Comparison of the market share of public and private hospitals under different Medical Alliances: an interrupted time-series analysis in rural China

BACKGROUND

China initiated the Medical Alliances (MAs) reform to enhance resource allocation efficiency and ensure equitable healthcare. In response to challenges posed by the predominance of public hospitals, the reform explores public-private partnerships within the MAs. Notably, private hospitals can now participate as either leading or member institutions. This study aims to evaluate the dynamic shifts in market share between public and private hospitals across diverse MAs models.

METHODS

Data spanning April 2017 to March 2019 for Dangyang County's MA and January 2018 to December 2019 for Qianjiang County's MA were analyzed. Interrupted periods occurred in April 2018 and January 2019. Using independent sample t-tests, chi-square tests, and interrupted time series analysis (ITSA), we compared the proportion of hospital revenue, the proportion of visits for treatment, and the average hospitalization days of discharged patients between leading public hospitals and leading private hospitals, as well as between member public hospitals and member private hospitals before and after the reform.

RESULTS

After the MAs reform, the revenue proportion decreased for leading public and private hospitals, while member hospitals saw an increase. However, ITSA revealed a notable rise trend in revenue proportion for leading private hospitals (p < 0.001), with a slope of 0.279% per month. Member public and private hospitals experienced decreasing revenue proportions, with outpatient visits proportions declining in member public hospitals by 0.089% per month (p < 0.05) and inpatient admissions proportions dropping in member private hospitals by 0.752% per month (p < 0.001). The average length of stay in member private hospitals increased by 0.321 days per month after the reform (p < 0.01).

CONCLUSIONS

This study underscores the imperative to reinforce oversight and constraints on leading hospitals, especially private leading hospitals, to curb the trend of diverting patients from member hospitals. At the same time, for private hospitals that are at a disadvantage in competition and may lead to unreasonable prolongation of hospital stay, this kind of behavior can be avoided by strengthening supervision or granting leadership.

Decision analysis of PPP project's parties based on deep consumer participation

Although PPP(Public-private partnership) mode has been applied for a long time in infrastructural project, the success rate is not very high. The sustainability of PPP projects is still influenced by many factors. In order to examine the evolutionary stable strategies (ESSs) of social capital, government, and paying consumers, a tripartite evolutionary game model is established in this work. In order to further promote consumer participation, it is necessary to make the assumption that customer oversight and review can have an impact on service prices. The results show: i)The strategy choice of consumer depends on the comparison between supervision cost of consumer and price coefficient for consumer to social capital. ii)Consumer supervision can promote the provision of high-quality services by social capital. iii)The difference between high-quality cost and low-quality cost, subsidy coefficient, price coefficient and supervision cost of consumer are critical factors influencing both evolutionary results and trajectories. This paper also puts forward policy implications for the three stakeholders to promote social capital's high-quality strategy so as to maintain the sustainability of PPP projects.

Working with Industry

In 1992, I completed a 9-year dual-degree program where I received both my DPM degree and a PhD in Bioengineering. Upon my graduation, it was apparent that "Industry" had an interest in me. Sponsored research and consulting opportunities where readily available, and I had to learn very quickly to sort the scientific from the sham, and the clinically worthwhile from the worthless. Partnering with Industry has provided me with another avenue to advance my profession, while helping to develop new treatment options that can potentially help many more patients then just the ones I see in my office.

Translational success of fundamental virology: a VSV-vectored Ebola vaccine

Ebola virus disease (EVD) caused by Ebola virus (EBOV) is a severe, often fatal, hemorrhagic disease. A critical component of the public health response to curb EVD epidemics is the use of a replication-competent, recombinant vesicular stomatitis virus (rVSV)-vectored Ebola vaccine, rVSVΔG-ZEBOV-GP (ERVEBO). In this Gem, we will discuss the past and ongoing development of rVSVΔG-ZEBOV-GP, highlighting the importance of basic science and the strength of public-private partnerships to translate fundamental virology into a licensed VSV-vectored Ebola vaccine.

Quality improvement in public-private partnerships in low- and middle-income countries: a systematic review

BACKGROUND

Public-private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs.

METHODS

We searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. The study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed in detail by a second author.

RESULTS

We identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We identified five key themes for successful QI projects in LMICs: 1) leadership support and alignment with overarching priorities, 2) local ownership and engagement of frontline teams, 3) shared authentic learning across teams, 4) resilience in managing external challenges, and 5) robust data and data visualization to track progress. We found great heterogeneity in QI tools, study designs, participants, and outcome measures. Most studies had diffuse aims and poor descriptions of the intervention components and their follow-up. Few papers formally reported on actual deployment of private-sector capital, and either provided insufficient information or did not follow the formal PPP model, which involves capital investment for a explicit return on investment. Few studies discussed the response to their findings and the organizational willingness to change.

CONCLUSIONS

Many of the same factors that impact the success of QI in healthcare in high-income countries are relevant for PPP in LMICs. Vague descriptions of the structure and financial arrangements of the PPPs, and the roles of public and private entities made it difficult to draw meaningful conclusions about the impacts of the organizational governance on the outcomes of QI programs in LMICs. While we found many articles in the published literature on PPP-funded QI partnerships in LMICs, there is a dire need for research that more clearly describes the intervention details, implementation challenges, contextual factors, leadership and organizational structures. These details are needed to better align incentives to support the kinds of collaboration needed for guiding accountability in advancing global health. More ownership and power needs to be shifted to local leaders and researchers to improve research equity and sustainability.

Learning from the End of the Public-Private Partnership for Lesotho's National Referral Hospital Network

Background

Public-private partnerships (PPP) are one strategy to finance and deliver healthcare in lower-resourced settings. Lesotho's Queen 'Mamohato Memorial Hospital Integrated Network (QMMH-IN) was sub-Saharan Africa's first and largest integrated healthcare PPP.

Objective

We assessed successes and challenges to performance of the QMMH-IN PPP.

Methods

We conducted 26 semi-structured interviews among QMMH-IN executive leadership and staff in early 2020. Questions were guided by the WHO Health System Building Blocks Framework. We conducted a thematic analysis.

Findings

Facilitators of performance included: 1) PPP leadership commitment to quality improvement supported by protocols, monitoring, and actions; 2) high levels of accountability and discipline; and 3) well-functioning infrastructure, core systems, workflows, and internal referral network. Barriers to performance included: 1) human resource management challenges and 2) broader health system and referral network limitations. Respondents anticipated the collapse of the PPP and suggested better investing in training incoming managerial staff, improving staffing, and expanding QMMH-IN's role as a training facility.

Conclusions

The PPP contract was terminated approximately five years before its anticipated end date; in mid-2021 the government of Lesotho assumed management of QMMH-IN. Going forward, the Lesotho government and others making strategic planning decisions should consider fostering a culture of quality improvement and accountability; ensuring sustained investments in human resource management; and allocating resources in a way that recognizes the interdependency of healthcare facilities and overall system strengthening. Contracts for integrated healthcare PPPs should be flexible to respond to changing external conditions and include provisions to invest in people as substantively as infrastructure, equipment, and core systems over the full length of the PPP. Healthcare PPPs, especially in lower-resource settings, should be developed with a strong understanding of their role in the broader health system and be implemented in conjunction with efforts to ensure and sustain adequate capacity and resources throughout the health system.

