Governance of Public-Private Partnerships for Primary Healthcare in Low- and Lower-Middle-Income Countries, 2000-2023: A Systematic Review

Dove, Georgina; Craig, Adam; Harris-Roxas, Ben; Kelly-Hanku, Angela

doi:10.34172/ijhpm.8442

Governance of Public-Private Partnerships for Primary Healthcare in Low- and Lower-Middle-Income Countries, 2000-2023: A Systematic Review

Document Type : Review Article

Authors

Georgina Dove ¹

Adam Craig ²

Ben Harris-Roxas ¹

Angela Kelly-Hanku ³^{, 1}

¹ University of New South Wales, Sydney, NSW, Australia

² University of Queensland, Brisbane, QLD, Australia

³ Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea

10.34172/ijhpm.8442

Abstract

Background
Public-private partnerships (PPPs) in the health sector are established to achieve health outcomes by maximising the combined resources of both public and private sectors. Good governance is core to PPP function and success. This paper explores the factors that enable and constrain governance in the delivery of PPPs for primary healthcare (PHC) in low- and lower-middle-income countries (LLMICs).

Methods
A systematic search of four literature databases was conducted to identify peer reviewed articles published between 2000 and 2023 related to the governance of PPPs for PHC in LLMICs. A deductive analysis of data extracted from selected articles against the domains of Greer’s TAPIC (transparency, accountability, participation, integrity, and policy capacity) governance framework was conducted to identify commonly reported enabling and constraining factors.

Results
Of the 4290 records screened, 14 were included. Common enabling factors for governance within each domain of the framework were found: Transparency: unequal and top-down resource allocation, and opaque and resource allocation was a barrier to PPP governance; Accountability and policy capacity: monitoring and evaluation; Participation: partner engagement, covering topics of developing and managing relationships, collaborative activities, and communication; and Integrity: the design of the PPP, covering formal agreements between partners, level of policy direction, and integration within the broader health system.

Conclusion
The five domains of the TAPIC governance framework provide guidance for considering governance in PPPs. The enabling factors identified in the review help facilitate the successful implementation of a PPP and thus influence the PPP’s impact on health outcomes, through establishing and maintaining healthy working relationships between partners, and defining and documenting systems and processes.

