This research deals with the development of framework for assessing a joint venture (JV) model as of outsourcing relationship that that can be used to lead to process improvements in the healthcare system in Low and Middle-Income Countries (LMIC). A range of articles were reviewed to  investigate different concepts relevant to the research toward exploring the factors affecting the successful implementation of a JV model as outsourcing relationship for healthcare services in LMICs. This was followed by three stages of semi-structured and structured interviews and group discussions and survey questionnaires, with healthcare providers, policy makers, vendors, consultants and other stakeholders from LMIC. The results support test of proposition and guide the validation process by using interpretive structural modelling (ISM) to allow the development of the implementation strategy framework. The research finding indicates that the healthcare system in the LMICs must incorporate JV in implementing outsourcing that addresses process improvement and needed knowledge transfer. One of the practical implications, the improvement of the LMIC healthcare setting require partnership with all major stakeholders and technology providers to explore further beyond the traditional organizational boundary as the framework for analysis. The findings presented in this research, help to support views on expanding the use of JV as an approach for improvement in LMIC healthcare system based on the conceptual framework in relation to the key identified factors. In addition, the researchers can use this model as a foundational framework for further research.\ud
Key words: Joint venture, outsourcing, healthcare, low and middle-income countries, developing countries