Applied Research on the Effect of Risks on Public Health Building Projects' Performance: Empirical Results From Tanzania.

Public health building projects encounter several risks throughout the project phases. Using a quantitative research approach, the study assessed risks, the effects of risks encountered in public health building projects and proposed risk management practices to enhance project performance. Fifty-six projects were involved in the present study. SPSS 21.0 and Microsoft Excel 2021 were used to analyse data, including regression analysis, linearity test, and risk heat map development. The overall Cronbach's alpha for the collected data was 0.809, indicating that the data were reliable. The findings show that most risks were at a low level, leaving fewer at the medium level, including the contractor's delay in cash flow, price fluctuations due to inflation and pollution from construction waste. The risk heat map visualised all risks by indicating each identified risk's severity (impact) and likelihood (occurrence). Furthermore, the regression model for the effect of the assessed risks on the performance of public health-buildings showed that there was a negative effect on the performance for all the measured risks (technological risks, financial risks, design risks, client or owner risks, management risks, construction risks, political risks, environmental risks, procurement risks and other risks). However, for the significance of those effects, the analysis demonstrated greater significance (i.e., p < 0.001) for two categories of risk: financial risks and client/owners' risks. Subsequently, there was a significant effect on the performance of public health building projects from the other six categories of risks (technological risks [p = 0.041], design risks (p = 0.031), management risks (p = 0.012), construction risks (p = 0.024), environmental risks (p = 0.049) and procurement risks (p = 0.047). The effects and significance of the risk categories on each public building project performance indicator (cost, schedule and time) are presented using unstandardised beta coefficients and p values. In conclusion, the study has demonstrated that, despite the many risks and risk factors analysed in public health projects being rated at low to medium levels, they still exert a statistically significant negative influence on project performance-particularly financial and client-related risks-therefore necessitating continuous monitoring and proactive management. The adoption of structured and adaptive risk management practices is therefore essential to mitigate potential impacts and enhance project outcomes in terms of cost, time and quality.