Assessing the performance of public-private partnerships in non-communicable disease management with a mixed-methods...

Non-communicable diseases (NCDs) are a major global health challenge, particularly in low- and middle-income countries (LMICs) with constrained health systems. Public-Private Partnerships (PPPs) are increasingly utilized to improve access and efficiency in primary healthcare. This study evaluates the performance of public and outsourced healthcare centers in managing NCDs and identifies systemic and operational barriers to effective PPP implementation. A sequential mixed-methods design was employed, combining quantitative analysis of NCD-related key performance indicators (KPIs) from the Integrated Health System (2018-2022) using SPSS v26 with qualitative insights from semi-structured interviews with 16 healthcare providers, analyzed via conventional content analysis in MAXQDA 2020. Public centers consistently outperformed outsourced centers in screening, diagnosis, and disease management KPIs. Two primary barrier categories were identified (1): managerial challenges, including ineffective outsourcing, poor coordination, inadequate incentive structures, and weak monitoring; and (2) operational challenges, such as staff turnover, suboptimal health information systems, fragmented service delivery, and inadequate infrastructure. While PPPs can enhance service delivery in resource-constrained settings, their effectiveness in NCD management is limited by structural and governance issues. Policy reforms focusing on robust oversight, intersectoral collaboration, and health system investments are critical. These findings provide valuable insights for optimizing PPPs in similar LMIC contexts.