Quality improvement in public–private partnerships in low- and middle-income countries: a systematic review
Abstract Background Public–private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs. Met...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-03-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-024-10802-w |
| _version_ | 1797259406877917184 |
|---|---|
| author | Cassandra B. Iroz Rohit Ramaswamy Zulfiqar A. Bhutta Paul Barach |
| author_facet | Cassandra B. Iroz Rohit Ramaswamy Zulfiqar A. Bhutta Paul Barach |
| author_sort | Cassandra B. Iroz |
| collection | DOAJ |
| description | Abstract Background Public–private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs. Methods We searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. The study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed in detail by a second author. Results We identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We identified five key themes for successful QI projects in LMICs: 1) leadership support and alignment with overarching priorities, 2) local ownership and engagement of frontline teams, 3) shared authentic learning across teams, 4) resilience in managing external challenges, and 5) robust data and data visualization to track progress. We found great heterogeneity in QI tools, study designs, participants, and outcome measures. Most studies had diffuse aims and poor descriptions of the intervention components and their follow-up. Few papers formally reported on actual deployment of private-sector capital, and either provided insufficient information or did not follow the formal PPP model, which involves capital investment for a explicit return on investment. Few studies discussed the response to their findings and the organizational willingness to change. Conclusions Many of the same factors that impact the success of QI in healthcare in high-income countries are relevant for PPP in LMICs. Vague descriptions of the structure and financial arrangements of the PPPs, and the roles of public and private entities made it difficult to draw meaningful conclusions about the impacts of the organizational governance on the outcomes of QI programs in LMICs. While we found many articles in the published literature on PPP-funded QI partnerships in LMICs, there is a dire need for research that more clearly describes the intervention details, implementation challenges, contextual factors, leadership and organizational structures. These details are needed to better align incentives to support the kinds of collaboration needed for guiding accountability in advancing global health. More ownership and power needs to be shifted to local leaders and researchers to improve research equity and sustainability. |
| first_indexed | 2024-04-24T23:08:56Z |
| format | Article |
| id | doaj.art-15d091c733144fdeaebb87bb36087cf9 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-24T23:08:56Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-15d091c733144fdeaebb87bb36087cf92024-03-17T12:19:57ZengBMCBMC Health Services Research1472-69632024-03-0124111610.1186/s12913-024-10802-wQuality improvement in public–private partnerships in low- and middle-income countries: a systematic reviewCassandra B. Iroz0Rohit Ramaswamy1Zulfiqar A. Bhutta2Paul Barach3Northwestern University Feinberg School of MedicineJames M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical CenterCentre for Global Child Health, The Hospital for Sick ChildrenThomas Jefferson UniversityAbstract Background Public–private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs. Methods We searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. The study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed in detail by a second author. Results We identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We identified five key themes for successful QI projects in LMICs: 1) leadership support and alignment with overarching priorities, 2) local ownership and engagement of frontline teams, 3) shared authentic learning across teams, 4) resilience in managing external challenges, and 5) robust data and data visualization to track progress. We found great heterogeneity in QI tools, study designs, participants, and outcome measures. Most studies had diffuse aims and poor descriptions of the intervention components and their follow-up. Few papers formally reported on actual deployment of private-sector capital, and either provided insufficient information or did not follow the formal PPP model, which involves capital investment for a explicit return on investment. Few studies discussed the response to their findings and the organizational willingness to change. Conclusions Many of the same factors that impact the success of QI in healthcare in high-income countries are relevant for PPP in LMICs. Vague descriptions of the structure and financial arrangements of the PPPs, and the roles of public and private entities made it difficult to draw meaningful conclusions about the impacts of the organizational governance on the outcomes of QI programs in LMICs. While we found many articles in the published literature on PPP-funded QI partnerships in LMICs, there is a dire need for research that more clearly describes the intervention details, implementation challenges, contextual factors, leadership and organizational structures. These details are needed to better align incentives to support the kinds of collaboration needed for guiding accountability in advancing global health. More ownership and power needs to be shifted to local leaders and researchers to improve research equity and sustainability.https://doi.org/10.1186/s12913-024-10802-wQuality improvementPublic–private partnershipsLow- and middle-income countriesNutritionPopulation healthImplementation |
| spellingShingle | Cassandra B. Iroz Rohit Ramaswamy Zulfiqar A. Bhutta Paul Barach Quality improvement in public–private partnerships in low- and middle-income countries: a systematic review BMC Health Services Research Quality improvement Public–private partnerships Low- and middle-income countries Nutrition Population health Implementation |
| title | Quality improvement in public–private partnerships in low- and middle-income countries: a systematic review |
| title_full | Quality improvement in public–private partnerships in low- and middle-income countries: a systematic review |
| title_fullStr | Quality improvement in public–private partnerships in low- and middle-income countries: a systematic review |
| title_full_unstemmed | Quality improvement in public–private partnerships in low- and middle-income countries: a systematic review |
| title_short | Quality improvement in public–private partnerships in low- and middle-income countries: a systematic review |
| title_sort | quality improvement in public private partnerships in low and middle income countries a systematic review |
| topic | Quality improvement Public–private partnerships Low- and middle-income countries Nutrition Population health Implementation |
| url | https://doi.org/10.1186/s12913-024-10802-w |
| work_keys_str_mv | AT cassandrabiroz qualityimprovementinpublicprivatepartnershipsinlowandmiddleincomecountriesasystematicreview AT rohitramaswamy qualityimprovementinpublicprivatepartnershipsinlowandmiddleincomecountriesasystematicreview AT zulfiqarabhutta qualityimprovementinpublicprivatepartnershipsinlowandmiddleincomecountriesasystematicreview AT paulbarach qualityimprovementinpublicprivatepartnershipsinlowandmiddleincomecountriesasystematicreview |