Public-Private-Partnership Stakeholders’ Alignment in Health System and Universal Health Coverage Attainment Progress in Kilimanjaro Region, Tanzania

Abstract

Public-Private-Partnerships (PPPs) have gained prominence in Tanzania and other low-and-middle-income countries (LMICs) since the 1990s. PPPs have emerged as an alternative approach to the provision of public goods including healthcare services to improve the progress toward attaining Universal Health Coverage (UHC). The reviewed body of literature has mostly dwelt on the benefits and challenges of PPPs in health services provision in different contexts from within and outside Tanzania. The contracted PPPs for healthcare providers are expected to align their objectives with those stipulated in the service agreement for better healthcare delivery. Thus, it was important to determine the extent to which PPP stakeholders’ alignment with services agreement can be attributed to the progress toward UHC attainment in the Kilimanjaro region. This article (i) examined PPP stakeholders’ adherence to key objectives as specified in the service agreement and (ii) determined the relationship between PPP alignment in the health system and progress towards UHC attainment. A case study research design was used involving a sample size of 40 respondents. Multi-stage sampling was employed to obtain the respondents for a structured questionnaire. Descriptive analysis (summated scales expressed in percentages) for objective one was done. Partial least square-structural equation modelling (PLS-SEM) was employed for the second study objective. Results revealed that PPP adherence to key objectives as specified in the service agreement was perceived to be high as per the respondents' rating from Likert items. Results for PLS-SEM indicated, R2 = 0.717 for UHC implying that 71.7% of the variance in UHC attainment was attributed to PPP stakeholders’ alignment with a service agreement in the health system. Factors including quality monitoring and control standards (β = 0.308, p < 0.05) and time span for contract implementation (β = 0.333, p < 0.05), had statistically significant effect on the progress towards UHC attainment. Besides, variables for PPP alignment with service agreement were positively related to the progress towards UHC attainment. Effective PPP alignment to the health system goes hand in hand with PPP partners’ adherence to the key objectives as specified in the service agreement. It is recommended that the LGAs and the Ministry of health should promote formal PPP collaborations through service agreements