Collaboration in a Partnership for Primary Health Care: A Case Study From Papua New Guinea

INTRODUCTION

In low- and middle-income countries, public-private partnerships (PPPs) are often used to support the delivery of primary health care (PHC). We explore the processes of collaboration in a corporate social responsibility investment in PHC that was delivered through a PPP model in Western Province, Papua New Guinea, in 2009-2018 to strengthen PHC services.

METHODS

Qualitative interviews were conducted with stakeholders in the PPP (N=20). Key program documents were also reviewed. Data were coded using a general inductive approach, and Actor-Network Theory (ANT) was used to frame the analysis.

RESULTS

Four dominant themes emerged: (1) interpersonal relationships accelerate collaboration, (2) collaboration requires time, (3) formal governance structures encourage collaboration, and (4) internal change disrupts collaboration. The research provides insight into the role of collaboration for more efficient, effective, and impactful design and implementation of PPP for PHC. It makes suggestions for how ANT may be used when designing PPPs and for the ongoing management of relationships between partners. We found ANT to be a useful framework to conceptualize the complex dynamics between the "actors" within the PPP and to identify opportunities for improvement where structural changes may be made to circumvent issues that may compromise effective collaboration.

CONCLUSION

Collaboration is key to the success of PPPs for PHC. We found collaboration is not formulaic but is driven by actors, relationships, time, and governance. ANT can assist in designing, understanding, and managing the complex relationships between stakeholders of a PPP, who often come with diverse agendas, experiences, values, and perspectives.

Public-Private Partnerships in Mexico: Implications of Engaging With the Food and Beverage Industry for Public Health Nutrition

BACKGROUND

In the last few years, Mexico adopted public health policies to tackle non-communicable diseases (NCDs), such as front of package nutrition labelling, food marketing restrictions to children, and a soda tax. In parallel, transnational food and beverage industries (F&BIs), their allies, and the government have agreed on public-private partnerships (PPPs) to implement policies or deliver programs. However, research has questioned the benefits of PPPs and exposed its limitations as a suitable mechanism to improve public health. This study analyses how four PPPs between the Mexican government, the F&BI, and allies are working to achieve their goals. We critically assessed the objectives, scope, reported impacts, governance principles and perceived risks and benefits for the public health agenda of these PPPs.

METHODS

This qualitative study is based on 26 interviews with key actors, and 170 publicly available documents, including 22 obtained through freedom of information (FOI) requests related to four purposively selected PPPs aiming to improve health.

RESULTS

We found that the four PPPs studied had minimal public information available on their implementation and impact. The private partners tend to dictate the design, information management, and implementation of the programs, while promoting their brands. Few independent evaluations of the PPPs exist, and none reported on their effectiveness or public health benefits. Good governance principles, such as accountability, transparency, fairness, participation, integrity, and credibility, were barely followed in each of the cases studied. Public officials did not automatically question the conflict of interest (CoI) of such arrangements. When there were COI, the potential risks these posed did not always outweigh the financial benefits of working with the F&BI and its allies.

CONCLUSION

The four PPPs studied produced minimal gains for public health while boosting credibility for the participating transnational F&BIs. It shows the lack of awareness of how these PPPs might be hindering public health gains.

Evaluation of the primary health care expansion program with public-private partnership in slum areas from the perspective of stakeholders: a qualitative study

BACKGROUND

Today, economic and social determinants of health in slum settlements are at the policymakers' center of attention. Iran has had an excellent experience in the Primary Health Care Program. This study aimed to evaluate the Primary Health Care Expansion Program with public-private partnerships in slum areas of Iran from the perspective of stakeholders in 2022.

METHODS

This qualitative study was conducted using the framework content analysis method. Participants were 17 experts and health managers involved in The Primary Health Care Expansion with Public-Private Partnerships in the suburban areas at the medical universities of Khorasan Razavi province in the east of Iran, who were selected through purposive sampling via snowball method. For data collection, a semi-structured interview was done and framework content analysis was used for data analysis and results categories based on the SWOT.

RESULTS

The study identified 23 main themes and 112 sub-themes, which were then grouped into four main categories - strengths, weaknesses, opportunities, and threats using the SWOT model.

CONCLUSION

Results of the study showed the internal and external factors affecting Primary Health Care Expansion with Public-Private Partnerships in suburban areas. This situational analysis can help health policymakers to better understand the performance of health facilities.

Investment analysis of the private firm under different financial arrangements in infrastructure projects

This study investigates the impact of various financial arrangements on the investment behavior of the private firm in PPP (Public-Private Partnership) projects. The results manifest that: first, the private firm will invest in the project earlier under long-term debt financing than under short-term debt financing or all equity financing; second, the investment boundary of the private sector decreasing with the probability of obtaining long-term debt financing under short-term debt financing, while increasing with the probability of obtaining long-term debt financing under long-term debt financing; third, the optimal debt level under short-term debt financing displays a U-shaped relationship with the refinancing risk probability; fourth, under short-term debt financing, the difference in the optimal capital structure between projects with different volatility of cash flow is larger when the refinancing risk probability is lower; and fifth, the private firm may exit the project earlier under short-term debt financing than under long-term debt financing. These results can help us to understand the investment behavior of the private firm under different financial arrangements.

Political embeddedness in public-private partnership for nature conservation: A land trust reserve case from China

Private sector plays an increasingly vital role in nature conservation globally. This study explores the concept of political embeddedness, which suggests that governments and environmental nongovernmental organizations (ENGOs) can leverage each other's strengths to achieve both formal and informal goals. Using the case of Laohegou Nature Reserve in China, this study illustrated how the complementary advantages of the government and ENGOs form the foundation of a land trust reserve. Within the case, the study found that power and interest balance between the government and ENGOs during project implementation supported their formal cooperation in nature conservation. This study proposed a political perspective to elaborate power and interest in the formal and informal dimensions of nature conservation public-private partnership (PPP) project. Moreover, it noted that a balance of power between the government and ENGOs is essential in building partnership networks with inclusive interests.

Differential impact of hospital and community factors on breadth and depth of hospital population health partnerships

OBJECTIVE

The aim was to identify hospital and county characteristics associated with variation in breadth and depth of hospital partnerships with a broad range of organizations to improve population health.

DATA SOURCES

The American Hospital Association Annual Survey provided data on hospital partnerships to improve population health for the years 2017-2019.

DESIGN

The study adopts the dimensional publicness theory and social capital framework to examine hospital and county characteristics that facilitate hospital population health partnerships. The two dependent variables were number of local community organizations that hospitals partner with (breadth) and level of engagement with the partners (depth) to improve population health. The independent variables include three dimensions of publicness: Regulative, Normative and Cultural-cognitive measured by various hospital factors and presence of social capital present at county level. Covariates in the multivariate analysis included hospital factors such as bed-size and system membership.

