Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.
Department of Internal Medicine, Nephrology Unit, College of Health Science, Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Tigray, Ethiopia.
Health Policy Plan. 2020 Nov 20;35(9):1262-1267. doi: 10.1093/heapol/czaa085.
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.
我们的目的是通过考察在资源匮乏环境中提供血液透析服务的独特公私合作伙伴关系，探索公私合作伙伴关系是否能够成为获取高成本医疗服务的一种模式。该研究地点为埃塞俄比亚北部一所拥有 500 张病床的教学医院，服务范围覆盖 800 万人口。通过当地数据收集、观察和深入访谈，我们确定了建立公私合作伙伴关系的动力，描述了合作协议，报告了 6 年活动后的结果，并考察了该项目启动以来出现的挑战，包括资金可持续性。该公私合作伙伴关系于 2013 年成立，基于当地领导层的一项决定，即治疗急性肾损伤（AKI）患者是必要而非奢侈的。寻求了一家私人合作伙伴，以确保服务提供以及消耗品的可靠供应。医院的贡献包括基础设施、人员和维护成本的分担。该合作伙伴关系为 101 名 AKI 患者和 202 名慢性肾病患者提供了不间断的血液透析服务。前者（>50%治愈）主要由医院领导层采购的慈善捐款提供支持，而后者则是自费。当地大学和社区为慈善事业做出了贡献。利用率逐年增加。资金和后勤问题仍然存在。总之，该公私合作伙伴关系使埃塞俄比亚北部能够获得以前无法获得的救命治疗，并且可以作为血液透析提供的潜在扩大模式，更广泛地说，也可以作为资源匮乏环境中高成本医疗服务的模式。提供服务的道德承诺，以及持续的行政和社区参与，有助于其持续成功。大多数需要慢性血液透析的患者负担不起费用，以及依赖慈善捐款为 AKI 患者提供治疗，这对长期可持续性构成了挑战。
