Public-private partnerships and efficiency in public procurement of primary healthcare infrastructure: a qualitative research in the NHS UK

Aim There is growing interest in the contribution of public-private partnerships (PPPs) bridging the shortage of financial resources and management expertise in developing public healthcare infrastructure. However, few studies have evidenced PPPs’ ability in increasing efficiency in public procurement of primary healthcare infrastructure. The aim of this study was to assess to what extent PPPs would increase efficiency in public procurement of primary healthcare facilities. Subject and Methods A qualitative analysis, adopting a realistic research evaluation method, used data collected from a purposive sample of public (n=23) and private sector staff (n=2) directly involved in the UK National Health Service Local Improvement Finance Trust (LIFT). Results We find a positive association of LIFT helping to bridge public sector capital shortages for developing primary care surgeries. LIFT is negatively associated with inefficient procurement because it borrows finance from private banks, leaving public agencies paying high interest rates. The study shows that some contextual factors and mechanisms in LIFT play a major part in obstructing public staff from increasing procurement efficiency. Conclusion PPP’s ability to increase efficiency may be determined by contextual factors and mechanisms that restrict discretion over critical decisions by frontline public sector staff. Developing their capacity in monitoring PPP activities may make partnerships more efficient

Is the protection afforded measles vaccines the same in children of all age groups?

A study on the effectiveness of protection afforded measles vaccines across age groups in Zimbabwe.A prospective study was carried out in the City of Gweru in 1988 toexamine the relationship between age and protection afforded measles vaccinees by the measles vaccine. The age group 10 months to nine years accounted for 240 cases or 87 pc of the 276 measles cases reported in 1988. The disease had shifted towards older age groups with children aged 10 to 59 months accounting for 105 cases or 43,7 pc and those aged five to nine years accounting for 135 cases or 56,3 pc of the 240 measles cases reported in the age group 10 months to nine years. In all the sub-age groups of the age group 10 months to nine years i.e. 10 to 23 months, 24 to 35 months, 36 to 47 months etc. the proportion of vaccinated cases was more than that of unvaccinated cases and the incidence rates in the un vaccinated population were all higher than in the vaccinated population. A correlation of age and relative risk (relative risk was calculated for each sub-age group) showed a significant negative trend (correlation coefficient=-0,79; p = 0,012)

Public–private partnerships to improve primary healthcare surgeries: clarifying assumptions about the role of private provider activities

To examine assumptions about public–private partnership (PPP) activities and their role in improving public procurement of primary healthcare surgeries. PPPs were developed to improve the quality of care and patient satisfaction. However, evidence of their effectiveness in delivering health benefits is limited. A qualitative study design was employed. A total of 25 interviews with public sector staff (n=23) and private sector managers (n=2) were conducted to understand their interpretations of assumptions in the activities of private investors and service contractors participating in Local Improvement Finance Trust (LIFT) partnerships. Realist evaluation principles were applied in the data analysis to interpret the findings. Six thematic areas of assumed health benefits were identified: (i) quality improvement; (ii) improved risk management; (iii) reduced procurement costs; (iv) increased efficiency; (v) community involvement; and (vi) sustainable investment. Primary Care Trusts that chose to procure their surgeries through LIFT were expected to support its implementation by providing an environment conducive for the private participants to achieve these benefits. Private participant activities were found to be based on a range of explicit and tacit assumptions perceived helpful in achieving government objectives for LIFT. The success of PPPs depended upon private participants’ (i) capacity to assess how PPP assumptions added value to their activities, (ii) effectiveness in interpreting assumptions in their expected activities, and (iii) preparedness to align their business principles to government objectives for PPPs. They risked missing some of the expected benefits because of some factors constraining realization of the assumptions. The ways in which private participants preferred to carry out their activities also influenced the extent to which expected benefits were achieved. Giving more discretion to public than private participants over critical decisions may help in ensuring that assumptions in PPP activities result in outcomes that match the anticipated health benefits

The human resource implications of improving financial risk protection for mothers and newborns in Zimbabwe

Peer reviewedPublisher PD

Adolescent pregnancy in Zimbabwe: distribution by socio-demographic factors.

We conducted a further analysis of the Zimbabwe 1994 demographic health survey data to determine demographic and social factors associated with adolescent pregnancies in Zimba notbwe. Out of a total of 1486 female adolescents sampled, 12 did not provide information on whether they had begun child bearing, and were therefore excluded from the analysis. Significantly elevated odds ratios (OR) were noted for age (OR=2.27,95% confidence interval (CI) 2.01-2.58) and having primary or no education (OR=1.58, 95%CI 1.35,1.87). Watching television every week was protective (OR=0.69, 95%CI 0.57-0.83). Heads of households with less than 25 years of age were 2.10 (95%CI 1.54-2.87) times more likely to have adolescents who were pregnant when compared with heads of households of age 35 years or more. We conclude that electronic media should be continued to be used to deliver sex education messages to adolescents in order to curb the adolescent pregnancy epidemic