Purpose: The study explored stakeholder perceptions of Public–Private Partnerships (PPPs) in Nigeria’s healthcare sector, with particular attention to opportunities, challenges and trust-building mechanisms. The aim was to assess how diverse stakeholders including policymakers, private investors, healthcare professionals and community representatives understand and respond to PPP initiatives.

Methodology/Design: The study adopted a qualitative research design underpinned by an interpretivist paradigm. A purposive sampling technique was used to select 25 participants directly involved in or affected by PPP projects. Data were collected through semi-structured interviews and analyzed thematically to capture patterns across stakeholder groups.

Findings: Results indicated that stakeholders perceived PPPs as creating vital opportunities for resource mobilization, improved healthcare infrastructure, and expanded service access. However, governance weaknesses, policy inconsistency, corruption, and limited technical capacity were identified as key challenges hindering effective implementation. Trust emerged as central to PPP sustainability, with mechanisms such as transparency, accountability, inclusive decision-making, and fair contractual agreements highlighted as critical for fostering collaboration.

Implications: The findings underscore the relevance of Stakeholder, Institutional, and Social Exchange Theories in understanding PPP dynamics. Practically, the study highlights the need for stronger institutional frameworks, inclusive engagement, and trust-building strategies to enhance healthcare PPP effectiveness in Nigeria.