The Governance and Financial Architecture of Laboratory Public-Private Partnership: Experience of A Tertiary Health Care Facility in Northern Nigeria

Abstract

ABSTRACTThe structural failure of health-care Public-Private Partnerships (PPPs) in developing nations is frequently attributed toweak governance, ambiguous risk allocation, and manual financial leakages rather than clinical incapacity. To analyze the governance framework and financial architecture of the strictly institutional revenue-sharing laboratory PPP at Barau Dikko Teaching Hospital (BDTH), Kaduna, Nigeria. This paper utilizes a structural case-study methodology to evaluate the administrative protocols, electronic financial routing, and risk-mitigation frameworks governing the BDTH laboratory contract. Baseline datasets from pre-implementation (2017) and post-implementation (2025) cycles were analyzed to measure fiscal transparency and accountability. The architecture successfully eliminated individual-level financial friction by implementing a strictly institutional "Clean Split" revenue system integrated into the hospital's Electronic Medical Records (EMR) central billing gate. Operational risk was entirely transferred to the private partners, resulting in zero public capital expenditure (CAPEX) for technical failures, while the hospital secured a steady 35% net share of laboratory profits for broader facility reinvestment. Joint monthly administrative reconciliation minimized accounting discrepancies to <1%.A rigid governance model that completely decouples individual staff incentives from the core institutional revenue split minimizes bureaucratic interference, prevents leakages, and offers a transparent, politically insulated model for sustainable tertiary health financing.