This Background Paper on private provision and public-private partnerships aims to summarize the latest evidence in relation to the following: current status of PPPs and other forms of private provision, the evidence on impacts and costs of these arrangements, government roles and responsibilities and the enabling environment within which they function (see Appendix I). This paper also focuses on important policy questions and implications, including on how entire secondary systems can be strengthened through the reforms and lessons that emerge from managing a PPP. In doing so, it situates the framing and synthesis within a 'systems approach'. In part, this is visualized as evaluating policy, not only specifically, but with 'big picture' foci on the structure of the system within which different actors are influencing each other and within which these policies are being implemented.' In addition to reviewing the literature, the paper also presents three case studies (Kenya, Ghana and Uganda) that provide evidence relevant to these themes.