An Assessment Of User Satisfaction With Public Private Partnership (PPP) Projects

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An Assessment Of User Satisfaction With Public Private Partnership (PPP) Projects


Government at all levels is forced to prioritize and restrict public expenditures due to budget deficits and the inefficient management of large infrastructure projects. Due to the shortage of resources for healthcare delivery leading to decline in the quality of care, there is considerable interest in PPP initiatives for the provision of finance and management of health care to ordinary people. The PPP option due to its complexities has led to some projects failure leading to wastage of huge resources and time. Studies have shown that majority of these project failures are as a result of public opposition leading to outright cancellation of the projects. Due to the lack of empirical studies on user satisfaction with PPP projects in Nigeria, this study assessed the satisfaction of users of PPP projects from both employees and patients’ perspectives of two university teaching hospitals in Nigeria.

Chapter One

1.0 Introduction

1.1 Background to the Study

Endemic budget deficits and the inefficient management of large infrastructure projects and services within the public sector are a few reasons why the traditional procurement method of governments funding infrastructure projects through fiscal budgets is increasingly considered unviable (Alitheia, 2010). In the past few decades, developed economies (e.g. the United Kingdom) have modeled a variety of public private partnerships (PPPs) for the delivery of infrastructure, public utilities and large services projects, achieving significant successes from harnessing the competences and expertise from both sectors. Emerging markets such as India and South Africa are also recording successes using tried and tested PPP templates to create, expand and modernise infrastructure (Workshop Report, 2008). It is apparent that these dynamic partnerships between the public and private sectors have become inevitable across the globe. Nigeria’s infrastructure challenge is huge. Reports suggest that the country requires between US$12 billion to $15 billion annually for the next six years to meet the infrastructure requirements (Izuwah, 2010). The World Bank estimates that every 1% of (government) funds invested in infrastructure leads to an equivalent 1% increase in gross domestic product (GDP). Nigeria has not had a consistent history of investment in infrastructure; however, government agenda show that infrastructure development is gaining momentum. In the past 10 years, over 25 major infrastructure projects have been rolled out through PPPs. The Federal Government of Nigeria, state and local government areas (LGAs) have contributed over N10 trillion ($66 billion) to these. However, the total investment required to meet the vision 2020 target for infrastructure projects is N32 trillion ($210 billion) (Izuwah, 2010).It has become evident that the government alone cannot muster the resources (finance and expertise) to meet this need and the involvement of the private sector is not just desirous, but necessary. Governments at all levels are forced to prioritize and restrict public expenditures to health. Leading to some government (owned and operated) hospitals in dire financial state and having shortage of resources for health care delivery. These include meeting patients’ expectations in terms of demand for modern medical facilities; the need to provide care for an aging population; improve quality of care; and also invest in expensive medical technology. Therefore, there has been considerable interest in Public Private Partnership (PPP) initiatives in the health sector in light of the challenges the public sector is facing in financing, managing and providing health care to ordinary people (Alitheia, 2010; Asoka, 2014; Anyaehie, Nwakoby, Chikwendu, Dim, Uguru, Oluka and Ogugua, 2014). The concept of Public Private Partnership (PPP) is underpinned by a government’s desire to resolve financial constraints by joining forces with the private sector to increase efficiency and effectiveness in the delivery of public services and facilities, whilst ensuring better risk management and increasing certainty of outcomes. PPPs are also often aimed at accelerating economic growth, development and infrastructure delivery; and achieving quality service delivery and good governance (Akintoye, 2006), especially in developing countries. The structure of PPPs are built around two main types – in one case, the cost of providing the facility/service is borne exclusively by the users of the service and in the other, the private company invests alongside government to provide a service and the cost of providing the service is wholly or partly carried by the government (Alitheia, 2010). Overwhelming evidence in the past 50 years of the use of PPP structures indicate that these arrangements are relatively cost efficient, foster best practices for sharing and transfer of risk, assure superior value for money, saves time, streamline contracts and simplifies procurements, facilitates innovation through public-private cohesion, eradicates bureaucratic and political processes, encourages technology transfer and acts as vehicles which adopt life cycle approaches to delivering infrastructure and services (Alitheia, 2010). PPP is rapidly becoming the preferred method for public procurement for delivering infrastructure projects throughout the world, thus gaining importance as a vehicle to finance much-needed public infrastructure across the globe (Gunnigan and Rajput, 2010),despite the conspicuous absence of systematic evaluations of quality improvement and/or customer satisfaction in the PPP context (Jamali, 2007), thereby leading to a number of unsuccessful projects reported as a result of users dissatisfaction (Levy, 1996; El-Gohary, Osman and El-Diraby, 2006; Gunnigan and Rajput, 2010). The fierce competition in the wake of globalization is pushing companies to improve continuously in order to stay in the business. It is a very challenging task to meet the ever-increasing and diversified customer (user) requirements. To tackle this challenge effectively and efficiently, the alignment of the business processes with the customer requirements is vital (Jochem, Menrath and Landgraf, 2010). El-Gohary et al. (2006) stated that stakeholders are individuals or organisations that are either affected by or affect the development of the project. Therefore, capturing their input is a crucial component of the project development process. It is important to gauge stakeholder opinion and concerns to better facilitate the development of a project that will meet the needs of those stakeholders. Tangkitsiri, Ogunlana, Oyegoke and Oladokun (2013) opined that customer satisfaction begins when the customers’ service expectations are met i.e. when the level of service provided by the service provider meets the expectations of the users. The importance of customer satisfaction in a PPP project is based on the assumption that the private sector can be more efficient in service delivery than the public sector. And also, if citizens are now being expected to pay for services they have been delivered free-of-charge in the past; they should have the right to expect better quality services. In order to measure levels of stakeholders’ satisfaction, it is necessary to study the real benefits from existing projects (Tangkitsiri et al., 2013) that is, project monitoring. They further described Project monitoring as a tracking process, comparing actual outcome to predicted outcome, analysing impact, and making appropriate adjustments. Positive attitudes towards bringing users’ ideas into the product development process of design, delivery and after-care can change the whole situation. Innovative approaches such as this can lead to new and more user-friendly forms of products and services which reflect user requirements. Specific requirements of end-users have to be captured in order to achieve a maximum level of customer satisfaction, which ultimately will contribute to the success of the business. Therefore, we need to know who the users are, what their requirements are and how they can be involved in the product development and design process. Various users need to be part of not only the image and vision of the project, but also the physical design, which should reflect the way they work. The new culture, images and visions need to be fully shared among all the stakeholders during the consultation, rather than only after the implementation (Ozaki and Yoshida, 2007). El-Gohary et al. (2006) opined that PPP infrastructure projects vary in the level of contention that they raise among stakeholders. Moreover, the involvement of the private sector – with its profit-making mindset – usually raises concerns that are not usually likely when the asset is publicly owned (e.g. quality assurance, safety, rate hikes, transfer agreement, etc.) There are many studies that have been carried out in various aspects of PPP projects both nationally and internationally. Some of these studies have shown that the dissatisfaction of users of some PPP projects have led to the cancellation of some projects which has led to loss of time and resources (Levy, 1996; El-Gohary et al., 2006; Gunnigan and Rajput,2010).

