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Are public-private partnerships the future of healthcare delivery in sub-Saharan Africa? Lessons from Lesotho

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Original languageEnglish
JournalBMJ Global Health
Early online date3 Apr 2019
Publication statusE-pub ahead of print - 3 Apr 2019


Many governments in sub-Saharan Africa are seeking to establish public-private partnerships (PPPs) for the financing and operation of new healthcare facilities and services. While there is a large empirical literature on PPPs in high-income countries, we know much less about their operation in low- and middle-income countries (LMICs). This paper seeks to inform debates about the use of PPPs in sub-Saharan Africa by describing the planning and operation of a high-profile case in Maseru, Lesotho. The paper highlights several beneficial impacts of the transaction, including the achievement of high clinical standards, alongside a range of key challenges – in particular, the higher than anticipated costs to the Ministry of Health. Governments have budget-related incentives to promote the use of PPPs - even in cases in which they may threaten financial sustainability in the long term. To address this, future proposals for PPPs need to be exposed to more effective scrutiny and challenge, taking into account state capacity to proficiently manage and pay for contracted services.

    Research areas

  • hospitals, private sector, public-private partnerships, PPPs, private finance, profits, capacity

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