Effects of public-private partnership on efficiency of health services delivery in Uganda: A case study of Kagando Hospital in Kasese District

Abstract

The extent to which public private partnership (PPP) strategy has enhanced efficiency in the health service delivery at Kagando Hospital is not well understood. This study was therefore undertaken to assess the extent to which of financial and human resources support through the PPP affect Kagando hospital’s delivery of healthcare service; and determine the Standard Unit of Output for Kagando hospital and its relationship to human resource, cost of medicine, total costs and user fees. The study used a time series study design with quantitative and qualitative techniques. The study used secondary data from hospital documents for the fiscal years between 1996/7 and 2006/7, a period for the existence of PPP in Uganda. Efficiency was determined using Standard Unit of Output (SUO) based on the health economics model developed by Giutsi (2002). Tables, charts, ratios and correlation coefficients were used to determine relationship of government financial and human resource support on hospital efficiency. Results show that there was a general increase in government funding to the hospital over the eleven year period. Seconded staff also increased over the five year period and the main staff seconded by government to the hospital are medical doctors. Admissions, deliveries and surgical operations show an increasing trend while Immunisations, Antenatal Care (ANC) and Outpatient Department (OPD) attendances reveal a declining trend. Some outputs increased due to increase in financial and human resource support to the hospital and other outputs reduced due to reduction in financial and human resource support to the hospital. The overall trend of SUO for the hospital reveals a declining trend while the overall trend of SUO per staff reveals an increasing trend. The study found out that Government of Uganda through PPPH extended grants amounting to 18.4 % of the hospital budget over the eleven years. Government seconded staff to the hospital accounted for 9-14 % of the staff establishment. The trend of Standard Unit of Output reveals a reduction in access to health services while the trend of SUO per staff reveals efficiency. The study recommends maintenance of government grants to the hospital and increase in the grants where possible and government should continue secondment of staff to Kagando hospital focusing on seconding more doctors.