1.2 Statement of the Problem

Alienation of actual users of the asset and lack of public support have increased project costs, delayed project completion, and ultimately jeopardized the sustainability of public services. Lack of communication and poor stakeholder management could become deal breakers: a predominant reason for this is lack of effective communication with the principal stakeholders of the project (Levy, 1996; El-Gohary et al., 2006; Asian Development Bank, 2007; Gunnigan and Rajput, 2010). Users are critical to the sustainability of PPP projects they need to communicate their ability and willingness to pay for the service, express priorities for quality and level of service and also identify existing strengths and weaknesses in services provided (Inter-American Development Bank, 2014) Alrubaiee and Alkaa‟ida (2011) recommended that analysis of service quality should enable management to better direct resources to improve hospital operations that will impact on customer perceptions of service quality. They also recommended that the perception of employees on the Hospital and the services need to be evaluated. They speculated that the perceptions of patients might not match the perceptions of employees. They also said that hospitals need to have a commonly held quality model to guide employees in their continuous quality improvement efforts. However, few studies exist that measures the success of existing PPP projects in Nigeria from the users‟ perspective. Amissah (2013) reported that studies in the area of customer satisfaction and quality have been carried out mostly in developed countries (King and Cichy, 2006; Faullant and Matzler, 2008; Markovi´c and Raspor, 2010; Alrubaiee and Alkaa‟ida, 2011) leaving developing countries such as Ghana and Nigeria with limited empirical studies. Therefore, a key approach to success is to understand the different aspects of service quality and satisfaction and the interactions of these aspects. This study seeks to fill the gap in service quality and user satisfaction knowledge in Nigeria and provide useful information for hospital managers as well as private partners to improve on the PPP projects

1.3 Objective of the Study

The objectives of the study are;

  1. Identify parameters for assessing satisfaction of PPP facilities and services
  2. Assess the level of users’ satisfaction with PPP facilities and services in selected UTHs
  3. Evaluate the relationship between quality dimensions and satisfaction.

