Public-Private partnership (PPP) and health service delivery in Malawi: The case of Christian Health Association of Malawi (CHAM) facilities in Mzimba district.

Background: PPPs are crucial in addressing healthcare challenges in Malawi, a low-income country. These partnerships, including those with CHAM, help improve access to health services by complementing the public sector, especially in areas with inadequate infrastructure and limited healthcare resources. Method: This study employed qualitative methods, including interviews, focus groups, and document analysis, to investigate the impact of PPP on healthcare infrastructure and access. Purposive and snowball sampling selected 30 interviewees and 20 focus groups. Thematic analysis revealed insights into PPP dynamics, resource allocation, stakeholder interactions, and socio-economic factors in healthcare. Results: Government officials recognise PPPs' positive impact on healthcare access, especially in rural areas, but raise concerns about sustainability due to policy inconsistencies, financial instability, and service duplication. CHAM and district health professionals highlight delayed payments, cost management, and infrastructure issues. While PPPs increase healthcare utilisation, challenges like drug shortages, staff shortages, and financial strain threaten long-term sustainability without better coordination. Conclusion: This study explores PPPs in Malawi's health sector, focusing on healthcare quality, efficiency, equity, and access. It identifies challenges like mistrust, misaligned incentives, data inflation, contract renegotiations, staffing shortages, and infrastructure issues. The study emphasises improving transparency, aligning incentives, and addressing sustainability through better resource management and financing.