Risk Sharing and Governance Through Public–Private Partnerships in Africa: Evaluating the West African Public Health Sector Experience

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Background: The gap between preserving and improving infrastructure to meet the needs of citizens has led governments and policymakers to rely on public–private partnerships (PPPs) for the delivery of public services. Purpose: The purpose of the study was to analyze the risk sharing and governance in the West African public health system while focusing on health care PPP drivers through a critical analysis of the approach to health care PPPs in West Africa. It explored the perception of health care recipients and key informants on the collaborative processes, challenges, successes, and failures. Methods: The study used the phenomenological approach of the qualitative method by conducting semi structured, open-ended interviews with health care recipients and key informants in Nigeria, Côte d’Ivoire, Ghana, and Togo. Data were analyzed using NVivo, a qualitative data analysis tool, to discover emerging themes. Results: The analyzed data revealed that the delivery of public health services in these countries is hindered by inadequate risk assessment and issues with accountability, management, and governance. The rural dwellers must travel many miles to access public health care, and their community health centers are manned by health care aides otherwise called auxiliary nurses. These factors and the unavailability of doctors have resulted in ineffective and inefficient service delivery. The study also revealed the ineffectiveness of the National Health Insurance Scheme (NHIS) and the PPP model in use. As a result, the current risk sharing and governance method is ineffective. The findings equally revealed that these countries have the same drivers of PPP and that institutional and innovative changes are possible and can lead to better service delivery because PPP had previously led to effective service delivery. Conclusion: Best practice recommendations for risk assessment, sharing, and governance in public health care delivery in West Africa are beneficial for the sustainability of positive institutional and innovative changes from successful PPPs. The challenges with accountability, understanding the drivers of health care PPP and a suitable PPP model for the delivery of health care services were revealed by this study. A suitable PPP model has been suggested.
A dissertation submitted in partial fulfillment of the requirements for the degree Doctor of Public Administration
Public Administration, Public Policy, Health Care Management