METHODS

We used hierarchical linear regression models to assess various hospital and county factors associated with breadth and depth of hospital-community partnerships, adjusting for covariates.

PRINCIPAL FINDINGS

Nonprofit and public hospitals provided a greater breadth (coefficient, 1.61; SE, 0.11; p < 0.001 and coefficient, 0.95; SE, 0.14; p < 0.001) and depth (coefficient, 0.26, SE, 0.04; p < 0.001 & coefficient, 0.13; SE, 0.05; p < 0.05) of partnerships than their for-profit counterparts, partially supporting regulative dimension of publicness. At a county level, we found community social capital positively associated with breadth of partnerships (coefficient, 0.13; SE, 0.08; p < 0.001).

CONCLUSIONS

An environment that promotes collaboration between hospitals and organizations to improve population health may impact the health of the community by identifying health needs of the community, targeting social determinants of health, or by addressing patient social needs. However, findings suggest that publicness dimensions at an organizational level, which involves a culture of public value, maybe more important than county factors to achieve community building through partnerships.

Analyzing the Costs and Impact of the TakeMeHome Program, a Public-Private Partnership to Deliver HIV Self-Test Kits in the United States

BACKGROUND

HIV testing is an entry point to access HIV care and prevention services. Building Healthy Online Communities developed a website ( TakeMeHome.org ) where participants can order HIV home test kits. The purpose of this study was to analyze the costs and impact of the TakeMeHome program.

METHODS

We estimated the costs of TakeMeHome across all participating jurisdictions for the first year of the program. We estimated program costs using purchase orders and invoices, contracts, and allocation of staff time, and the costs included website design, participant recruitment, administration and overhead, HIV self-test kits, and shipping and handling. Primary outcomes of the analysis were total program cost, cost per HIV test, and cost per new HIV diagnosis.

RESULTS

The TakeMeHome program distributed 5323 HIV self-tests to 4859 participants over a 12-month period. The total program cost over this period was $314,870. The cost per HIV test delivered was estimated at $59, and the cost per person tested was $65. The program identified 18 confirmed new HIV diagnoses (0.6% positivity) verified with surveillance data in 7 health jurisdictions at $169,890. The cost per confirmed new HIV diagnosis was estimated at $9440.

CONCLUSIONS

The TakeMeHome program delivered HIV self-testing at a reasonable cost, and the program may be a cost-effective use of HIV prevention resources. The public-private partnership can be an effective mechanism to validate HIV diagnoses identified with self-testing and provide HIV prevention and linkage to care services.

A Nationwide Network of Health AI Assurance Laboratories

Importance

Given the importance of rigorous development and evaluation standards needed of artificial intelligence (AI) models used in health care, nationwide accepted procedures to provide assurance that the use of AI is fair, appropriate, valid, effective, and safe are urgently needed.

Observations

While there are several efforts to develop standards and best practices to evaluate AI, there is a gap between having such guidance and the application of such guidance to both existing and new AI models being developed. As of now, there is no publicly available, nationwide mechanism that enables objective evaluation and ongoing assessment of the consequences of using health AI models in clinical care settings.

Conclusion and Relevance

The need to create a public-private partnership to support a nationwide health AI assurance labs network is outlined here. In this network, community best practices could be applied for testing health AI models to produce reports on their performance that can be widely shared for managing the lifecycle of AI models over time and across populations and sites where these models are deployed.

Opportunities and challenges in public-private partnerships to reduce social inequality in health in upper-middle-income and high-income countries: a systematic review and meta-synthesis

OBJECTIVES

There is a need for novel approaches to address the complexity of social inequality in health. Public-private partnerships (PPPs) have been proposed as a promising approach; however, knowledge on lessons learnt from such partnerships remain unclear. This study synthesises evidence on opportunities and challenges of PPPs focusing on social inequality in health in upper-middle-income and high-income countries.

DESIGN

A systematic literature review and meta-synthesis was conducted using the Mixed Methods Appraisal Tool for quality appraisal.

DATA SOURCES

PubMed, PsychInfo, Embase, Sociological Abstracts and SocIndex were searched for studies published between January 2013 and January 2023.

ELIGIBILITY CRITERIA

Studies were eligible if they applied a quantitative, qualitative, or mixed methods design and reported on lessons learnt from PPPs focusing on social inequality in health in upper-middle-income and high-income countries. Studies had to be published in either English, Danish, German, Norwegian or Swedish.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data and appraised the quality of the included studies. A meta-synthesis with a descriptive intent was conducted and data were grouped into opportunities and challenges.

RESULTS

A total of 16 studies of varying methodological quality were included. Opportunities covered three themes: (1) creating synergies, (2) clear communication and coordination, and (3) trust to sustain partnerships. Challenges were identified as reflected in the following three themes: (1) scarce resources, (2) inadequate communication and coordination, and (3) concerns on distrust and conflicting interest.

CONCLUSIONS

Partnerships across public, private and academic institutions hold the potential to address social inequality in health. Nevertheless, a variety of important lessons learnt are identified in the scientific literature. For future PPPs to be successful, partners should be aware of the availability of resources, provide clear communication and coordination, and address concerns on distrust and conflicting interests among partners.

PROSPERO REGISTRATION NUMBER

CRD42023384608.

Novel Approach to Accelerate Lung Cancer Research: Lung-MAP and the Potential of Public-Private Partnerships

The National Cancer Institute recently found that death rates for non-small cell lung cancer (NSCLC) have been reduced by over 6% overall in recent years. This reduction in mortality has been accompanied by an average increase in overall survival and largely credited to the therapeutic advancements for the effective treatment of NSCLC. Numerous molecular alterations have been identified in NSCLC that have enabled the development of new drugs capable of targeting these changes and efficiently kill cancerous cells. New treatments to modulate patients' immune systems have been shown to be effective in stimulating natural immune cells to have an improved anti-cancer effect. While these types of approaches to treat cancer are providing new options for patients, leadership from the Food and Drug Administration (FDA) recognized that the expansion of targeted therapy in NSCLC presented significant promise, but evaluation of the safety and efficacy of these new drugs would be slowed if new models for conducting clinical studies were not identified. Specifically, the FDA recommended that a comprehensive approach be implemented to identify the patients that are the best candidates for these, and other new treatments based upon the molecular characteristics of their tumors, and more efficiently conduct the clinical studies necessary to evaluate the safety and efficacy of new drugs. To address this growing challenge, leading lung cancer experts and stakeholders across academia, government, industry, and patient advocacy came together to design a clinical research approach that could serve as a sustainable infrastructure for new lung cancer treatments called the Lung Cancer Master Protocol.

Constructing public-private partnerships to undermine the public interest: critical discourse analysis of Working Together published by the International Alliance for Responsible Drinking

BACKGROUND

The global burden of alcohol harm has increased and is forecast to grow further without effective policy implementation. Public-private partnerships aiming to address global health, and other societal challenges, are a burgeoning feature of neoliberal governance. Rhetorically distancing themselves from tobacco, the major alcohol companies are committed to tackling 'harmful drinking' and have created a distinct type of public relations organization for this purpose. The activities of such organizations are increasingly recognized as an impediment to the implementation of policies to reduce alcohol harm, including in low- and middle-income countries where markets are expanding.

