title: Constraints, challenges and prospects of public-private partnership in health-care delivery in a developing economy.
abstract: BACKGROUND
  In Nigeria, concerns on the quality and financing of health-care delivery especially in the public sector have initiated reforms including support for public-private partnerships (PPP) at the Federal Ministry of Health. Likewise, Enugu State has developed a draft policy on PPP since 2005. However, non-validation and non-implementation of this policy might have led to loss of interest in the partnership.
  
  
  OBJECTIVE
  The aim of this study was to provide evidence for planning the implementation of PPP in Enugu State health system via a multi-sectoral identification of challenges, constraints and prospects.
  
  
  METHODS
  Pre-tested questionnaires were administered to 466 respondents (251 health workers and 215 community members), selected by multi-stage sampling method from nine Local Government Areas of Enugu State, Nigeria, over a study period of April 2011 to September 2011. Data from the questionnaires were collated manually and quantitative data analyzed using SPSS version 15 (Chicago, IL, USA).
  
  
  RESULTS
  Only 159 (34.1%, 159/466) of all respondents actually understood the meaning of PPP though 251 (53.9%) of them had claimed knowledge of the concept. This actual understanding was higher among health workers (57.8%, 145/251) when compared with the community members (6.5%, 14/215) (P < 0.001). Post-PPP enlightenment reviews showed a more desire for PPP implementation among private health-care workers (89.4%, 101/113) and community leaders/members (55.4%, 119/215).
  
  
  CONCLUSIONS
  PPP in health-care delivery in Enugu State is feasible with massive awareness, elaborate stakeholder's engagements and well-structured policy before implementation. A critical challenge will be to convince the public sector workers who are the anticipated partners to accept and support private sector participation.
authors.affiliation: Department of Physiology, University of Nigeria, Enugu Campus, Enugu State, Nigeria ; Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
authors.forename: Usb
authors.initials: U
authors.lastname: Anyaehie
authors.affiliation: Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
authors.forename: Ban
authors.initials: B
authors.lastname: Nwakoby
authors.affiliation: Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
authors.forename: C
authors.initials: C
authors.lastname: Chikwendu
authors.affiliation: Department of Physiology, University of Nigeria, Enugu Campus, Enugu State, Nigeria ; Department Obstetrics and Gynecology, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
authors.forename: Cc
authors.initials: C
authors.lastname: Dim
authors.affiliation: Department of Health Management, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
authors.forename: N
authors.initials: N
authors.lastname: Uguru
authors.affiliation: Enugu State Health Board, Enugu State, Nigeria.
authors.forename: Cpi
authors.initials: C
authors.lastname: Oluka
authors.affiliation: Department of Medicine, Medway Maritime Hospital, Gillingham, Kent, UK.
authors.forename: C
authors.initials: C
authors.lastname: Ogugua
keywords: Enugu; Government; Health-care; Public-private partnership; Reform