to performanceindicators, started showing discontentment around political support andinappropriate risk assessment, thus threaten the long-term sustainability ofthe partnership. Indeed, despite some issues, the Hospital doSuburbio PPP can be referred as innovative, since its financial arrangementsinclude payments to the private partner that is linked to key performanceindicators, based on quantitative and qualitative targets, therefore creatingincentives for high levels of performance. As a means to guarantee long-termviability for the partnership, these arrangements has been focused on the possibilityof obtaining financing for the project by minimizing the governments creditrisk, which directly benefits the private sector.Finally, joint initiatives have beenimplemented to address these issues, indicating that the partners involved inthis first healthcare PPP in Brazil, are becoming gradually more aware of theimportance of commitment and mutual support to build an ideal public-privatepartnership, where, public and private interests are transformed into benefitsand opportunities to achieve public outcomes.RecommendationsBased on the analysis above it is recommendedthat a horizontal communication plan takes place in order to stimulate staff inpromoting equitable access to quality healthcare for the community, by sharingwith their managers, issues that could affect their commitment to the project.Besides, a formal external communication plan is also recommended, as it mayhelp addressing reputational threats for the project as well as assist managingissues around equity and access considerations. . Managers, on the other hand,may have to concentrate in finding the best means of linking public values tothe public interest. Benoit(1995) states that when anorganizations reputation is threatened, whether or not the accusations aretrue is irrelevant, as the public perception is all that is needed to damageits image, calling for urgent actions.Moreover, due to increasing concerns aroundcontractual adjustments, the parties may focus on improving theirrelationships, as a weak interconnection may represent high strategic risk forthe project (Landells 2013).Further, managing stakeholders participationand involvement may help clarifying the level of synergy as well as identifyingweaknesses or strengths of relationships and interpersonal connections. Accordingto Landells (2013) organizations that share value with their stakeholders andinvolve them in their strategic decisions, could gain unmeasurable benefits, byencouraging knowledgesharing to generate both economic and social values.Moreover, rigorous process of riskidentification, assessment, analysis, and mitigation are recommended to allow amore effective risk allocation of this PPP. Thus, when risks are understood andtheir consequences are measured, decisions can be made to allocate risks(Flinders 2005) in a manner that minimizes costs, promotes project goals, andultimately aligns stakeholders with the needs and objectives of the partnership(Hodge & Greve2007). Furthermore, based on theproposition that optimal risk sharing with the private partner delivers bettervalue for money for the public sector and ultimately for the end user, the aimis not maximize risk transfer but optimize it (Delmon 2009).ConclusionPublic Private Partnership is graduallybecoming a universal, adopted form of procurement to improve performance ofhealth systems worldwide, wherein the public and private sectors collaborate todeliver better health services, improving efficiency, quality, and innovationof public health networks. According to(PPP Development stage-establishing principles2012), countries with differing government andlegislative frameworks sign an impressive number of common features associatedwith successful implementation of PPPprograms, however there is no defined solution to address many issues in the healthsystem in Brazil and around the world. If