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Table 2 Challenges of Public-Private Partnerships in Primary Healthcare

From: Public-private partnerships in primary health care: a scoping review

Education
▪ Inadequate education for justification of people to participate in collaborative projects [38, 51]
▪ Insufficient knowledge of the private about testing and treatment procedures [51, 56, 61, 67]
Management
▪ Lack of commitment of public and private sector managers and decision-makers [9, 51, 52, 58, 73]
▪ Lack of clear vision on the way forward [68, 70]
▪ Non-formulation of strategic direction for PPPs models by the government [70]
▪ Lack of accountability, poorly defined roles and lack of advisory committees [30, 52]
▪ The difficulty of coordinating different members, especially in the early stages [47, 66]
▪ Poor leadership skills [32]
Human resource
▪ Lack of trust between the public and private sectors(9, 47, 54, 57, 70)s
▪ Disparities in power actors involved in partnership [15, 32]
▪ Limited access to people willing and able to participate in the private sector [32, 38]
▪ Lack of capacity of private practitioners and hospitals to undertake non-clinical tasks such as treatment supervision or prompt recording and reporting of required data [51, 61, 68]
▪ Lack of perceived ownership of the project by partners [42, 61]
▪ Reported disrespect and distrust of the public sector towards partners from the private sector [9, 67, 70]
Financial resources
▪ Downsizing of social capital [15]
▪ Inadequate financial resources [28, 40, 42, 59, 68]
▪ Sustainability of the PPPs [49]
▪ Insecure funding [31, 68, 70]
▪ Lack of trust by private sector partners at the reimbursement system [51, 62]
▪ The unwillingness of the public sector to use financial incentives for private sector motivation [43, 67]
▪ Not setting the specified budget for PPP [9]
Information and technology systems
▪ A weakness of the private sector in the documentation of services provided by the private sector [34, 35, 41, 49, 51, 53, 56, 63]
▪ Lack of consistent form of interaction between the public and private sectors due to different systems [9, 15, 51, 67]
▪ Lack of appropriate monitoring and reporting mechanisms [9, 15, 49, 67]
▪ Lack of clarity in policies regarding the implementation and evaluation of PPPs [15, 46, 70]
▪ Absence of support systems for supervision and record-keeping for private-sector employees [26, 58]
▪ Inefficient administrative system [61, 62]
▪ Weak capacity to collaborate or regulate [54, 57, 68, 70]
▪ Weakness in implementing regulations [68]
▪ Inadequate mechanisms to ensure continuity of care [68]
▪ Information gaps exist between public and private sector [10, 40, 57, 67]
▪ Absence of external performance assessment of PPPs [10]
▪ Lack of standard internal monitoring system [10]
▪ Failure to define an indicator for evaluation of PPPs [8, 9, 11]
Others
▪ Low efficiency of the private sector in taking care of the poorest sectors of society [15]
▪ The poor capacity of the public sector to design and manage contracts with private organisations [10, 45, 68]
  1. PPP Public-Private Partnership