Keywords

Governance

Public-Private Partnership

Primary Healthcare

Collaboration

LMIC

Kostyak L, Shaw DM, Elger B, Annaheim B. A means of improving public health in low- and middle-income countries? Benefits and challenges of international public-private partnerships. Public Health. 2017;149:120-129. doi:1016/j.puhe.2017.03.005
Whyle EB, Olivier J. Models of public-private engagement for health services delivery and financing in Southern Africa: a systematic review. Health Policy Plan. 2016;31(10):1515-1529. doi:1093/heapol/czw075
Reich MR. Public-private partnerships for public health. Nat Med. 2000;6(6):617-620. doi:1038/76176
Reich MR. Public-Private Partnerships for Public Health. Cambridge, MA: Harvard Center for Population and Development Studies; 2002.
Widdus R. Public-private partnerships: an overview. Trans R Soc Trop Med Hyg. 2005;99 Suppl 1:S1-S8. doi:1016/j.trstmh.2005.06.005
Field E, Abo D, Samiak L, et al. A partnership model for improving service delivery in remote Papua New Guinea: a mixed methods evaluation. Int J Health Policy Manag. 2018;7(10):923-933. doi:15171/ijhpm.2018.50
Dove G, Kelly-Hanku A, Usurup J, O'Keeffe A, Scahill G, Craig A. Collaboration in a partnership for primary health care: a case study from Papua New Guinea. Glob Health Sci Pract. 2024;12(1):e2300040. doi:9745/ghsp-d-23-00040
Buse K, Walt G. Global public-private partnerships: part I--a new development in health? Bull World Health Organ. 2000;78(4):549-561.
Buse K, Walt G. Global public-private partnerships: part II--what are the health issues for global governance? Bull World Health Organ. 2000;78(5):699-709.
Roehrich JK, Lewis MA, George G. Are public-private partnerships a healthy option? A systematic literature review. Soc Sci Med. 2014;113:110-119. doi:1016/j.socscimed.2014.03.037
Fanelli S, Salvatore FP, De Pascale G, Faccilongo N. Insights for the future of health system partnerships in low- and middle-income countries: a systematic literature review. BMC Health Serv Res. 2020;20(1):571. doi:1186/s12913-020-05435-8
Joudyian N, Doshmangir L, Mahdavi M, Tabrizi JS, Gordeev VS. Public-private partnerships in primary health care: a scoping review. BMC Health Serv Res. 2021;21(1):4. doi:1186/s12913-020-05979-9
Barbazza E, Tello JE. A review of health governance: definitions, dimensions and tools to govern. Health Policy. 2014;116(1):1-11. doi:1016/j.healthpol.2014.01.007
World Health Organization (WHO). Everybody's Business--Strengthening Health Systems to Improve Health Outcomes: WHO's Framework for Action. Geneva: WHO; 2007.
Edwards S, Ritman D, Burn E, Dekkers N, Baraitser P. Towards a simple typology of international health partnerships. Global Health. 2015;11:49. doi:1186/s12992-015-0132-x
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:1136/bmj.n71
World Health Organization (WHO), United Nations Children's Fund. Primary Health Care Measurement Framework and Indicators: Monitoring Health Systems Through a Primary Health Care Lens. Geneva: WHO; 2022.
The World Bank. World Bank Country and Lending Groups. Available at: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. Accessed July 19, 2023.
Greer S, Wismar M, Figueras J. Strengthening Health System Governance: Better Policies, Stronger Performance. Maidenhead, UK: McGraw-Hill Education; 2016.
Greer SL, Vasev N, Jarman H, Wismar M, Figueras J. It’s the Governance, Stupid! TAPIC: A Governance Framework to Strengthen Decision Making and Implementation. Copenhagen, Denmark: European Observatory on Health Systems and Policies; 2019.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:1191/1478088706qp063oa
Terry G, Hayfield N, Clarke V, Braun V. Thematic analysis. In: The SAGE Handbook of Qualitative Research in Psychology. London: SAGE Publications Ltd; 2017:17-36.
Critical Appraisal Skills Programme. CASP Qualitative Studies Checklist. 2018. https://casp-uk.net/images/checklist/documents/CASP-Qualitative-Studies-Checklist/CASP-Qualitative-Checklist-2018.pdf. Accessed July 19, 2023.
Orobaton N, Nsabagasani X, Ekochu E, Oki J, Kironde S, Lippeveld T. Promoting unity of purpose in district health service delivery in Uganda through partnerships, trust building and evidence-based decision-making. Educ Health (Abingdon). 2007;20(2):58.
Amo-Adjei J. Conforming to partnership values: a qualitative case study of public-private mix for TB control in Ghana. Glob Health Action. 2016;9:28000. doi:3402/gha.v9.28000
Hushie M. Public-non-governmental organisation partnerships for health: an exploratory study with case studies from recent Ghanaian experience. BMC Public Health. 2016;16(1):963. doi:1186/s12889-016-3636-2
Kamugumya D, Olivier J. Health system's barriers hindering implementation of public-private partnership at the district level: a case study of partnership for improved reproductive and child health services provision in Tanzania. BMC Health Serv Res. 2016;16(1):596. doi:1186/s12913-016-1831-6
Mkoka DA, Kiwara A, Goicolea I, Hurtig AK. Governing the implementation of emergency obstetric care: experiences of rural district health managers, Tanzania. BMC Health Serv Res. 2014;14:333. doi:1186/1472-6963-14-333
Mshana HY, Aagard M, Cullen C, Tschida PA. Leadership in community public-private partnership health and social care initiatives. Journal of Sustainable Social Change. 2018;10(1):134-144. doi:5590/josc.2018.10.1.11
Njau RJ, Mosha FW, De Savigny D. Case studies in public-private-partnership in health with the focus of enhancing the accessibility of health interventions. Tanzan J Health Res. 2009;11(4):235-249. doi:4314/thrb.v11i4.50196
Nuhu S, Mpambije CJ, Ngussa K. Challenges in health service delivery under public-private partnership in Tanzania: stakeholders' views from Dar es Salaam region. BMC Health Serv Res. 2020;20(1):765. doi:1186/s12913-020-05638-z
Prasad N, Mwakatundu N, Dominico S, et al. Improving maternal and reproductive health in Kigoma, Tanzania: a 13-year initiative. Glob Health Sci Pract. 2022;10(2):e2100484. doi:9745/ghsp-d-21-00484
Aveling EL, Martin G. Realising the transformative potential of healthcare partnerships: insights from divergent literatures and contrasting cases in high- and low-income country contexts. Soc Sci Med. 2013;92:74-82. doi:1016/j.socscimed.2013.05.026
Potvin L, Clavier C, de Leeuw E. Actor-Network Theory: The Governance of Intersectoral Initiatives. Oxford: Oxford University Press; 2013.
Awale J, Choudhary M, Solomon R, Chaturvedi A. Effective partnership mechanisms: a legacy of the polio eradication initiative in India and their potential for addressing other public health priorities. Am J Trop Med Hyg. 2019;101(4 Suppl):21-32. doi:4269/ajtmh.18-0938
Salve S, Harris K, Sheikh K, Porter JDH. Understanding the complex relationships among actors involved in the implementation of public-private mix (PPM) for TB control in India, using social theory. Int J Equity Health. 2018;17(1):73. doi:1186/s12939-018-0785-1
Miles K, Conlon M, Stinshoff J, Hutton R. Public-private partnerships in the response to HIV: experience from the resource industry in Papua New Guinea. Rural Remote Health. 2014;14(3):2868.
Thomason J, Rodney A. Public-private partnerships for health--what does the evidence say? P N G Med J. 2009;52(3-4):166-178.