Official websites use. Share sensitive information only on official, secure websites. This is an open-access article distributed under the terms of the Creative Commons Attribution 4. Public-private partnerships PPP are one strategy to finance and deliver healthcare in lower-resourced settings.
We conducted a thematic analysis. Facilitators of performance included: 1 PPP leadership commitment to quality improvement supported by protocols, monitoring, and actions; 2 high levels of accountability and discipline; and 3 well-functioning infrastructure, core systems, workflows, and internal referral network.
Barriers to performance included: 1 human resource management challenges and 2 broader health system and referral network limitations. Going forward, the Lesotho government and others making strategic planning decisions should consider fostering a culture of quality improvement and accountability; ensuring sustained investments in human resource management; and allocating resources in a way that recognizes the interdependency of healthcare facilities and overall system strengthening.
Contracts for integrated healthcare PPPs should be flexible to respond to changing external conditions and include provisions to invest in people as substantively as infrastructure, equipment, and core systems over the full length of the PPP.
Healthcare PPPs, especially in lower-resource settings, should be developed with a strong understanding of their role in the broader health system and be implemented in conjunction with efforts to ensure and sustain adequate capacity and resources throughout the health system. Keywords: heath systems research, public private partnerships, qualitative research, human resources, personnel, sub-Saharan Africa, low-and-middle-income countries.
