Public-Private Partnership Governance in Health System Transformation: Stakeholder Evidence From Saudi Arabia's...

Under Saudi Arabia's Vision 2030, public-private partnerships (PPPs) have become a key mechanism for implementing the Health Sector Transformation Program (HSTP). However, limited quantitative evidence identifies which governance capacities stakeholders perceive as most critical to PPP implementation. This study examines how health sector stakeholders assess PPP governance and how key governance dimensions relate to perceived achievement of HSTP objectives. An exploratory cross-sectional survey was conducted among 505 public and private stakeholders in Riyadh with knowledge of healthcare PPPs. A structured questionnaire assessed 3 governance capacities regulatory financial governance, technical capacity, and institutional risk climate and their perceived contribution to HSTP objectives. Data were analyzed using exploratory factor analysis, correlations, and multiple linear regression. Overall perceptions of PPP contributions to HSTP objectives were positive (M = 4.08). Institutional risk climate (M = 4.12) and regulatory financial governance (M = 3.98) were rated positively, whereas technical capacity scored substantially lower (M = 2.75). Greater PPP exposure was associated with more negative technical ratings. Institutional risk climate was the strongest predictor of perceived HSTP goal achievement (β = .795), followed by technical capacity (β = .092) and regulatory financial governance (β = .083). Stable regulation and strong institutional governance were the leading enablers, while unclear contracts and limited specialized expertise were the main barriers. In the Saudi reform context, PPP implementation appears to depend more on institutional governance and public stewardship than on financial structuring alone. Future contracts should include explicit provisions for innovation, knowledge transfer, and workforce development.