Abate, Deribsa (PhD)Hurissa, Bikila2018-07-102023-11-042018-07-102023-11-042016-04http://etd.aau.edu.et/handle/123456789/7463This dissertation investigates the context within which PPP programs are taking place in the Ethiopian heath sector and examines the extent to which the theoretically appealing principles of PPPs, in general, and health service PPPs, in particular, are implemented in Ethiopia by taking the health sector of Addis Ababa as a particular case. The current status and constraints of the public health sector in terms of effectively addressing the health needs of citizens are investigated with the view of involving the private health sector in addressing the challenges of the public health sector. Within the framework of New Public Management, the study attempts to critically assess the policy and regulatory environment of health sector PPPs in Addis Ababa. Institutional capacity for managing health sector PPPs and the extent of risk sharing and mutual support in the existing public private collaborations in Addis Ababa’s health sector are also evaluated using the governance approach to PPPs as a conceptual framework. Mixed concurrent triangulation methods with qualitative emphasis were applied as a methodology to address the research questions. Primary data was collected through detailed structured questionnaire distributed to 242 purposively selected respondents in the health sector of the city. In addition to the 24 key informant interviews conducted one-to-one with health sector leaders, experts and experienced resource persons, secondary data was collected from various sources including FMoH, AAHB, USAID-PHSP, statistical reports and many other sources. The Data collected from multiple sources was analyzed using both qualitative and quantitative approaches giving due emphasis to the qualitative approach owing to the nature of the research questions under study. The study generally indicated that the status and realities in the existing health system in Ethiopia calls for collaboration with the private health sector which should be informed by appropriately designed PPP model. It was found out that while the public health sector in Ethiopia as well as Addis Ababa is severely resource-constrained, which calls for active involvement of non-state actors, the private health sector is not properly incorporated into the health system. This dissertation argues that the policies, legal and regulatory frameworks of the incumbent government and the Addis Ababa City Government in particular do not provide adequate room for the development of PPPs in the health service delivery. The study also discovered that the existing institutional framework and capacity of the public sector is not adequate and appropriate to manage both the existing and future PPP initiatives in the health sector of Addis Ababa. Although the existence of different types and levels of risks in PPP initiatives theoretically calls for fair risk sharing and government support to encourage the private partner, no meaningful support is currently provided by the government to the private sector in Addis Ababa. The government offers little or no practical support to the private health sector in the areas of subsidy, access to finance, tax relief and duty-free privileges and creation of demand for PPP delivered health services. Finally, the study recommends that the health sector of the city should be considered as a total system that effectively involves the role and contribution of the private health sector. The policy and regulatory environment of health sector PPPs should be formally established which, this dissertation argues, will in turn address the issues of institutional capacity, risk sharing and mutual support in PPP initiatives. As the body of knowledge in PPPs in general and health sector PPPs in particular is developing rapidly, this study also suggests further scholarly research to be conducted in the area of applying PPPs within the developmental state political context, promoting public interest goals in health sector PPPsen-USEthiopian health sectorPPPThesis