CBPM Conference 2026 · Vol. 2026, Issue 1

Sustainable Public-Private Partnerships for Effective Management of South Africa’s Public Health Infrastructure

Mello, P. and Tshehla, M.F.

Keywords: Public-Private Partnerships, sustainability, public health infrastructure, governance

Abstract

South Africa’s public health system continues to face persistent challenges associated with deteriorating infrastructure and limited capital investment. These challenges have contributed to overcrowded healthcare facilities and inequitable service delivery across many parts of the country. While the public sector provides healthcare services to most of the population, the private healthcare sector serves a smaller proportion of citizens and has comparatively greater access to resources and infrastructure. To address these constraints, Public-Private Partnerships (PPPs) have been increasingly used to leverage private sector expertise, resources, and efficiency in delivering infrastructure and public services. Despite their potential, PPP outcomes have been uneven, often hindered by complex stakeholder dynamics, fragmented policy frameworks, weak governance, inadequate risksharing, and insufficient long-term planning. While some projects have delivered high-quality facilities, others have stalled due to mismanagement or conflicting priorities, highlighting a critical gap in sustainable implementation. This study acknowledges that the sustainability of healthcare PPPs extends beyond the successful delivery of physical infrastructure and includes the ability of such infrastructure to support accessible, efficient, and quality healthcare service delivery over time. Existing literature tends to examine governance, sustainability, and stakeholder management as separate concepts, with limited focus on how these factors collectively influence public health infrastructure management within the South African context. This study employs a systematic literature review (SLR) guided by the PRISMA framework and analyses 28 selected studies to examine how sustainability can be integrated into all strategic phases of PPPs, from design and financing to governance and post-project adaptation, to improve infrastructure management and service quality in the public health sector. The findings reveal that fragmented governance structures, stakeholder misalignment, and coordination challenges are among the key barriers affecting the long-term sustainability of healthcare PPPs. The findings provide insights for developing effective, long-term, sustainable PPP models that enhance public health infrastructure resilience and service delivery. This study contributes to the body of knowledge by bringing together previously fragmented literature on healthcare PPPs, emphasising the interconnected role of governance, stakeholder engagement, and sustainability in developing the effective management of public health infrastructure in South Africa.