Exploring relationship dynamics to enhance effectiveness of public private partnerships for improving maternal health services delivery in Sindh

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


The Pakistan demographic and health survey 2012-13, had highlighted the suboptimal maternal health indicators in Sindh. Service delivery indicators for the antenatal care in Sindh, particularly in rural areas were also persistently low. Public private partnership is a viable strategy to improve maternal health services delivery in sindh. The study aims to provide evidence based information for health policy makers in improving effectiveness of public private partnerships, for maternal health services delivery. The objective was to explore the relationship dynamics that influence the effectiveness of public private partnership n maternal health services delivery. In this regard, conceptual understanding of stakholders, enabling conditions, communication and coordination, distribution of authority were being explored. Methodology: The study was conducted from July to September 2014. An exploratory case study design was chosen. The study was conducted purposively in the different settings of primary health care level Public Private Partnership(PPP), Tertiary care level PPP and Provincial Health Secretariat. The methods included the Key Informatics (KI) interviews, End User Client Satisfaction Survey and Document review. The KI were purposively selected from the settings while end user clients were selected from the partnership implemantation site. Data collection was done through the semi-structured 15 Key Informants interviews and transcribed data analyzed for generating themes. 37 patients were surveyed for client satisfaction for antenatal care services and only frequencies were generated. Results:The results have shown that participants consider PPP as a purposeful collaboration and a viable strategy to achieve access for maternal health services in remote areas. There is a knowledge gap about the existence of "Sindh Public Private Partnership Act" among stakeholders and most of the PPP lack legitimacy according to the Policy makers. There is a feeling of distrust among the partners. Lack of Health Information system in reporting channels and a predisposition of PPP Coordination Unit towards infrastructure related activities influences effectiveness of partnership in service delivery. The act is too generic for all sectoral PPP. Participants highlighted that the leadership role by Executive District Officer Health, administrative authority in human resource management and community involvement plays a pivotal role in enhancing effectiveness of the partnership for maternal health services.Conclusion: It is recommended to introduce the "Public Private Health Partnership Act" in Sindh and Institutinalize EDO (H) role. In exploring therelationship dynamics, seven criticqal elements can enhance effectiveness of PPP for improving maternal health services delivery in Sindh. These are: legitimacy for the partnership through act, advocacy for the PPP phenomenon, Community participation, Health Information System for reporting, Authority in Human Resource Management to private partners, Institutionalization of EDO (H) role and PPP Coordination Unit within te Department of Health.

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