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

## TL;DR

This study evaluates how public and private healthcare centers perform in managing non-communicable diseases and finds that public centers perform better due to structural and operational challenges in private partnerships.

## Contribution

The study introduces a mixed-methods approach to assess PPP effectiveness in NCD management in low- and middle-income countries.

## Key findings

- Public healthcare centers outperformed outsourced centers in NCD screening, diagnosis, and management.
- Managerial and operational challenges, such as poor coordination and inadequate infrastructure, hinder PPP effectiveness.
- Policy reforms focusing on oversight and intersectoral collaboration are needed to optimize PPPs in NCD management.

## Abstract

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.

The online version contains supplementary material available at 10.1038/s41598-025-23266-7.