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

Abstract

Qualitative primary study Methods: Semi structured in-depth interviews were conducted with 13 stakeholders selected using purposive sampling methods including officials from provincial government and district administration (legislators, district managers, deputy commissioners and assistant commissioners) and representatives from private sector organisations with direct or indirect role in implementation of PPP policy. Data were analysed using a thematic approach. Results: Participants had very limited in-depth understanding about the concept of PPP. They considered multifaceted corruption in the health system, and the success of existing PPP initiatives, as the main reasons for the PPP policy adoption. Resistance from healthcare staff was perceived as the main barrier for implementation of PPP. There was a common perception that better monitoring capacity in the private sector management can be a cause of concern for public sector employees who may have become used to less efficient working. A common theme found in the narratives was the possible apprehensions from healthcare staff about the loss of their jobs. Conclusion: Our findings indicated lack of effective engagement with key stakeholders and the resistance from healthcare staff as the key barriers for PPP implementation in Sindh, Pakistan. These findings provide useful insights for the successful implementation of such initiatives both in Pakistan as well as in other similar settings.

Caregiver acceptability of the guidelines for managing young infants with possible serious bacterial infections (PSBI) in primary care facilities in rural Bangladesh

“…Previous research has promoted PPP to improve nationwide coverage of emergency obstetric and newborn care in Bangladesh [55]. Additionally, public sector providers' opinions around engaging with private providers as allies should be explored as this has previously been identified as a barrier to implementation of PPP [56].…”

Healthcare System of Pakistan: Strengths and Weaknesses

“…The major failure in the healthcare system of Pakistan is lack of governance and monitoring policy in public sector hospitals due to which government has introduced autonomous bodies, (NICVD, SIUT, GIMS, SMBB Trauma center) to serve the population [22]. Monitoring in private sector hospital is a critical process which is followed by the firm on equal basis there is no external or internal influence in in hiring or firing, there is no compromise on patient health and the staff trained they are supposed to obey the rules in serving the community on the other hand in public sector hospitals the scenario is vice versa [23]. Provinces work under the federal government and are supposed to follow the national commands, however there is no participation of stakeholders, local communities and individual groups in development of healthcare policies which is the prime weakness of healthcare system as the ones who are supposed be served have not given their feedback [24].…”

Quality Evaluation of Health Services Using the Kano Model in Two Hospitals in Peru

“…From the literature on health service management models, Public–Private Partnerships (PPP) have become popular worldwide as a way of improving healthcare service delivery and are typically associated with project financing. The PPP model is based on contracts by which a public entity delegates responsibility to a private entity to manage certain health services, for which they are responsible for a specific period of time and with predetermined performance indicators [ 5 ]. In addition, PPP management models have an important component of accountability.…”

“…In addition, the Kano model represents a valuable opportunity to evaluate the characteristics regarding healthcare service quality improvement under the PPP model, in a comprehensive way [ 5 , 8 ]. Taking the above in consideration, the Kano model is presented in this paper as an alternative evaluation approach, based on the user’s perspective, and because the PPP model considers several elements, integrated to the delivery of healthcare services [ 22 ].…”