Evaluation of public-private partnerships (ppps): In health supply chain management in Rwanda

Abstract

Introduction: The 2030 Agenda for Sustainable Development serves as a blueprint for global development and catalyse the private sector investment across various sectors(4, 5). This calls for the immediate mechanisms to enhance the partnership between the Government and private sector including civil society, businesses and others to achieve Sustainable Development Goals (SDGs) (1). The Government of Rwanda (GOR) takes into consideration the private sector to play an important role in supporting augmented provision of strategic national investments through Public Private Partnerships (PPPs). PPPs are an alternative method for procuring and delivering both infrastructure assets and services (3). Governments under increasing budgetary pressure especially in developing countries were looking to public-private partnerships (PPPs) as a means to expand access to higher quality health services, enhancing capital, managerial capacity, and know-how from the private sector (4). According to HSSPIV, there was outstanding challenges including the important external financing of the sector, which was not sustainable and limited capacity in terms of internal revenues (5). It was thus crucial to conduct the study to evaluate various aspects regarding the PPPs in HSCM in Rwanda and came up with the findings and recommendations that may help decision makers and stakeholders to streamline the implementation of PPPs towards effective financing in HSCM in Rwanda. Methods: The descriptive, cross-sectional and quantitative research design was used in this study. The study population were 103 experts and professionals of the health system and individuals familiar with HSCM PPP from institutions namely the Ministry of Health, RBC divisions, District Pharmacies and Private Wholesale Pharmacies. The sample size of this study was 75 respondents from aforementioned institutions. This study used a non-probability sampling techniques known as purposive sampling. The suitable method of data collection used for this study was the semistructured questionnaire. For data analysis, after data entry in the template was done by MS excel and exported into SPSS to perform test statistical testing. Univariate analysis and Bivariate analysis were used. The data found were also rated according to the concerned questions. The approval clearance was given by the university, Institutional Review Board and National Health Research Committee as seen in appendices 5 and 6. Results: There were different PPP Areas used in HSCM in Rwanda namely supply of commodities (99%), delivered health supplied IT supplies and equipment (operate) (53%), Finance (52%), maintenance iv area (40%) designing of projects (35%). build area, construction of health facilities/buildings (31%). The contribution of the company in PPPs were availability of health commodities (99%), cost effectiveness of treatment to patients (84%), transportation (71%), finance (61%), and infrastructure (36%). The opportunities available for the implementation of PPPs in HSCM in Rwanda were the political will at 95%, active private pharmaceutical sector at 92%, well-structure health supply chain at 83%, universal health coverage at 80% and e-health systems (e-procurement, online importation) at 76%. The respondents agreed that there were challenges in the implementation of PPPs projects in HSCM and included limited conversation/dialogue and absence of formal platforms or systems for public and private engagement (83.7%), complex procurement requirements for medical Products and equipment by public institutions (73.3%), ineffective coordination/management and clarity of roles and responsibilities between Public institutions and key stakeholders (67.6%), contracting issues (64.8%) and lack of Regulations/laws about PPPs in HSCM (58.1 %). The measures/strategies to improve the PPPs in HSCM and these were to effective management/coordination of PPPs (93.3%), improved dialogue and formal platforms (90.6%), foster transparencies from all partners (89.3%), enhance trust between parties in PPPs (84%), appropriate risk allocation (financial) (81.3%), put and make aware laws and regulations about PPPs in HSCM (65.33%) and well prepared contract document (64%), Conclusion: From the study results, it was found that private sector through PPPs plays a great role in the health supply chain management in Rwanda. The engagement of the private sector can increase the financial support in terms of financing the HSCM activities like delivery or supply of health commodities and equipment etc. Through PPPs in HSCM, there has been also effective and affordable cost of treatment to patients via availability and accessibility of subsidized medicines. This calls for the public decision makers in different levels to greatly and always consider the involvement of private sector in HSCM