Public–Private Partnerships and Oral Healthcare Delivery in Ghana: Revisiting Access, Equity and Efficiency

Abstract

This paper revisits a qualitative study of public–private partnership (PPP) in Ghana's health sector, using oral healthcare as the case. The original study examined whether greater private-sector participation could improve access, equity and efficiency in oral healthcare and considered the factors that influenced private investment. The study was undertaken in 2016, at a time when Ghana's PPP arrangements were guided mainly by the 2011 National Policy on Public Private Partnerships and when a comprehensive statutory framework was still being developed. The original evidence showed that, although PPP activity was present in the wider health sector, its contribution to oral healthcare was limited. Respondents pointed to inadequate funding, shortages of facilities and equipment, insufficient and unevenly distributed personnel, weak coordination, limited private-sector engagement, inadequate PPP capacity and weaknesses in monitoring and information systems. Secondary data used in the study also showed marked regional differences in the distribution of dental facilities and dental surgeons. This paper retains those findings as historical evidence and does not present them as a measure of the situation in 2026. It places them alongside subsequent developments, particularly Ghana's Public Private Partnership Act, 2020 (Act 1039), and the World Health Organization's renewed emphasis on oral health as part of universal health coverage. The paper argues that the central issue has consequently shifted. The policy question is no longer simply whether Ghana should encourage private participation in oral healthcare, but how such participation can be structured so that private investment complements public responsibility and produces measurable gains in access, equity, quality and efficiency. The paper concludes that PPP can make a useful contribution, but only where project preparation, risk allocation, regulation, workforce planning, monitoring and equity considerations are built into the arrangement from the outset.