METHODS

The approach of critical discourse analysis is used to examine the discursive tactics and strategies used in Working Together; a 'toolkit' published by the key global level alcohol industry public relations organization, the International Alliance for Responsible Drinking (IARD). This study considers how it works discursively to set the terms of, and overcome skepticism about partnerships, to define aims and position various actors by constructing their roles. The construction of prospective partners provides insights into the alcohol industry itself.

RESULTS

The toolkit operates as an ideological resource for forming public-private partnerships across the world based on the accumulated know-how of the major companies through IARD. This allows the largest alcohol companies to exercise leadership of the industry, while remaining off-stage. The toolkit relies on a form of rhetorical work which creates distance from obvious corporate interests and the harms caused to population health and society. This is accomplished by working against evidence-informed population level approaches, and thus avoiding policies that will make any significant difference to overall alcohol harm. Unspecific "complexity" affords opportunity for preferred types of "actions", and "partnership" provides opportunity to gain credibility by association, further minimizing the likelihood of any material harm being reduced.

CONCLUSIONS

The toolkit is designed to not only legitimate the inclusion of alcohol industry actors as initiating 'partners', but also assigns them roles as managers of a set of carefully constructed relationships. This vision of public-private partnership reproduces the hegemonic narrative that has successfully blocked policy advances for decades and led to growing alcohol harm globally.

Evaluation of PPP-ABS investment environment based on combined weighting of level difference maximization and TOPSIS method

Asset-backed securitization (ABS) is currently used to refinance public-private partnership (PPP) projects in the infrastructure field. To stimulate the investors' enthusiasm, this study evaluated the investment environment of PPP projects asset-backed securitization (PPP-ABS). Firstly, we established a PPP-ABS investment environment evaluation indicator system based on the literature review and the practice of PPP-ABS. Then, the optimal weights of each indicator were determined by the combined weighting of level difference maximization method, where the subjective weights were determined by the AHP method, and the objective weights were determined by the entropy method. Finally, we evaluated the PPP-ABS investment environment from 2015 to 2022 with the technique for order preference by similarity to ideal solution (TOPSIS) method. The final valuation results are consistent with the actual situation. The results showed that the PPP-ABS investment environment exhibits a stable and upward trend. Under the overall guidance of the government, the approval process, information disclosure and supervisory systems have continued to improve, the number of ABS products issued has continued to grow, and the overall market risk is controllable. However, some problems still need to be solved and improved, including inadequate accounting and tax systems, insufficient liquidity in the secondary market, and the recovery of economic development in the post-COVID-19 era. This study fills the research gap in PPP-ABS. It proves the rationality and feasibility of PPP-ABS and is expected to provide a reference for investors' decision-making and promote the sustainable and healthy development of PPP-ABS.

Strengthening immunization programs through innovative sub-national public-private partnerships in selected provinces in the Democratic Republic of the Congo

BACKGROUND

Low immunization coverage rates in the Democratic Republic of Congo (DRC) have been reflective of challenges with vaccine access, support and delivery in the country. Motivated by measles and vaccine-derived polio virus (VDPV) outbreaks in 2016-17 and low vaccination rates, the provinces of Haut Lomami and Tanganyika were identified as pilot locations for an innovative approach focused on establishing a consortium of partners supporting local government. This approach was formalized through Memorandums of Understanding (MoUs) between the Bill and Melinda Gates Foundation and Provincial governments in 2018. A third province, Lualaba, established an MoU in 2021.

MOU IMPLEMENTATION

These MoUs were 5-year partnerships designed to aid provinces in meeting four key objectives: 80 % immunization coverage, management/elimination of polio/cVDPV outbreaks, improvement of vaccine accessibility, and transfer of immunization service management to provincial leadership.

OUTCOMES

During the MoU period, Haut-Lomami saw an increase in full immunization coverage, from 35.7 % (MICS 2018) to 88.9 % (VCS 2021-22), the highest in country. A sharp drop in percentage of zero-dose children was observed in the 3 provinces, confirming improved access to immunization services. Tanganyika saw initial improvement in full immunization coverage, followed by a drop in the VCS 2021-22 due to COVID-19 and healthcare worker strikes. Coverage improved in Tanganyika in the 2023 VCS. The 3 provinces increased their financial contributions to routine immunization and are now the top contributing provinces. While no cVDPV cases were recorded in 2020 and 2021, cVDPV1 and cVDPV2 outbreaks are afflicting the 3 provinces since 2022.

CONCLUSIONS

Ultimately, the provincial MoUs were successful in bolstering provincial autonomy and capacity building with the biggest success being a drop in zero-dose children. While not all objectives have been met, the MoU approach served as an innovative program for key aspects of strengthening routine immunization in the DRC.

General Practitioner's Experience of Public-Private Partnerships to Develop Team-Based Care: A Qualitative Study

Objectives: A tripartite public-private partnership was established between GPs' practices, public health authorities and a university department of family medicine, to develop multidisciplinary teams and integrate nurses into GPs' practices. The present paper describes the points of view of the GPs involved in this collaboration. Methods: We conducted a qualitative study, with data coming from eight interviews with GPs, one from each practice. We also used the facilitator's project diary to complete the discussion. Results: The principal issue discussed was the financial aspects of the collaboration. GPs are generally satisfied, but time spent coordinating with nurses and transferring activities made them fear financial losses. Secondly, the partnership with public health authorities was well appreciated, but not clear enough. Some aspects of the partnership, such as referring patient to the nurse should have been better defined et controlled. The last aspect was the academic support. It allowed reducing GPs' workload in training nurses and supporting the project implementation within the GPs' practice. Conclusion: GPs have a positive point of view of such public-private partnership and saw an opportunity to be involved in developing public health policies.

Analyzing Financial Efficiency of Public-Private Partnerships Hospitals in Taiwan

This study evaluates the management capacity ability and profitable capacity of eight public-private partnership hospitals in Taiwan from 2015 to 2020. By conducting various ratio analyses of the financial statement, this study found these hospitals have achieved a balance between management efficiency and profitability, thereby confirming the viability of the PPP model for hospital management. In addition, the subject hospitals play a vital role as isolation hospitals during the COVID-19 pandemic. Beyond offering medical assistance to infected individuals, these hospitals contribute to the integrity of Taiwan's medical network, mitigating the impact of the pandemic. Overall, establishing and managing hospitals with PPP partnership is a feasible solution as it alleviates governmental financial burdens related to medical welfare and achieves profitability.

