Quality Improvement in Public-Private Partnerships in Low- and Middle-Income Countries: A Systematic Review 

Abstract

Background Public-private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMIC). We therefore aimed to systematically review the literature about the aim and impact of quality improvement (QI) approaches in PPP in LMIC. Methods We searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. Study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed by a second author. Results We identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We identified five themes for successful QI projects in LMIC: 1) leadership support and alignment with overarching priorities, 2) local ownership and engagement of frontline teams, 3) shared authentic learning across teams, 4) resilience in managing external challenges, and 5) robust data and data visualization to track progress. We found great heterogeneity in QI tools, study designs, participants, and outcome measures. Most studies had diffuse aims and poor descriptions of the intervention components. Few studies discussed the response to the finding and their willingness to change. Conclusions Empirical research is needed to explore the implementation challenges and contextual factors that influence how a PPP can best be implemented to improve population health. Vague descriptions of the structure of the PPPs and roles of public and private entities made it difficult to draw conclusions about the impact of the organizational governance on the outcomes of QI programs in LMIC. We outline a rich area future research, including the need for a clearer description of the interventions, uniform outcome measures, and focus on response to the findings. To improve research equity, more ownership and power should be shifted to local leaders and researchers.

Impact of health system governance on healthcare quality in low-income and middle-income countries: a scoping review

“…This has been identified as a challenge in a recent systematic review of the impacts of PPP on QoC. 46 Most studies limit their evaluations to changes in structural aspects of quality or utilisation of services, while many others use composite scores for overall quality of services.…”

“…An evidence-gap map of primary healthcare policy and governance in LMICs identified gaps in social accountability, public-private partnerships (PPP) and intersectoral collaboration. 24 Other reviews have analysed the impacts of specific governance interventions such as demand-side and supply-side health financing strategies, [25][26][27][28][29][30][31][32][33][34] stakeholder and community engagement, 35 36 social accountability mechanisms, [37][38][39] private sector partnerships [40][41][42][43][44][45][46] and regulatory approaches. 43 47-49 However, a broader mapping of the various governance interventions linked to the quality of healthcare services in LMICs is absent.…”