Quality Improvement in Public-Private Partnerships in Low- and Middle-Income Countries: A Systematic Review

Abstract

Abstract Background Public-private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMIC). We therefore aimed to systematically review the literature about the aim and impact of quality improvement (QI) approaches in PPP in LMIC. Methods We searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. Study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed 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 themes for successful QI projects in LMIC: 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. Few studies discussed the response to the finding and their willingness to change. Conclusions Empirical research is needed to explore the implementation challenges and contextual factors that influence how a PPP can best be implemented to improve population health. Vague descriptions of the structure of the PPPs and roles of public and private entities made it difficult to draw conclusions about the impact of the organizational governance on the outcomes of QI programs in LMIC. We outline a rich area future research, including the need for a clearer description of the interventions, uniform outcome measures, and focus on response to the findings. To improve research equity, more ownership and power should be shifted to local leaders and researchers.