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

Abstract

Background: Public-private partnership in the health sector was introduced to improve the delivery of health services in Tanzania. Contrary, the expected outcomes have not been fully realised. This study aimed at investigating challenges encountered in implementing public-private partnership institutional arrangements in health service delivery in Kinondoni Municipality, Dar es Salaam, Tanzania.Methods: A qualitative case study design was employed, where in-depth interviews with stakeholders were held and document reviews conducted. Fourteen (n=14) participants engaged in this study. Eight (n=8) and six (n=6) of the fourteen participants were from the public and private sector, respectively. The thematic approach was used to analyse data, and ethical principles in the research process were upheld.Results: Findings revealed that although public-private partnerships are hailed for supplementing the government’s efforts in the provision of health services, institutional arrangements for the smooth provision of these services are lacking. Several challenges encumber smooth provision of health services and these include inadequate resources, ineffective monitoring and evaluation, and insufficient consultations between partners.Conclusion: Inadequate legal and policy framework, or ineffective implementation practices may influence challenges facing institutional arrangements for public-private partnerships. Therefore, strengthening of public-private partnerships is recommended to improve implementation mechanisms and practices such as adherence to partnership agreements and compliance to the policies, laws and regulations.

Key recommendations to strengthen public-private partnership for adolescent health in resource constrained settings: Formative qualitative inquiry in Mongolia, Myanmar and the Philippines

“…Indeed, a lack of leadership and unclear inter-institutional arrangement are recognised barriers to ineffective PPP. [40] In most published examples for adult-focussed PPP in the Asia Pacific region, the government had a lead role in coordination and management of the partnership, with core responsibilities specified at national, district and local level. However, there were examples of coordination being provided by NGOs acting as intermediaries between the public and private sectors, drawing on their greater management expertise and capacity.…”

Brucellosis in dairy herds: Farm characteristics and practices in relation to likely adoption of three potential private–public partnership (PPP) vaccination control strategies in West and Central Africa

“…For this model to be successful, there has to be adequate commercial gain for the private veterinarians to meet the requirements of the contract and effective monitoring, evaluation and legislation to prevent contract failure between the parties. The infrastructure and institutional arrangements to enable the environment for such arrangements is often lacking which leads to the downfall of appropriate delivery of services (Claire Heffernan & Federica Misturelli, 2001; Nuhu, Mpambiji, & Ngussa, 2020). At present in the study countries, brucellosis vaccine is only available in Burkina Faso; farmers can voluntarily pay to access the vaccine through private veterinarians who have agreements with government for the procurement of vaccines.…”

Hospital services under public-private partnerships, outcomes and, challenges: A literature review

“…Weak regulations were described as inadequate guidelines, non-compliance with guidelines, and a lack of coordination between relevant stakeholders. 29 Another challenge in the guidelines was integrating the guidelines into treatment procedures in hospitals. 32 Policy barriers affected the use of reproductive health services on the one hand and affected service delivery in public health facilities on the other hand.…”

“…In addition, budget constraints also likely cause monitoring and evaluation activities not to run as expected. 29 Diwan et al acknowledged the problem of late payments by the government as a challenge. 30…”