1.4 Research Hypotheses

For the successful completion of the study, the following research hypotheses were formulated by the researcher;

  1. H0: there are no parameters for assessing satisfaction of PPP facilities and services
    H1: there are parameters for assessing satisfaction of PPP facilities and services
  2. H02: there is no relationship between quality dimensions and satisfaction.
    H2: there is relationship between quality dimensions and satisfaction.

1.5 Significance of the Study

This study will give a clear insight on an assessment of users satisfaction with public private partnership project. The study will be beneficial to student, government and private organization and the general public. It will also serve as a reference to other researchers that will embark on this topic.

1.6 Scope and Limitation of the Study

The study covered the perception of users’ of PPP projects in two government Hospitals situated in Ibadan (Oyo state) and Lagos (Lagos state) using product- and service-quality dimensions for the assessment of the facilities and services rendered. The quality dimensions were used to determine the level of satisfaction of the users of this section of the hospital due to the fact that previous studies carried out in this domain have been conducted successfully. ). The researcher encounters some constrain which limited the scope of the study;

a) Availability of Research Material:

The research material available to the researcher is insufficient, thereby limiting the study

b) Time:

The time frame allocated to the study does not enhance wider coverage as the researcher has to combine other academic activities and examinations with the study.

c) Organizational Privacy:

Limited Access to the selected auditing firm makes it difficult to get all the necessary and required information concerning the activities.

1.7 Definition of Terms


Confident acceptance of something as satisfactory, dependable, true, etc. reparation or compensation, as for a wrong or injury. the opportunity to redress or right a wrong, as by a duel. payment or discharge, as of a debt or obligation


In public relations and communication science, publics are groups of individual people, and the public (a.k.a. the general public) is the totality of such groupings.


Belonging to or for the use of one particular person or group of people only.


A partnership is an arrangement where parties, known as partners, agree to cooperate to advance their mutual interests. The partners in a partnership may be individuals, businesses, interest-based organizations, schools, governments or combinations.

1.8 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows

  • Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
  • Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
  • Chapter three deals on the research design and methodology adopted in the study.
  • Chapter four concentrate on the data collection and analysis and presentation of finding.
  • Chapter five gives summary, conclusion, and recommendations made of the study

Chapter Five

Summary, Conclusion and Recommendation

5.1 Introduction

It is important to ascertain that the objective of this study was to ascertain an assessment of user’s satisfaction with public private partnership project

In the preceding chapter, the relevant data collected for this study were presented, critically analyzed and appropriate interpretation given. In this chapter, certain recommendations made which in the opinion of the researcher will be of benefits in addressing the challenges of an assessment of user’s satisfaction with public private partnership project

5.2 Summary

This study was on an assessment of user’s satisfaction with public private partnership project. Three objectives were raised which included: Identify parameters for assessing satisfaction of PPP facilities and services, assess the level of users’ satisfaction with PPP facilities and services in selected UTHs, evaluate the relationship between quality dimensions and satisfaction. In line with these objectives, two research hypotheses were formulated and two null hypotheses were posited. The total population for the study is 200 staff of university teaching hospital Lagos and Oyo state. The researcher used questionnaires as the instrument for the data collection. Descriptive Survey research design was adopted for this study. A total of 133 respondents made up doctors, nurses, lab technicians and junior staff was used for the study. The data collected were presented in tables and analyzed using simple percentages and frequencies

5.3 Conclusion

The study has attempted to shed some light on the satisfaction of users with the quality of facilities and services provided for two PPP projects from a conceptual and practical perspective. It concludes that the satisfaction of users of a particular facility as in this 72 case PPP projects, is very important and should be considered seriously. Generally, the overall perception of users‟ satisfaction of these projects as obtained by this study is that the healthcare quality is „good‟. However, the patients rated the competence of staff members a little bit higher than other factors indicating that their satisfaction levels were not the same for all the factors evaluated. It also indicates that the patients are quite confident in the healthcare service providers‟ reliability and expertise. On the other hand, the employees indicated lower levels of satisfaction as compared to the patients, indicating that they may have higher expectation from PPP projects than they are experiencing. Therefore, management at all levels are required to note the areas with low ratings and come up with improvement strategies to increase their quality levels. Also they should carry out user satisfaction surveys constantly to ensure that quality is not only maintained but improved upon regularly to ensure good productivity and customer satisfaction.

5.4 Recommendation

  1. In terms of the methodology used for the study, attention should be paid to the socio-demographic distributions of respondents to avoid the results being skewed to one direction.
  2. The structures need to be looked into due to the fact that both employees and patients had their lowest ratings on the appearance and functionality of the facilities.
  3. Also, the employees need to be motivated; their overall ratings were quite low generally which might begin to affect their output which was well rated by the patients.
  4. Lastly, the customized questions used for the research can be used periodically to assess the satisfaction levels of users of PPP projects.

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