A public-private partnership for dialysis provision in Ethiopia: a model for high-cost care in low-resource settings.

Our purpose was to explore whether private-public partnerships (PPPs) can serve as a model for access to high-cost care in low-resource settings by examining a unique PPP providing haemodialysis services in a remote setting, investigating challenges and enablers. The study setting is a 500-bed teaching hospital serving a catchment population of 8 million in Northern Ethiopia. Based on local data collection, observation and in-depth interviews, we identified the impetus for the PPP, described the partnership agreement, reported outcomes after 6 years of activity and examined challenges that have arisen since the programme's inception, including funding sustainability. The PPP was established in 2013 based on a decision by local leadership that treatment of patients with acute kidney injury (AKI) is a necessity rather than a luxury. A private partner was sought who could ensure service delivery as well as a reliable supply of consumables. The hospital contributions included infrastructure, personnel and sharing of maintenance costs. The partnership has facilitated uninterrupted haemodialysis service to 101 patients with AKI and 202 with chronic kidney disease. The former (>50% cured) were mainly supported by charitable donations procured by the hospital's leadership, while the latter were self-funded. The local university and community contributed to the charity. Utilization has increased yearly. Funding and logistical issues remain. In conclusion, this PPP enabled access to previously unavailable lifesaving care in Northern Ethiopia and could serve as a model for potential scale-up for haemodialysis provision in particular, and more broadly, high-cost care in low-resource settings. An ethical commitment to provide the service, combined with ongoing administrative and community involvement has contributed to its sustained success. Lack of affordability for most patients requiring chronic haemodialysis and reliance on charitable donations for treatment of patients with AKI pose challenges to long-term sustainability.