Ethiopia’s first health-sector public–private partnership: a qualitative evaluation of the design, procurement, and early implementation of an integrated diagnostic center
5 affiliations
- 1International Institute for Primary Health Care- Ethiopia, Addis Ababa, Ethiopia. [email protected].
- 2International Institute for Primary Health Care- Ethiopia, Addis Ababa, Ethiopia.
- 3Ministry of Health, Addis Ababa, Ethiopia.
- 4Clinton Health Access Initiative (CHAI), Ethiopia Country Office, Addis Ababa, Ethiopia.
- 5Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Abstract
Background Public–private partnerships (PPPs) are increasingly used to strengthen health systems in resource-constrained settings. In Ethiopia, PPPs in the health sector remain limited, with the Integrated Diagnostic Center (IDC) representing the first pilot initiative aimed at improving access to high-quality diagnostic services. Objective This study aimed to evaluate the design, procurement, and contracting processes of the IDC PPP in Ethiopia and to generate lessons for future PPP development. Methods A qualitative descriptive study was conducted using key informant interviews with nine stakeholders from government institutions, private sector partners, and implementing facilities. Participants were selected through purposive and snowball sampling techniques based on their knowledge and involvement in the program. Interviews were audio-recorded, transcribed verbatim and analyzed using thematic analysis with the support of Atlas.ti software. Results Five major themes emerged: (1) project design, procurement, and contracting; (2) financing and risk-sharing mechanisms; (3) service delivery and system readiness; (4) implementation challenges; and (5) recommendations and scalability. The IDC PPP follows a Design–Build–Finance–Operate–Transfer (DBFOT) model, with predominantly private-sector financing complemented by public in-kind contributions. The project underwent extensive iterative processes across feasibility assessment, procurement, and contractual design, including adaptation of qualification criteria following an initial unsuccessful procurement round. Key challenges included regulatory gaps, limited institutional capacity, financial constraints, and external shocks such as COVID-19 and political instability. Risk mitigation mechanisms, including minimum revenue guarantees and revenue-sharing arrangements, were incorporated to address financial and operational uncertainties. Recommendations emphasized strengthening regulatory frameworks, enhancing institutional capacity, improving procurement alignment with market conditions, and integrating digital and operational systems. Scalability considerations further positioned the IDC as a model for potential expansion within the health system. Conclusion The IDC PPP illustrates how health-sector PPPs can be developed in a resource-constrained setting through adaptive and iterative processes, despite significant regulatory, institutional, and financial constraints. The study highlights the importance of aligning procurement design with market capacity, strengthening institutional coordination, and embedding risk mitigation mechanisms in shaping PPP structures within evolving health systems.
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BibTeX
@article{gessese2026ethiopias,
title = {{Ethiopia’s first health-sector public–private partnership: a qualitative evaluation of the design, procurement, and early implementation of an integrated diagnostic center}},
author = {Rewina Tilahun Gessese and Getnet Mitike Kassie and Tsegereda Abebe Andargie and Mohammed Abseno and Mazengia Ayalew Mekonnen and Abdissa Kabeto and Jennifer Applegate and Sara Bennett},
journal = {BMC Health Services Research},
year = {2026},
month = jul,
doi = {10.1186/s12913-026-15207-5},
url = {https://doi.org/10.1186/s12913-026-15207-5},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Ethiopia’s first health-sector public–private partnership: a qualitative evaluation of the design, procurement, and early implementation of an integrated diagnostic center
AU - Rewina Tilahun Gessese
AU - Getnet Mitike Kassie
AU - Tsegereda Abebe Andargie
AU - Mohammed Abseno
AU - Mazengia Ayalew Mekonnen
AU - Abdissa Kabeto
AU - Jennifer Applegate
AU - Sara Bennett
PY - 2026
DA - 2026/07/01
JO - BMC Health Services Research
DO - 10.1186/s12913-026-15207-5
UR - https://doi.org/10.1186/s12913-026-15207-5
AB - Background Public–private partnerships (PPPs) are increasingly used to strengthen health systems in resource-constrained settings. In Ethiopia, PPPs in the health sector remain limited, with the Integrated Diagnostic Center (IDC) representing the first pilot initiative aimed at improving access to high-quality diagnostic services. Objective This study aimed to evaluate the design, procurement, and contracting processes of the IDC PPP in Ethiopia and to generate lessons for future PPP development. Methods A qualitative descriptive study was conducted using key informant interviews with nine stakeholders from government institutions, private sector partners, and implementing facilities. Participants were selected through purposive and snowball sampling techniques based on their knowledge and involvement in the program. Interviews were audio-recorded, transcribed verbatim and analyzed using thematic analysis with the support of Atlas.ti software. Results Five major themes emerged: (1) project design, procurement, and contracting; (2) financing and risk-sharing mechanisms; (3) service delivery and system readiness; (4) implementation challenges; and (5) recommendations and scalability. The IDC PPP follows a Design–Build–Finance–Operate–Transfer (DBFOT) model, with predominantly private-sector financing complemented by public in-kind contributions. The project underwent extensive iterative processes across feasibility assessment, procurement, and contractual design, including adaptation of qualification criteria following an initial unsuccessful procurement round. Key challenges included regulatory gaps, limited institutional capacity, financial constraints, and external shocks such as COVID-19 and political instability. Risk mitigation mechanisms, including minimum revenue guarantees and revenue-sharing arrangements, were incorporated to address financial and operational uncertainties. Recommendations emphasized strengthening regulatory frameworks, enhancing institutional capacity, improving procurement alignment with market conditions, and integrating digital and operational systems. Scalability considerations further positioned the IDC as a model for potential expansion within the health system. Conclusion The IDC PPP illustrates how health-sector PPPs can be developed in a resource-constrained setting through adaptive and iterative processes, despite significant regulatory, institutional, and financial constraints. The study highlights the importance of aligning procurement design with market capacity, strengthening institutional coordination, and embedding risk mitigation mechanisms in shaping PPP structures within evolving health systems.
SN - 1472-6963
ER -