Uptake and Discontinuation of Pre-Exposure Prophylaxis Among Uninsured Transgender and Cisgender Women: A Public-Private Partnership Model in North Carolina

HIV pre-exposure prophylaxis (PrEP) remains underutilized among cis and trans women. The PrEP Initiative Program (PIP) is a novel public-private partnership implemented at 12 local clinics in North Carolina. PIP provides HIV/sexually transmitted infection (STI) testing and clinical and laboratory monitoring for PrEP to uninsured/underinsured clients. We sought to understand service-related differences among both cis and trans women enrolled in PIP, including STIs diagnoses, clinic type, sources of referral, services needed, and reasons for PrEP discontinuation. The Kaplan-Meier curves display retention on PrEP over the duration of the program. Since 2018, 142 women (cis n = 113; trans n = 29) enrolled, and 136 started PrEP. The majority were ages 25-34 years (31.7%) or 18-24 years (29.6%), Black (57.8%) or Latinx (24.7%). Approximately 20.6% of recipients reported at least one STI while enrolled. Overall, trans women requested fewer services than cis women. After accounting for the amount of time each patient was taking PrEP, there were higher rates of trans women diagnosed with syphilis than cis women. Rates of persons with other STIs were not notably different between trans and cis women. Clinic access varied by gender: 69% of trans women were enrolled at only one site. Trans women were retained significantly longer: The Kaplan-Meier adjusted median time to discontinuation was 560 and 238 days for trans and cis women, respectively. PIP successfully reached historically marginalized and uninsured cis and trans women who may benefit from PrEP. Further investigations into factors contributing to recruitment and retention of women in HIV prevention programs are needed.

Public-private partnerships influencing the initiation and duration of clinical trials for neglected tropical diseases

Public-private partnerships (PPPs) for neglected tropical diseases (NTDs) are often studied as an organizational form that facilitates the management and control of the huge costs of drug research and development. Especially the later stages of drug development, including clinical trials, become very expensive. This present study investigates whether and how the type of PPPs influences the initiation and duration of NTD clinical trials. Using the ClinicalTrials.gov database, a dataset of 1175 NTD clinical studies that started between 2000 and 2021 is analyzed based on affiliation information and project duration. For the NTD clinical trials that resulted from PPPs, the collaborating types were determined and analyzed, including the public sector-, private sector-, governmental sector-, and nongovernmental organization-led collaborations. The determinants for the discontinuation of all stopped clinical trials were categorized into scientific-, funding-, political-, and logistic dimensions. The results reveal that public sector-led PPPs were the most common collaborative types, and logistic and scientific issues were the most frequent determinants of stopped clinical trials. Trial registration: ClinicalTrials.gov.

Principles of engagement on research and other collaborations between the brewing sector and research entities: the FACT Principles

Public-private partnerships are subject to intense scrutiny. This is specifically the case for sensitive health-related topics such as alcohol consumption. The brewing sector and representatives of the scientific community therefore stressed the need for specific principles for the proper and transparent governance of research and other collaborations between the brewing sector and research entities. At a 1-day seminar, a group of scientists and representatives from the brewing and food sector reached a consensus for such principles. They adhere to the following four fundamental conditions: Freedom of research, Accessibility, Contextualisation and Transparency. The points of focus in the FACT principles are open science, meaning that the methods and results are made accessible and reusable, and relationships are clearly disclosed. Actions to be taken for dissemination and implementation of the FACT Principles are, for instance, publishing them on public websites, including them in formal research agreements, and citing them in scientific publications. Scientific journals and (research) societies are encouraged to support the FACT Principles. In conclusion, the FACT Principles provide a framework for increased transparency and control of funding-related bias in research and other collaborations between the brewing sector and research entities. Monitoring their use and evaluating their impact will help to further refine and enforce the FACT Principles in the future.

[The fight against antibiotic resistance: what does the future hold?]

The fight against antibiotic resistance is faced with a lack of therapeutic innovation, due to the low return on investment for players in the pharmaceutical sector. Research challenges need to integrate a translational research strategy for the development of new therapeutics in a One Health approach. For synergistic collaboration, public-private partnerships have been set up with financial support mechanisms for the marketing of new anti-infectives, enabling a return on investment for players in the pharmaceutical sector.

Plasma proteomic associations with genetics and health in the UK Biobank

The Pharma Proteomics Project is a precompetitive biopharmaceutical consortium characterizing the plasma proteomic profiles of 54,219 UK Biobank participants. Here we provide a detailed summary of this initiative, including technical and biological validations, insights into proteomic disease signatures, and prediction modelling for various demographic and health indicators. We present comprehensive protein quantitative trait locus (pQTL) mapping of 2,923 proteins that identifies 14,287 primary genetic associations, of which 81% are previously undescribed, alongside ancestry-specific pQTL mapping in non-European individuals. The study provides an updated characterization of the genetic architecture of the plasma proteome, contextualized with projected pQTL discovery rates as sample sizes and proteomic assay coverages increase over time. We offer extensive insights into trans pQTLs across multiple biological domains, highlight genetic influences on ligand-receptor interactions and pathway perturbations across a diverse collection of cytokines and complement networks, and illustrate long-range epistatic effects of ABO blood group and FUT2 secretor status on proteins with gastrointestinal tissue-enriched expression. We demonstrate the utility of these data for drug discovery by extending the genetic proxied effects of protein targets, such as PCSK9, on additional endpoints, and disentangle specific genes and proteins perturbed at loci associated with COVID-19 susceptibility. This public-private partnership provides the scientific community with an open-access proteomics resource of considerable breadth and depth to help to elucidate the biological mechanisms underlying proteo-genomic discoveries and accelerate the development of biomarkers, predictive models and therapeutics1.

Development of medicines for rare diseases and inborn errors of metabolism: Toward novel public-private partnerships

Medicine development for rare diseases, including inborn errors of metabolism (IEMs) is challenging. Many academic innovations fail to reach the patient, either by stranding in the translational stage or due to suboptimal patient access related to pricing or uncertain effectiveness. Expanding and solidifying the role of the academic in public-private partnerships (PPPs) may present an innovative solution to help overcome these complexities. This narrative review explores the literature on traditional and novel collaborative approaches to medicine development for rare diseases and analyzes examples of PPPs, with a specific focus on IEMs. Several academic institutions have introduced guidelines for socially responsible licensing of innovations for private development. The PPP model offers a more integrative approach toward academic involvement of medicine development. By sharing risks and rewards, failures in the translational stage can be mutually absorbed. If socially responsible terms are not included, however, high pricing can impede patient access. Therefore, we propose a framework for socially responsible PPPs aimed at medicine development for metabolic disorders. This socially responsible PPP framework could stimulate successful and accessible medicine development for IEMs as well as other rare diseases if the establishment of such collaborations includes terms securing joint data ownership and evidence generation, fast access, and socially responsible pricing.

