Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Indonesia.
Soc Sci Med. 2011 Nov;73(9):1386-94. doi: 10.1016/j.socscimed.2011.08.017. Epub 2011 Sep 10.
Public-private partnerships (PPP) for improving the health of populations are currently attracting attention in many countries with limited resources. The Public-Private Mix for Tuberculosis Control is an example of an internationally supported PPP that aims to engage all providers, including hospitals, to implement standardized diagnosis and treatment. This paper explores mainly the local actors' views and experiences of the process of PPP in delivering TB care in hospitals in Yogyakarta Province, Indonesia. The study used a qualitative research design. By maximum variation sampling, 33 informants were purposefully selected. The informants were involved in the Public-Private Mix for Tuberculosis Control in Yogyakarta Province. Data were collected during 2008-2009 by in-depth interview and analyzed using content analysis techniques. Triangulation, reference group checking and peer debriefing were conducted to improve the trustworthiness of the data. This analysis showed that the process of partnership was dynamic. In the early phase of partnership, the National Tuberculosis Program and hospital actors perceived barriers to interaction such as low enthusiasm, lack of confidence, mistrust and inequality of relationships. The existence of an intermediary actor was important for approaching the National Tuberculosis Program and hospitals. After intensive interactions, compromises and acceptance were reached among the actors and even enabled the growth of mutual respect and feelings of programme ownership. However, the partnership faced declining interactions when faced with scarce resources and weak governance. The strategies, power and interactions between actors are important aspects of the process of collaboration. We conclude that good partnership governance is needed for the partnership to be effective and sustainable.
公私合作伙伴关系（PPP）在资源有限的许多国家中，目前正吸引着人们的关注。《结核病控制公私混合模式》就是一个得到国际支持的 PPP 范例，旨在使包括医院在内的所有提供者参与进来，实施标准化的诊断和治疗。本文主要探讨了印度尼西亚日惹省医院提供结核病护理的公私合作伙伴关系进程中，当地行为者的观点和经验。本研究采用了定性研究设计。通过最大变异抽样，有目的选择了 33 名知情者。这些知情者参与了日惹省的《结核病控制公私混合模式》。2008-2009 年期间，通过深入访谈收集数据，并使用内容分析技术进行分析。三角检验、参考组检查和同行讨论用于提高数据的可信度。该分析表明，合作进程是动态的。在伙伴关系的早期阶段，国家结核病规划和医院行为者认为存在互动障碍，如积极性低、缺乏信心、不信任和关系不平等。中间行为者的存在对于接近国家结核病规划和医院是很重要的。经过密集的互动、妥协和接受，行为者之间甚至建立了相互尊重和对规划的归属感。然而，当面临资源匮乏和治理薄弱时，伙伴关系面临着互动减少的问题。行为者的策略、权力和互动是合作进程的重要方面。我们的结论是，良好的伙伴关系治理对于伙伴关系的有效性和可持续性是必要的。
