Constraints; Challenges and Prospects of Public-Private Partnership in Health-Care Delivery in a Developing Economy

Background: In Nigeria; concerns on the quality and financing of health-care delivery especially in the public sector have initiated reforms including support for public-private partnerships (PPP) at the Federal Ministry of Health. Likewise; Enugu State has developed a draft policy on PPP since 2005. However; non-validation and non-implementation of this policy might have led to loss of interest in the partnership. Aim: The aim of this study was to provide evidence for planning the implementation of PPP in Enugu State health system via a multi-sectoral identification of challenges; constraints and prospects. Subjects and Methods: Pre-tested questionnaires were administered to 466 respondents (251 health workers and 215 community members); selected by multi-stage sampling method from nine Local Government Areas of Enugu State; Nigeria; over a study period of April 2011 to September 2011. Data from the questionnaires were collated manually and quantitative data analyzed using SPSS version 15 (Chicago; IL; USA). Results: Only 159 (34.1; 159/466) of all respondents actually understood the meaning of PPP though 251 (53.9) of them had claimed knowledge of the concept. This actual understanding was higher among health workers (57.8; 145/251) when compared with the community members (6.5; 14/215) (P 0.001). Post-PPP enlightenment reviews showed a more desire for PPP implementation among private health-care workers (89.4; 101/113) and community leaders/members (55.4; 119/215). Conclusion: PPP in health-care delivery in Enugu State is feasible with massive awareness; elaborate stakeholder's engagements and well-structured policy before implementation. A critical challenge will be to convince the public sector workers who are the anticipated partners to accept and support private sector participation

Integrating maternal health services into a health insurance scheme: effect on healthcare delivery

Healthcare delivery is a foremost important basic social services.This study reviews the influence of the integration of maternal health services into the Anambra State of Nigeria government-community health care financing scheme on health service delivery at primary health care level in Igboukwu; Aguata Local Government Area of Anambra State; Nigeria.A descriptive; cross-sectional study with an intervention component; conducted amongst 120 women of reproductive age group at Obiuno health centre; Igboukwu.Mean age of respondents was 30.5 +/- 6.0 years with majority; 44 (36.7); in the age range of 26-30 years. Almost half; forty eight (40); of the participants are of post secondary educational status; 60 (50) are civil servants. Utilization of maternal health servicesantenatal and delivery services; were significantly better at the late intervention period when compared to the early intervention period. Quality of service from clients' perspective also showed significant improvement at the late intervention period. There was an overall greater availability of maternal health service equipments; drugs and consumables; and medical records in the health facility later during the scheme.Community based health insurance schemes that focus on maternal health services ensure the provision of adequate funds for maternal health services that cover a great proportion of the rural communities