Effects of public-private partnership on diet-related obesity risk factors among school-aged children: A systematic literature review

Background: Childhood obesity is a major public health challenge. Public-private partnerships (PPPs) have been proposed as a solution; however, valid concerns exist as to whether commercial interest can be balanced with public health goals. Aims: This study describes the effects of interventions carried out through PPPs on diet-related obesity risk factors, namely fruit and vegetable (F&V), sugar-sweetened beverage (SSB), and energy-dense food consumption, among school-aged children. Methods: A systematic literature review was conducted from January 1990 to December 2021 across three databases. Out of the 276 articles initially identified, 8 were included. Data were extracted from each article on study characteristics, partners involved, partnership descriptions, and partnership outcomes. A descriptive analysis included frequency counts for specific study attributes. Results: All studies took place in the United States and were published between 2010 and 2017. Most were cohort studies (75%) and involved structured, healthy lifestyle interventions (75%). Nearly all interventions included components targeting F&V consumption (88%), followed by energy-dense food consumption (50%), and SSB consumption (38%). Business sector partners were largely food producers, food retailers, and private healthcare providers; however, few studies provided details on their partnering arrangements. No studies reported harmful changes in diet-related obesity risk factors. Conclusion: Collaboration across sectors is needed to address drivers of obesity where children live, learn, and play. The small sample size and heterogeneity in this review prohibits definitive conclusions pertaining to the effect of PPPs on childhood obesity. Future research efforts are needed to develop a taxonomy for better classifying and examining PPPs.

Application of an evaluation tool for mega-hospital site sustainability. Assessment of public private partnership large sized healthcare infrastructures in European context

BACKGROUND AND AIM

Healthcare facilities are large and complex infrastructures designed to respond to a growing need of sanitary services in specialized environments to serve an increasing population number while containing costs. New financial and design models emerged for large sized Hospital -Facilities (Mega-hospitals) but their site sustainability is questioned.

METHODS

The paper focuses on a comparison -between European region case studies of Public Private Partnership (PPP) Mega-Hospitals. A total of 21 large sized hospitals in operation after 2010 have been compared with the application of the Assessment Tool for -Hospital Site Sustainability (ATHOSS). A specific focus on Turkish Hospitals has been also provided as the PPP model is widely adopted in this country.

RESULTS

This analysis shows that Turkish cases gets general lower scores than European ones in terms of Construction Density and Community Connectivity (28%;50%), Alternative Transportation (18%; 50%), Site Development (26%; 38%). Connection to Natural World (30%; 52%) and Heat Island Effect (33%; 43%). Only in Development Density criteria (30%; 16%) the score was higher. It also emerged that gross floor area per bed ratio is much larger for Turkish cases (334m2/bed; 198 m2/bed) which can be interpreted as one of the weaknesses related to oversizing such infrastructures.

CONCLUSIONS

The tool application highlighted some point of attention to be considered when designing and planning Mega-hospital facilities and improvement strategies for site sustainability are -suggested.

Evolutionary game analysis of rural public-private partnership older adult care project in the context of population aging in China

Introduction

Public-private partnership (PPP) older adult care project is an effective means to solve the dilemma of the aging population in China's rural areas, but there are some problems in the operation process, such as a low participation rate and poor service quality, resulting in the needs of rural older adult groups not being met.

Methods

To alleviate the pressure of the aging population in rural areas, this study establishes an evolutionary game model for the PPP older adult care project, then defines the interests of local government, the private sector, and rural older adult residents, based on which it discusses the strategic choices of the three parties in the evolutionary process, and finally analyzes the influencing factors of the strategic choices of the game parties through simulation.

Results

The results suggest that whether the private sector chooses to actively participate in the project will be influenced by the willingness of local government and rural older adult residents to participate in the project. Local government could play the role of supervisor through reward and punishment mechanisms. Whether older rural residents choose to participate in the project depends on the number of benefits they would receive.

Discussion

Based on these findings, local governments should clarify the responsibilities of relevant stakeholders, adopt a regulatory strategy combining subsidies and penalties, improve the participation efficiency of rural older adult residents, promote the effective operation of PPP older adult care projects, and improve the quality of rural older adult care services in the new era.

Biopharma innovation trends during COVID-19 and beyond: an evidence from global partnerships and fundraising activities, 2011-2022

BACKGROUND

Co-development alliances and capital-raising activities are essential supports for biopharmaceutical innovation. During the initial outbreak of the COVID-19, the level of these business activities has increased greatly. Yet the magnitude, direction, and duration of the trend remain ambiguous. Real-time real-world data are needed to inform strategic redirections and industrial policies.

METHODS

This observational study aims to characterize trends in global biopharma innovation activities throughout the global pandemic outbreak. Our extensive deal dataset is retrieved from the commercial database GlobalData (12,866 partnership deals and 32,250 fundraising deals announced between 2011 and 2022). We perform Chi-squared tests to examine the changes in qualitative deal attributes during and beyond the outbreak. Our deal-level sample is further aggregated into category-level panel data according to deal characteristics such as therapy area, molecule type, and development phase. We run a series of regressions to examine how the monthly investment amount raised in each category changed with the onset of the pandemic, controlling for the US Federal funds rate.

RESULTS

The temporary surge of partnership and capital-raising activities was associated with the increase in infectious disease-related deals. Academic and government institutions played an increased role in supporting COVID-related co-development partnerships in 2020, and biopharma ventures had been securing more investments in the capital market throughout 2020 and 2021. The partnership and investment boom did not last till the later pandemic in 2022. The most significant and enduring trend was the shifting focus toward discovery-phase investments. Our regression model reveals that the discovery-phase fundraising deals did not suffer from a bounce back in the late pandemic, consistent with a persistent focus on early innovation.

CONCLUSIONS

Despite the reduced level of partnership and fundraising activities during 2022, we observe a lasting change in focus toward biopharmaceutical innovation after the pandemic outbreak. Our evidence suggests how entrepreneurs and investors should allocate resources in response to the post-pandemic tight monetary environment. We also suggest the need for policy interventions in financing private/public co-development partnerships and non-COVID-related technologies, to maintain their research capacity and generate breakthroughs when faced with unforeseen diseases.

An integrated, systems-wide approach is needed for public-private partnerships to drive genetic innovation in crops

Public-private partnerships are key to successfully translate knowledge to products, but current frameworks do not foster the systems-wide approach required to improve crops to meet the agricultural production challenges of the 21st century.

A selectivity index for public-private partnership projects in the urban water and sanitation sector in Latin America and the caribbean

The rapid urban development, the Agenda 2030, the climate change adaptation and the COVID 19 crisis highlight the need to increase investment in public infrastructure and improve water supply and sanitation services. For this, an alternative to traditional public procurement is the participation of the private sector under the public-private partnership (PPP) model. The objective of this article is to develop a tool based on critical success factors (CSFs) that allows for evaluation during early stages of the convenience of developing a PPP project for W&S in urban areas of Latin America and the Caribbean. The index was developed based on literature review (779 variables), review of cases (20 variables) and expert opinion to assign them an estimated value of importance. The results were analysed by exploratory and confirmatory factor analysis, selecting 17 main variables grouped into 6 CSFs, the most relevant of which are Convenience, Certainty, Leadership, Attraction, Performance and Reliability. The application of this index allows an early assessment of the feasibility of a PPP project and/or the selection of the alternatives with the best chances of success. On the other hand, this study contributes to the international discussion on the most relevant elements related to the success of PPP in W&S projects.

