Analysing Public-private Partnership Practices for Haemodialysis Services using Collaborative Governance Framework: A Qualitative Study

Introduction: Public-Private Partnerships (PPPs) are viewed as a solution for gaps in healthcare access, quality and affordability. Operational Cooperation (OC) is a common practice in haemodialysis services at regional hospitals in Indonesia. Aim: To analyse the implementation of OC for haemodialysis services at Regional Public Service Agency (RPSA) hospitals from the perspective of collaborative governance. Materials and Methods: This qualitative research utilised interviews, focus groups, and document analysis to explore the implementation of OC from a collaborative governance perspective. The study was conducted at Regional Hospitals, Regional Government Offices, the Ministry of Health, the Ministry of Home Affairs, Medical Device Companies, and the Association of Regional Hospitals of Indonesia from December 2021 to March 2022. Data were collected from indepth interviews and Focus Group Discussions (FGDs) with 15 informants, including policymakers, hospital managers, and partner companies. Other data included nine national-level and 29 regional-level policy documents. NVivo software was used for coding and to ensure data validity through triangulation. The parameters evaluated included system context, drivers, collaborative processes, and collaboration outcomes according to Emerson's collaborative governance framework. Results: The implementation of PPP for haemodialysis services at regional hospitals is driven by the need for these services and limited resources. Despite the incomplete policy framework, regional hospitals are taking steps to establish collaboration. Hospitals are streamlining operational process flows, creating a domino effect for other services. Even without a feasibility study, the implementation of PPP in regional hospitals in Indonesia has successfully addressed the community's need for access to haemodialysis services. Conclusion: The implementation of PPPs in the form of OC has successfully expanded access to haemodialysis services. However, challenges related to policy, human resources, and corruption pose significant obstacles to the implementation of OC.