Preventive Maintenance and Project Sustainability: A Comparative Study of Public and Private Healthcare Service Organizations in Rivers State

Abstract

This study compares preventive maintenance practices and project sustainability outcomes between public and private healthcare service organisations in Rivers State, Nigeria. The study aims at examine how ownership type influences maintenance effectiveness. Using a qualitative multiple-case study design with a most similar systems basis for comparison, four hospitals (two public, two private) are compared across six criteria: maintenance frequency, budget allocation, documentation, training, equipment uptime, and perceived sustainability. Thematic comparison and cross-case analysis are used to analyse data from 24 interviews, document analyses, and observations. Private hospitals outperform public hospitals on all criteria: 84%–89% schedule adherence versus 38%–42%, and 3–5 annual generator failures versus 12–14. However, both sectors share common challenges: technician retention difficulties, poor fuel quality, and absence of long-term replacement funds. The comparison reveals that governance structures (procurement autonomy, budget flexibility, and accountability), not staff motivation or technical knowledge explain the performance gap. Theoretical implications offer a synthetic model integrating institutional theory, agency theory, and the resource-based view. Practical implications recommend decentralised procurement and maintenance imprest accounts for public hospitals.