Governance of Public-Private Partnerships for Primary Healthcare in Low- and Lower-Middle Income Countries, 2000-2023: A Systematic Review

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Background: Public-private partnerships (PPPs) in the health sector are established to achieve health outcomes by maximising the combined resources of both public and private sectors. Good governance is core to PPP function and success. This paper explores the factors that enable and constrain governance in the delivery of PPPs for primary health care in low-and lower-middleincome countries (LMICs). Methods: A systematic search of four literature databases was conducted to identify peer reviewed articles published between 2000 and 2023 related to the governance of PPPs for primary health care in LMICs. A deductive analysis of data extracted from selected articles against the domains of Greer’s TAPIC governance framework was conducted to identify commonly reported enabling and constraining factors. Results: Of the 4,290 records screened, 14 were included. Common enabling factors for governance within each domain of the framework were found: Transparency: unequal and topdown resource allocation, and opaque and resource allocation was a barrier to PPP governance; Accountability and policy Capacity: monitoring and evaluation; Participation: partner engagement, covering topics of developing and managing relationships, collaborative activities, and communication; and Integrity: the design of the PPP, covering formal agreements between partners, level of policy direction, and integration within the broader health system. Conclusion: The five domains of the TAPIC governance framework provide guidance for considering governance in PPPs. The enabling factors identified in the review help facilitate the successful implementation of a PPP and thus influence the PPP’s impact on health outcomes, through establishing and maintaining healthy working relationships between partners, and defining and documenting systems and processes.