Constraints, Challenges and Prospects of Public‑Private Partnership in Health‑Care Delivery in a Developing Economy

Abstract

Background: In Nigeria, concerns on the quality and financing of health‑care delivery especially in the public sector have initiated reforms including support for public‑private partnerships (PPP) at the Federal Ministry of Health. Likewise, Enugu State has developed a draft policy on PPP since 2005. However, non‑validation and non‑implementation of this policy might have led to loss of interest in the partnership. Aim: The aim of this study was to provide evidence for planning the implementation of PPP in Enugu State health system via a multi‑sectoral identification of challenges, constraints and prospects. Subjects and Methods: Pre‑tested questionnaires were administered to 466 respondents (251 health workers and 215 community members), selected by multi‑stage sampling method from nine Local Government Areas of Enugu State, Nigeria, over a study period of April 2011 to September 2011. Data from the questionnaires were collated manually and quantitative data analyzed using SPSS version 15 (Chicago, IL, USA). Results: Only 159 (34.1%, 159/466) of all respondents actually understood the meaning of PPP though 251 (53.9%) of them had claimed knowledge of the concept. This actual understanding was higher among health workers (57.8%, 145/251) when compared with the community members (6.5%, 14/215) (P < 0.001). Post‑PPP enlightenment reviews showed a more desire for PPP implementation among private health‑care workers (89.4%, 101/113) and community leaders/members (55.4%, 119/215). Conclusion: PPP in health‑care delivery in Enugu State is feasible with massive awareness, elaborate stakeholder’s engagements and well‑structured policy before implementation. A critical challenge will be to convince the public sector workers who are the anticipated partners to accept and support private sector participation. 

Keywords: Enugu, Government, Health‑care, Public‑private partnership, Reform