Investigating the most Important Advantages, Disadvantages and Obstacles of Public-Private Sector Partnership in Providing Primary Health Care Services from the Viewpoint of Health Managers

Extended Abstract
Background and Objectives
Partnership with the private sector is one of the most important pillars of health system reform in all over the world. Public-private partnerships can lead to increased efficiency, equity, accountability, quality and access to health services. The aim of this study was to investigate the views of health managers about the advantages, disadvantages and barriers of public-private partnership in the provision of primary health care services.
Material and Methods
In the present study, a mixed method (quantitative-qualitative) was adopted to achieve the research objectives. In order to prepare the questions of the public-private partnership questionnaire in providing primary health care services, the views and opinions of experts experienced in the fields of public health care, public-private, managerial and executive participation were sought and incorporated into the researcher's assumptions. For this purpose, semi-structured interviews developed and conducted with a number of specialists working in the field of primary health care. Finally, the main themes of the questionnaire were drafted in 3 sections: advantages (8 questions), disadvantages (9 questions) and obstacles (18 questions) the grading of the questionnaire was determined on a 5-point Likert scale ranging from completely agree, to completely disagree. The content validity and face validity of the questionnaire were assessed through interviews with experts. The results of validation showed that the questionnaire has sufficient validity for being employed in the studies related to the subject under study.The quantitative part of the study was also conducted in two phases. In the first phase, based on the validation results of the questionnaire, the overall content validity of the questionnaire was assessed through CVR (content validity ratio) and CVI (content validity index) both of which were estimated 90%, and the reliability of the questionnaire was measured using Cronbach's alpha which was estimated to be 0.83. In the second phase, the population of the satudy was selected through convenient sampling method for data collection. The study population consisted of senior and mid-level managers who had managerial experience providing health services in public and private sectors in Tehran. The data obtained from 100 questionnaires completed officially and in person by the participants were included in the data analysis. The mean and standard deviation of the scores for the sections of the questionnaire were estimated separately. The collected data were analyzed, using Stata 14 at confidence level of 0.95.
Results
The results of the first part of the study found the highest score to belong to the benefits of public-private partnership in the provision of primary health care services, including three cases of "financing of public partnership projects in primary health care" with a mean of 4.02 and standard deviation of 1/00, "high technical and managerial efficiency in the private sector" with mean of 3.89 and standard deviation of 0.60 and "increasing the quality of primary health care services in the private sector through fair competition" with a mean of 3.87 and standard deviation 0.57. "Low cost of services in the private sector" received the lowest score in this sector. The findings of the second part of the study showed that the three most important disadvantages assiciated with public-private partnership for providing primary health care services include "lack of full coverage of primary health care services and ignoance of social justice" with mean score of 3.99 and standard deviation of 0.92, "inadequate job security in the private sector" with mean score of 3.97 and standard deviation of 0.9 and "insufficient government supervision of private sector performance" with mean score of 3.95 and standard deviation of 0.79, "lack of financial protection of private service recipients" was given a minimum score. The findings of the third part of the study revealed that the three major obstacles hindering public-private partnership in service delivery include "legal, and monitoring shortcomings alongside hampering rules and regulations in partnership with the private sector" with mean score of 4.06 and standard deviation of 0.60, "reluctance of health managers for risk-taking when in partnership with the pivate sector" with mean score of 4.05 and standard deviation of 0.61 and "insufficient expertise of government managers regarding knowledge of partnership with the private sector" with mean score of 4.04 and standard deviation of 0.53.
Conclusion
The results of this study show that the financing of participatory projects in the primary health care sector by the private sector and also the positive performance of the private sector compared to the public sector as the most important benefits of partnership can provide opportunity to develop primary health care services. It seems that managers' attention to the disadvantages of partnership, such as lack of full coverage of services and withdrawal from social justice, etc., can pave the way for developing much clearer and smoother public-private sectors’ partnerships. Recognizing the barriers to public-private sector participation, such as legal, regulatory barriers, lack of expertise of public managers in knowledge of participation, lack of risk-taking of managers in the public sector, etc. can make the removal of barriers more visible.

Practical implications of the research

By removing legal barriers, focusing on the benefits of public-private partnerships, and creating healthy competition, the government can enable the private sector to participate in the provision of health services. The transfer of services to the private sector and its participation, and also the reduction of entrepreneurship can create an opportunity for the quantitative and qualitative development of primary health care services.
Ethical considerations
This article is taken from the PhD dissertation with code 14121213972004 and ethics ID IR.SBMU.RETECH.REC.1399.832, and ethical considerations, human and ethical principles have been observed based on the Helsinki Declaration.
Conflict of interest
The authors state that this work is the result of an independent study and has no conflict of interest with other organizations and individuals.
Acknowledgement
This study is taken from a specialized PhD dissertation in the Department of Health Services Management, Faculty of Management, Islamic Azad University, South Tehran Branch. All participants in the study, including senior and mid-level managers working in the Deputy of Health in the Ministry of Health and Medical Education, the Deputy of Health at Shahid Beheshti University of Medical Sciences, Tehran University of Medical Sciences and Iran University of Medical Sciences, are appreciated for completing the questionnaire and cooperation in designing the questionnaire.