From paper to practice: an exploratory study of policy making and implementation in alternative forms of healthcare public‐private partnership in Ghana

There has been growing advocacy for public‐private partnership (PPP) in healthcare in both policy and academic circles over the last 3 decades. However, our understanding of the tensions between the policy cycle and critical organisational trade‐offs that characterise alternative forms of healthcare PPPs remains limited. In this paper, we use Walt and Gilson's policy analysis triangle to explore the policy and practice of two alternative models of healthcare PPPs–autonomous and integrative partnerships–at the sub‐national level in Ghana, a typical case of a polycentric health management structure. The study is a sequential exploratory qualitative design, consisting of review of four policy documents and in‐depth interviews with 13 key informants, comprising health managers from the regional and district health directorates, and medical directors of selected private health facilities. Our findings reveal that in spite of the natural potential of integrative PPP models to present a relatively stronger policy capacity to the private partner than autonomous models, the capacity of sub‐national level public‐private actors to participate in policy making and implementation remains very limited across both models. We further find that effective policy making and implementation requires significant governance attention to building the policy capacity of actors across vertical and horizontal levels of the partnership, regardless of the model of engagement. We suggest that this is achievable through instrumental multistakeholderism in PPP policy, planning and management. The paper contributes to developing understanding of the policy and practice of healthcare PPP in polycentric institutional settings.