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Public-private partnerships and efficiency in public procurement of primary healthcare infrastructure: a qualitative research in the NHS UK



There is growing interest in the contribution of public-private partnerships (PPPs) bridging the shortage of financial resources and management expertise in developing public healthcare infrastructure. However, few studies have evidenced PPPs’ ability in increasing efficiency in public procurement of primary healthcare infrastructure. The aim of this study was to assess to what extent PPPs would increase efficiency in public procurement of primary healthcare facilities.

Subject and methods

A qualitative analysis, adopting a realistic research evaluation method, used data collected from a purposive sample of public (n = 23) and private sector staff (n = 2) directly involved in the UK National Health Service Local Improvement Finance Trust (LIFT).


We find a positive association of LIFT helping to bridge public sector capital shortages for developing primary care surgeries. LIFT is negatively associated with inefficient procurement because it borrows finance from private banks, leaving public agencies paying high interest rates. The study shows that some contextual factors and mechanisms in LIFT play a major part in obstructing public staff from increasing procurement efficiency.


PPP’s ability to increase efficiency may be determined by contextual factors and mechanisms that restrict discretion over critical decisions by frontline public sector staff. Developing their capacity in monitoring PPP activities may make partnerships more efficient.

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This article draws on a public health research project hosted by the IHHD at UEL. We thank the study participants and the health officials for their support and cooperation during the study. We would also like to thank Dr Patrick Tobi, University of East London UK, and Dr Colin Thunhurst, Coventry University UK, for their insightful comments in preparing this paper.

Authors’ contribution

This manuscript is a joint effort between the authors (OM and KR) in design, data analysis and interpretation, and final review.

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Corresponding author

Correspondence to Krishna Regmi.

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The authors declare that there is no conflict of interest.

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Mudyarabikwa, O., Regmi, K. Public-private partnerships and efficiency in public procurement of primary healthcare infrastructure: a qualitative research in the NHS UK. J Public Health 24, 91–100 (2016).

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  • Efficiency
  • Public-private partnerships
  • Primary care buildings
  • LIFT
  • NHS
  • UK