Public Private Partnership and Health Service Delivery in Mogadishu, Somalia

ABSTRACT The purpose of the study was to establish the effect of public-private partnership on health service delivery particularly in Mogadishu, Somalia. The objectives of the study were to; examine the relationship between leases and Affermage Contracts and health service delivery in Mogadishu-Somalia, establish the relationship between full divestiture and health service delivery in Mogadishu-Somalia and examine the relationship between civil Works and Service Contracts and health service delivery in Mogadishu-Somalia. This study used a correlational research design to assess the respondents’ views towards public-private partnership and health service delivery in Mogadishu, Somalia. The researcher chose this research design in order to be able to determine the relationship between Public Private Partnership and Health Service Delivery in Mogadishu, Somalia. The study was conducted from Mogadishu in Somalia. The total population of Mogadishu was 2,587,183 inhabitants. However, there were approximately 136 health centers whereby 3 are public health centers and 133 are private health centers. The study Population comprised 240 participants and these included; 5 Mogadishu Local Government delegates, 5 Officials from Ministry of Health, Mogadishu, 20 Health workers and 210 Patients who were accessible. The coded data were entered into the Computer, checked and statistically analyzed using the Statistical Package for Social Scientists (SPSS) software package to generate descriptive and inferential statistics. From the study findings, a lease contract the private sector retains the revenue and pays a lease fee to the hospital or health facility was most prominent. This implies that leases and Affermage Contracts are vital in public private partnerships which also influence the delivery of health services to the people within communities. The study concludes that in the affermage/lease type of arrangement an operator (the leaseholder) is responsible for operating and maintaining the health facility (that already exists) and services, but generally, the operator is not required to make any large investment. The study recommends that most of the time in PPP, the private sectors are considered by the government as the underdogs and that they ought to be highly regulated. Contrary to this, the private sector should be allowed to enjoy its liberties, as this would ensure that the sector remains objective and is not distracted from its course. This can be done by allowing the private sector to be the formulator of the policies which affect them most.

TABLE OF CONTENTS

DECLARATION ............................................................................................................................ ii

APPROVAL ..................................................................................................................................iii

DEDICATION............................................................................................................................... iv

ACKNOWLEDGEMENTS............................................................................................................ v

LIST OF TABLES......................................................................................................................... ix

LIST OF FIGURES ........................................................................................................................ x

LIST OF ACRONYMS ................................................................................................................. xi

CHAPTER ONE ........................................................................................................................... 1

INTRODUCTION......................................................................................................................... 1

1.0 Introduction............................................................................................................................... 1

1.1 Background of the Study .......................................................................................................... 1

1.1.1 Historical Perspective ............................................................................................................ 1

1.1.2 Theoretical Perspective.......................................................................................................... 3

1.1.3 Conceptual Perspective.......................................................................................................... 4

1.1.4 Contextual Perspective........................................................................................................... 5

1.2 Statement of the Problem.......................................................................................................... 6

1.3 Purpose of Study....................................................................................................................... 6

1.4 Objectives of the study.............................................................................................................. 7

1.5 Research Questions................................................................................................................... 7

1.6 Research Hypothesis................................................................................................................. 7

1.7 Scope of the study..................................................................................................................... 7

1.7.1 Geographical Scope ............................................................................................................... 7

1.7.2 Content Scope ........................................................................................................................ 8

1.7.3 Time Scope ............................................................................................................................ 8

1.8 Significance of the Study.......................................................................................................... 8

1.9 Operational Definition of Key terms ........................................................................................ 9

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CHAPTER TWO ........................................................................................................................ 10

LITERATURE REVIEW .......................................................................................................... 10

2.0 Introduction............................................................................................................................. 10

2.1 Theoretical review .................................................................................................................. 10

2.2 Conceptual Framework........................................................................................................... 10

2.3Related literature review.......................................................................................................... 12

2.3.1 Relationship between leases and Affermage Contracts and health service delivery ........... 12

2.3.2 Relationship between privatization and health service delivery.......................................... 13

2.3.3 Relationship between civil Works and Service Contracts and health service delivery ....... 14

2.4 Related Studies........................................................................................................................ 16

2.5 Gaps in the literature............................................................................................................... 17

CHAPTERTHREE..................................................................................................................... 19

METHODOLOGY ..................................................................................................................... 19

3.0 Introduction............................................................................................................................. 19

3.1 Research Design...................................................................................................................... 19

3.2 Study Population..................................................................................................................... 19

3.3 Sample Size............................................................................................................................. 19

3.4 Sample Procedure ................................................................................................................... 20

3.5Sources of Data ........................................................................................................................ 21

3.5.1 Primary Data ........................................................................................................................ 21

3.5.2 Secondary Data .................................................................................................................... 21

3.6 Data Collection instruments.................................................................................................... 21

3.6.1 Interviews............................................................................................................................. 21

3.6.2 Questionnaires...................................................................................................................... 21

3.7Validity and reliability of the instrument................................................................................. 22

3.7.1 Validity ................................................................................................................................ 22

3.7.2 Reliability............................................................................................................................. 22

3.8 Data Analysis.......................................................................................................................... 22

3.9 Research Procedure................................................................................................................. 23

3.10 Ethical Consideration............................................................................................................ 23

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CHAPTERFOUR........................................................................................................................ 25

DATAPRESENTATION, ANALYSIS,ANDINTERPRETATIONS ..................................... 25

4.0 Introduction............................................................................................................................. 25

4.1 Demographic characteristics of respondents .......................................................................... 25

4.2 Findings on Relationship between leases and Affermage Contracts and health service

delivery ......................................................................................................................................... 28

4.3 Findings on the relationship between privatization and health service delivery .................... 30

4.4 Relationship between civil Works and Service Contracts and health service delivery .......... 32

CHAPTERFIVE ......................................................................................................................... 36

DISCUSIONS, CONCLUSIONS AND RECOMMENDATION ........................................... 36

5.0Introduction.............................................................................................................................. 36

5.1 Discussion of findings............................................................................................................. 36

5.1.1 Relationship between leases and Affermage Contracts and health service delivery ........... 36

5.1.3 Relationship between privatization and health service delivery.......................................... 36

5.1.4 Relationship between civil Works and Service Contracts and health service delivery ....... 37

5.2 Conclusions............................................................................................................................. 37

5.2.1 Relationship between leases and Affermage Contracts and health service delivery ........... 37

5.2.2 Relationship between privatization and health service delivery.......................................... 37

5.2.3 Relationship between civil Works and Service Contracts and health service delivery ....... 38

5.3 Recommendations................................................................................................................... 38

5.4Areasof further research........................................................................................................... 39

REFERENCES............................................................................................................................ 41

APPENDICES............................................................................................................................. 47

APPENDIX I: QUESTIONNAIRE .............................................................................................. 47

APPENDIX II: INTERVIEW GUIDE ......................................................................................... 51

APPENDIX III: A MAP OF SOMALIA SHOWING MOGADISHU ........................................ 52

APPENDIX IV: TIME FRAME FOR RESEARCH .................................................................... 53