private sector resources to further public health goals. PPE initiatives can take a variety of forms and understanding of these models is limited. This paper presents the results of a Campbell systematic literature review conducted to establish the types and the prevalence of PPE projects for health service delivery and financing in Southern Africa. PPE initiatives identified through the review were categorized according to a PPE typology. The review reveals that the full range of PPE models, eight distinct models, are utilized in the Southern African context. The distribution of the available evidence-including significant gaps in the literature-is discussed, and key considerations for researchers, implementers, and current and potential PPE partners are presented. It was found that the literature is disproportionately representative of PPE initiatives located in South Africa, and of those that involve for-profit partners and international donors. A significant gap in the literature identified through the study is the scarcity of information regarding the relationship between international donors and national governments. This information is key to strengthening these partnerships, improving partnership outcomes and capacitating recipient countries. The need for research that disaggregates PPE models and investigates PPE functioning in context is demonstrated.

Partnerships for Global Child Health

“…34 Public-private partnerships combine skills and resources from institutions in the public and private sectors. 35 The Baylor International Pediatric AIDS Initiative is an example. This partnership is between Baylor College of Medicine and 10 countries and various private partners that vary by country.…”

Insights for the future of health system partnerships in low- and middle-income countries

“…An in-depth investigation of PPPs reveals strong growth in industrialised countries where they increase the utilisation of healthcare infrastructures such as technologies, medical devices, clinical and non-clinical services, and facility management services [20]. Public approval was also found in developing countries where health systems are predominantly "mixed" [21]. In many LMICs, the public health system exists in parallel with the non-public health system, where for-profit organisations play a key role [22].…”

“…In most Global South countries, low capacity to meet health needs is a result of insufficient drugs supply, poor healthcare infrastructures, scarce resources and generally low quality of care [23,24]. Thanks to their effectiveness and efficiency, PPPs are the main tool used to implement public, health and social policies in LMICs [21]. They provide potential access to public services and ensure resources can be allocated in an effective and impartial way.…”

“…Barr identifying eight principal aspects, develops a protocol to evaluate the effectiveness of PPPs [2]. Whyle and Olivier classify partnerships into eight categories and identify characteristics and critical success factors for each of them [21].…”

Challenges in health service delivery under public-private partnership in Tanzania: Stakeholders’ views from Dar es Salaam Region

“…However, PPP arrangements have not been without challenges. A review study by Basu et al on the performance of PPP in low and middle-income countries and Whyle and Olivier in Southern Africa revealed a violation of medical standards and inadequate: human resource; equipment; and medication in the public sector [23,24]. Notably, different geographical settings may have varying contextual challenges and therefore the ndings from Basu et al, Whyle and Olivier may not universally apply in all low and middle-income countries.…”