Feasibility of implementing public-private mix approach for tuberculosis case management in Pokhara Metropolitan City of western Nepal: a qualitative study

Background

The Public-Private Mix (PPM) approach is a strategic initiative that involves engaging all private and public health care providers in the fight against tuberculosis using international health care standards. For tuberculosis control in Nepal, the PPM approach could be a milestone. This study aimed to explore the barriers to a public-private mix approach in the management of tuberculosis cases in Nepal.

Methods

We conducted key informant interviews with 20 participants, 14 of whom were from private clinics, polyclinics, and hospitals where the PPM approach was used, two from government hospitals, and four from policymakers. All data were audio-recorded, transcribed, and translated into English. The transcripts of the interviews were manually organized, and themes were generated and categorized into 1. TB case detection, 2. patient-related barriers, and 3. health-system-related barriers.

Results

A total of 20 respondents participated in the study. Barriers to PPM were identified into following three themes: (1) Obstacles related to TB case detection, (2) Obstacles related to patients, and (3) Obstacles related to health-care system. PPM implementation was challenged by following sub-themes that included staff turnover, low private sector participation in workshops, a lack of trainings, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies.

Conclusion

Government stakeholders can significantly benefit by applying a proactive role working with the private in monitoring and supervision. The joint efforts with private sector can then enable all stakeholders to follow the government policy, practice and protocols in case finding, holding and other preventive approaches. Future research are essential in exploring how PPM could be optimized.

FAIR in action - a flexible framework to guide FAIRification

The COVID-19 pandemic has highlighted the need for FAIR (Findable, Accessible, Interoperable, and Reusable) data more than any other scientific challenge to date. We developed a flexible, multi-level, domain-agnostic FAIRification framework, providing practical guidance to improve the FAIRness for both existing and future clinical and molecular datasets. We validated the framework in collaboration with several major public-private partnership projects, demonstrating and delivering improvements across all aspects of FAIR and across a variety of datasets and their contexts. We therefore managed to establish the reproducibility and far-reaching applicability of our approach to FAIRification tasks.

Public Health Risk Evaluation through Mathematical Optimization in the Process of PPPs

The public sector is becoming increasingly appealing. In the context of declining public money to support health studies and public health interventions, public-private partnerships with entities (including government agencies and scientific research institutes) are becoming increasingly important. When forming this type of cooperation, the participants highlight synergies between the private partners and the public's missions or goals. The tasks of private and public sector actors, on the other hand, frequently diverge significantly. The integrity and honesty of public officials, institutions, trust, and faith in those individuals and institutions may all be jeopardized by these collaborations. In this study, we use the institutional corruption framework to highlight systemic concerns raised by PPPs affiliated with the governments of one of South Asia's countries. Overall analytical frameworks for such collaborations tend to downplay or disregard these systemic impacts and their ethical implications, as we argue. We offer some guidelines for public sector stakeholders that want to think about PPPs in a more systemic and analytical way. Partnership as a default paradigm for engagement with the private sector needs to be reconsidered by public sector participants. They also need to be more vocal about which goals they can and cannot fulfill, given the limitations of public financing resources.

CONCEPTUAL, FUNCTIONAL-ORGANISATIONAL MODEL OF THE REGIONAL CENTRE FOR CARDIOLOGY AND CARDIAC SURGERY BASED ON PUBLIC-PRIVATE PARTNERSHIP

OBJECTIVE

The aim: To substantiate the model of the Regional Center for Cardiology and Cardiac Surgery (RCCCS) based on the principles of public-private partnership (PPP).

PATIENTS AND METHODS

Materials and methods: A systematic approach and analysis, medical-statistical and sociological method, expert assessment and method of conceptual modelling.

RESULTS

Results: A comprehensive medical and social study of the morbidity rate of the population of the Kyiv region (Ukraine) with circulatory system diseases (CSD), as well as an analysis of the activities of the cardiological service of the Kyiv region in 2010-2019, have been made. Deficiencies in the organisation of medical care were identified, and strategic directions for its improvement were substantiated. The results of a sociological survey of CSD patients, cardiologists and experts - health care organisers have been analysed. According to the results of the expert assessment, health care institutions (HCI) providing cardiac care to the population in the Kyiv region are not ready to work under the conditions of the market economy; there is no appropriate regulatory framework, economic and legal independence of HCI, there is no market strategy for the development of HCI.

CONCLUSION

Conclusions: The model of RCCCS, based on the principles of PPP being a medical institution of a new organisational and legal form, is capable of providing high-quality and affordable highly specialised medical care of the third level to the population with diseases of the circulatory system at the regional level.

COVAX and the rise of the 'super public private partnership' for global health

COVAX, the vaccines pillar of the Access to Covid-19 Tools Accelerator (ACT-A), has been promoted as 'the only global solution' to vaccine equity and ending the Covid-19 pandemic. ACT-A and COVAX build on the public-private partnership (PPP) model that dominates global health governance, but take it to a new level, constituting an experimental form that we call the 'super-PPP'. Based on an analysis of COVAX's governance structure and its difficulties in achieving its aims, we identify several features of the super-PPP model. First, it aims to coordinate the fragmented global health field by bringing together existing PPPs in an extraordinarily complex Russian Matryoshka doll-like structure. Second, it attempts to scale up a governance model designed for donor-dependent countries to tackle a health crisis affecting the entire world, pitting it against the self-interest of its wealthiest government partners. Third, the super-PPP's structural complexity obscures the vast differences between constituent partners, giving pharmaceutical corporations substantial power and making public representation, transparency, and accountability elusive. As a super-PPP, COVAX reproduces and amplifies challenges associated with the established PPPs it incorporates. COVAX's limited success has sparked a crisis of legitimacy for the voluntary, charity-based partnership model in global health, raising questions about its future.

Stakeholder engagement variability across public, private and public-private partnership projects: A data-driven network-based analysis

Stakeholder engagement is generally considered one of the most pertinent factors impacting project outcomes. However, there is lacking empirical evidence documenting patterns of stakeholder engagement and their potential differences between public, private and public-private partnership (PPP) projects. This study leverages social network research methods to capture and quantitively compare these engagement structures. Stakeholder network data were collected by an online questionnaire from 17 public, 30 private and 9 PPP projects. A series of network-based analyses were subsequently applied to the data at both the level of individual project stakeholders and entire project stakeholder ecologies. A statistically significant difference (p<0.05) exists among the network-level measures of network size, edge number, density and betweenness centralization across the three project types. Among these four network measures, the density varies significantly (p<0.05) between 'within budget' and cost overrun projects for the private and PPP projects. The top-5 stakeholder lists with respect to three node-level centrality values reveal distinctive differences across the three project types. To further interpret the data, exponential random graph models were also applied to determine the most statistically prevalent network motifs within each type of project. Again, statistically significant differences were found across these three project types. The findings consistently point to structural differences in patterns of stakeholder engagement across the public and private domain and illustrate the applicability of network data and analytical techniques to monitoring and managing complex webs of relationships among actors who affect and are affected by diverse types of projects.

