Abstract:
This paper draws upon a process evaluation of a public–private partnership (PPP) for diagnostics in three Sub-Saharan African
countries, Ethiopia, Ghana and Kenya. The study sought to identify challenges in managing health PPP projects and potential
solutions. We used an extensive document review and 72 recent key informant interviews (KIIs), building on 63 KIIs previously
conducted to analyze the African Health Diagnostics Platform (AHDP) project in-depth. Our analysis employed a framework
developed by Magalhaes et al based on the broader (non-health) PPP literature that identifies key challenges, strategies and
success factors in PPP management across three main stages of PPP implementation. We find considerable alignment
between the management challenges identified in the broader PPP literature and AHDP. Certainly, intensive negotiations and
high transaction costs; difficulties managing risks and financing; the need for highly complex planning; and challenging
stakeholder management all played a role in slowing progress on AHDP. An additional, critical theme concerns lack of capacity
for managing health PPPs. The AHDP project generated a number of innovations to facilitate management but overall, if
health PPPs are to succeed, more needs to be done to support their implementation. In particular, we propose investment in
training government and technical assistance providers in health PPPs; development of repositories of guidance documents to
support health PPPs; employment of systems-thinking based planning approaches that illuminate connections across the
health system; more sophisticated approaches to stakeholder management; and investment in research that supports
modeling of different PPP arrangements and how their progression is influenced by local contextual factors. While evidence on
the impact of health PPPs remains scarce, moves toward increased healthcare corporatization in the context of dwindling aid
underscores the urgency of building experience and evidence on PPPs in healthcare and other social sectors.
