Mediation Effect of Relational Norms on Interplay between Public-Private Partnership Management and Performance of Managed Equipment Services Project in Kenya

Healthcare projects are essential for improving accessibility and quality of healthcare, yet they often face obstacles such as delays, budget overruns, and compromised quality. Public-private partnerships (PPPs) have been introduced to address these challenges in project implementation. In Kenya, the Managed Equipment Services (MES) project, implemented through a PPP model, encountered significant difficulties, raising questions about the effective management of various project aspects. This study examined the mediation influence of relational norms on the relationship between PPP management and the performance of the MES project in Kenya. The study is grounded in network and stakeholder theories. The target population comprised 250 participants, including hospital managers, procurement officials, hospital committees/boards of management, and county executive committees of the health department from 8 counties. Using stratified random sampling, a sample size of 155 respondents was selected for this mixed-methods research. 112 respondents were reached, translating to a 73% response rate, which was deemed adequate for further analysis. Findings indicate that PPP management process had a significant direct effect on the mediator, relational norms (b = 0.79, p < .001) and on the performance of the MES project (b = 0.72, p <. 001), highlighting the importance of managing various aspects of a PPP arrangement to achieve positive project outcomes. However, relational norms do not significantly impact project performance, nor do they mediate the relationship between PPP management and project performance. These results underscore the critical role of practitioners in ensuring effective contract management, building institutional capacity for managing PPPs, and engaging stakeholders. Policymakers should strive to enhance the environments within which PPPs operate to achieve optimal project outcomes. This study advances the theoretical understanding of the interplay between PPP management and project performance, particularly in resource-constrained settings.