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

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dc.contributor.authorKamugumya, Denice
dc.contributor.authorOlivier, Jill
dc.date.accessioned2021-10-08T06:20:23Z
dc.date.available2021-10-08T06:20:23Z
dc.date.issued2016
dc.description.abstractAbstract Background Public-private partnership (PPP) has been suggested as a tool to assist governments in lower to middle income countries fulfil their responsibilities in the efficient delivery of health services. In Tanzania, although the idea of PPP has existed for many years in the health sector, there has been limited coordination, especially at a district level – which has contributed to limited health gains or systems strengthening obviously seen as a result of PPP. Methods This case study was conducted in the Bagamoyo district of Tanzania, and employed in-depth interviews, document reviews, and observations methods. A stakeholder analysis was conducted to understand power distribution and the interests of local actors to engage non-state actors. In total 30 in-depth interviews were conducted with key informants that were identified from a stakeholder mapping activity. The initial data analysis guided further data collection in an iterative process. The provision of Reproductive and Child Health Services was used as a context. This study draws on the decision-space framework. Results Study findings reveal several forms of informal partnerships, and the untapped potential of non-state actors. Lack of formal contractual agreements with private providers including facilities that receive subsidies from the government is argued to contribute to inappropriate distribution of risk and reward leading to moral hazards. Furthermore, findings highlight weak capacity of governing bodies to exercise oversight and sanctions, which is acerbated by weak accountability linkages and power differences. Disempowered Council Health Services Board, in relation to engaging non-state actors, is shown to impede PPP initiatives. Conclusion Effective PPP policy implementation at a local level depends on the capacity of local government officials to make choices that would embrace relational elements dynamics in strategic plans. Orientation towards collaborative efforts that create value and enable its distribution is argued to facilitate healthy partnership, and in return, strengthen a district health system. This study highlights a need for new social contracts that will support integrative collaboration at the local level and bring all non-state actors to the centre of the district health system.
dc.identifier.apacitationKamugumya, D., & Olivier, J. (2016). 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. <i>BMC Health Services Research</i>, 16(1), 174 - 177. http://hdl.handle.net/11427/34266en_ZA
dc.identifier.chicagocitationKamugumya, Denice, and Jill Olivier "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." <i>BMC Health Services Research</i> 16, 1. (2016): 174 - 177. http://hdl.handle.net/11427/34266en_ZA
dc.identifier.citationKamugumya, D. & Olivier, J. 2016. 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. <i>BMC Health Services Research.</i> 16(1):174 - 177. http://hdl.handle.net/11427/34266en_ZA
dc.identifier.issn1472-6963
dc.identifier.ris TY - Journal Article AU - Kamugumya, Denice AU - Olivier, Jill AB - Abstract Background Public-private partnership (PPP) has been suggested as a tool to assist governments in lower to middle income countries fulfil their responsibilities in the efficient delivery of health services. In Tanzania, although the idea of PPP has existed for many years in the health sector, there has been limited coordination, especially at a district level – which has contributed to limited health gains or systems strengthening obviously seen as a result of PPP. Methods This case study was conducted in the Bagamoyo district of Tanzania, and employed in-depth interviews, document reviews, and observations methods. A stakeholder analysis was conducted to understand power distribution and the interests of local actors to engage non-state actors. In total 30 in-depth interviews were conducted with key informants that were identified from a stakeholder mapping activity. The initial data analysis guided further data collection in an iterative process. The provision of Reproductive and Child Health Services was used as a context. This study draws on the decision-space framework. Results Study findings reveal several forms of informal partnerships, and the untapped potential of non-state actors. Lack of formal contractual agreements with private providers including facilities that receive subsidies from the government is argued to contribute to inappropriate distribution of risk and reward leading to moral hazards. Furthermore, findings highlight weak capacity of governing bodies to exercise oversight and sanctions, which is acerbated by weak accountability linkages and power differences. Disempowered Council Health Services Board, in relation to engaging non-state actors, is shown to impede PPP initiatives. Conclusion Effective PPP policy implementation at a local level depends on the capacity of local government officials to make choices that would embrace relational elements dynamics in strategic plans. Orientation towards collaborative efforts that create value and enable its distribution is argued to facilitate healthy partnership, and in return, strengthen a district health system. This study highlights a need for new social contracts that will support integrative collaboration at the local level and bring all non-state actors to the centre of the district health system. DA - 2016 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Health Services Research LK - https://open.uct.ac.za PY - 2016 SM - 1472-6963 T1 - 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 TI - 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 UR - http://hdl.handle.net/11427/34266 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34266
dc.identifier.vancouvercitationKamugumya 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 Services Research. 2016;16(1):174 - 177. http://hdl.handle.net/11427/34266.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Public Health and Family Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceBMC Health Services Research
dc.source.journalissue1
dc.source.journalvolume16
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12913-016-1831-6
dc.subject.otherCollaboration
dc.subject.otherContractual governance
dc.subject.otherEngagement
dc.subject.otherNon-state actors
dc.subject.otherPartnership
dc.subject.otherRelational elements
dc.subject.otherService level agreement
dc.subject.otherValue
dc.subject.otherChild
dc.subject.otherChild Health Services
dc.subject.otherContracts
dc.subject.otherDelivery of Health Care
dc.subject.otherGovernment Programs
dc.subject.otherHumans
dc.subject.otherInterprofessional Relations
dc.subject.otherMedical Assistance
dc.subject.otherPublic-Private Sector Partnerships
dc.subject.otherReproductive Health Services
dc.subject.otherSocial Responsibility
dc.subject.otherTanzania
dc.titleHealth 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
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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