A model for public-private partnership during the COVID-19 pandemic: Lessons from Biolab and public laboratories working in the Hashemite Kingdom of Jordan

INTRODUCTION

The global COVID-19 pandemic overwhelmed national public health and laboratory capacity in Jordan and globally. In response, Biolab, a private laboratory group with 27 branches across Jordan, assisted with testing. Biolab was equipped to quickly increase molecular testing capacity without compromising quality or turnaround time, allowing them to contribute to national COVID-19 surveillance efforts.

METHODS

Biolab expanded testing in Jordan by operationalizing automated testing platforms at various locations, including 16 branches, 2 drive-through and 2 walk-through centres, and entry points for airports and marine passenger arrivals. Genomic and molecular testing were implemented to track variants. Information technology platforms were introduced for sample management, registration, and commercial sample payments. Data were directly provided to the Ministry of Health through these platforms to support public health decision-making and responses. Biolab prioritized staff well-being by providing mental, financial, and physical health support during the pandemic.

RESULTS

Biolab processed more than two million samples, with a turnaround time of ~1.5 h. Results were transmitted directly to key stakeholders in near real time. Biolab conducted variant evaluations on >1.4 million samples using molecular variant testing and >1000 samples using whole genome sequencing. Biolab prioritized staff well-being, improving staff satisfaction from 74% to 91%, a remarkable achievement when many laboratory systems experienced staff burnout and dissatisfaction.

CONCLUSION

The collaboration between public and private laboratories during COVID-19 established a model for future joint efforts to prevent outbreaks from becoming pandemics. Biolab's focus on efficiency, quality, and staff well-being enabled consistent, high-quality performance. The introduction of innovative information technology platforms ensured swift information dissemination. Biolab plans to continue investing in these platforms and expand pathogen testing, creating a top-tier testing infrastructure in Jordan with a demonstrated ability to cooperate with the government for public benefit.

Applying a Commercial Determinants of Health Lens to Understand, Expose and Counter Industry Co-option, Appeasement and Partnership Comment on "'Part of the Solution': Food Corporation Strategies for Regulatory Capture and Legitimacy"

Lacy-Nichols and Williams' examination of the food industry illustrates how it altered its approach from mostly oppositional to regulation to one of appeasement and co-option. This reflection builds upon this by using a commercial determinants of health (CDoH) lens to understand, expose and counter industry co-option, appeasement and partnership strategies that impact public health. Lessons learned from tobacco reveal how tobacco companies maintained public credibility by recruiting scientists to produce industry biased data, co-opting public health groups, gaining access to policy elites and sitting on important government regulatory bodies. Potential counter solutions to food industry appeasement and co-option include (i) understanding corporate actions of health harming industries, (ii) applying mechanisms to minimize industry engagement, (iii) dissecting industry relationship building, and (iv) exposing the negative effects of public private partnerships (PPPs). Such counter-solutions might help to neutralise harmful industry practices, products and policies which currently threaten to undermine healthy food policies.

Decision making behaviours and management mechanisms for construction and demolition waste recycling based on public-private partnership

Generation of construction and demolition waste (CDW) is a challenge for sustainable development. Recycling is required in response to energy consumption and natural resource depletion caused by CDW. Public-private partnership (PPP) mode provides a strategy for CDW recycling. This study aims to investigate the decision-making behaviours of the government and recyclers and propose management mechanisms to improve CDW recycling. Based on evolutionary game model, the influencing factors of stakeholders' behavioural strategies were identified, including the government supervision costs, penalty, subsidy, the benefits and costs of recyclers' cooperation and opportunism and consumers' purchase intention. The results revealed how the initial strategy proportions, penalties, subsidies and consumers' purchase intentions affect the evolutionary paths of stakeholders' decision-making behaviours in CDW recycling PPP projects. The larger the initial strategy value, the faster the evolutionary trajectory reaches ESS (0, 1). The penalty can restrain speculative behaviours of recyclers, whilst the subsidy has no significant effect. Consumer purchase intention can reduce the cost of government supervision and improve the cooperation efficiency of recyclers. These findings may contribute to enriching the body of knowledge in CDW and providing management mechanisms for CDW recycling practice. Appropriate penalty, subsidy and financial support policies should be formulated to promote the development of CDW recycling PPP projects.

Observational study of the clinical performance of a public-private partnership national referral hospital network in Lesotho: Do improvements last over time?

Public-private partnerships (PPP) may increase healthcare quality but lack longitudinal evidence for success. The Queen ‘Mamohato Memorial Hospital (QMMH) in Lesotho is one of Africa’s first healthcare PPPs. We compare data from 2012 and 2018 on capacity, utilization, quality, and outcomes to understand if early documented successes have been sustained using the same measures over time. In this observational study using administrative and clinical data, we assessed beds, admissions, average length of stay (ALOS), outpatient visits, and patient outcomes. We measured triage time and crash cart stock through direct observation in 2013 and 2020. Operational hospital beds increased from 390 to 410. Admissions decreased (-5.3%) while outpatient visits increased (3.8%). ALOS increased from 5.1 to 6.5 days. Occupancy increased from 82% to 99%; half of the wards had occupancy rates ≥90%, and Neonatal ward occupancy was 209%. The proportion of crash cart stock present (82.9% to 73.8%) and timely triage (84.0% to 27.6%) decreased. While overall mortality decreased (8.0% to 6.5%) and neonatal mortality overall decreased (18.0% to 16.3%), mortality among very low birth weight neonates increased (30.2% to 36.8%). Declines in overall hospital mortality are promising. Yet, continued high occupancy could compromise infection control and impede response to infections, such as COVID-19. High occupancy in the Neonatal ward suggests that the population need for neonatal care outpaces QMMH capacity; improvements should be addressed at the hospital and systemic levels. The increase in ALOS is acceptable for a hospital meant to take the most critical cases. The decline in crash cart stock completeness and timely triage may affect access to emergency treatment. While the partnership itself ended earlier than anticipated, our evaluation suggests that generally the hospital under the PPP was operational, providing high-level, critically needed services, and continued to improve patient outcomes. Quality at QMMH remained substantially higher than at the former Queen Elizabeth II hospital.

Digital Health to Strengthen District-Based Public-Private Mix Tuberculosis Control in Purwakarta District, Indonesia: A Qualitative Research

This study aimed to explore the problem that occurs in district-based public-private mix tuberculosis (DPPM TB) in the Purwakarta district, and how digital health can help overcome this problem. This study used a qualitative research design. By purposive sampling, 46 informants were selected to be interviewed and 9 informants participated in focus group discussion. Data were collected during January to November 2020 and analyzed using the content analysis technique. Trustworthiness is obtained through the triangulation method and peer debriefing. The problems identified in public and private partnership were the lack of communication and awareness, the under-reporting of TB cases in the private health sector, and the limitation of the existing information system. Communication is important in delivering information about a tuberculosis program, patient referrals, and contact investigation; therefore, digital health is considered as a potential strategy to facilitate that. Digital health must consider ethical issues, avoid redundancy, be user-friendly, and include intervention packages. We conclude that the lack of communication between the public and the private health sectors in TB control was a major problem in DPPM TB. Digital health is needed to ensure the flow of information and communication between the public and the private health sectors.