Hongoro Charles, Funani I Itumeleng N, Chitha Wezile, Godlimpi Lizo
Albertina Sisulu Centre for Global Health and Research, Faculty of Health Sciences, Walter Sisulu University , Mthatha, South Africa.
J Public Health Afr. 2015 Aug 17;6(2):525. doi: 10.4081/jphia.2015.525.
Low- and middle-income countries are striving towards universal health coverage in a variety of ways. Achieving this goal requires the participation of both public and the private sector providers. The study sought to assess existing capacity for independent general practitioner contracting in primary care, the reasons for the low uptake of government national contract and the expectations of general practitioners of such contractual arrangements. This was a case study conducted in a rural district of South Africa. The study employed both quantitative and qualitative data collection methods. Data were collected using a general practitioner and practice profiling tool, and a structured questionnaire. A total of 42 general practitioners were interviewed and their practices profiled. Contrary to observed low uptake of the national general practitioner contract, 90% of private doctors who had not yet subscribed to it were actually interested in it. Substantial evidence indicated that private doctors had the capacity to deliver quality care to public patients. However, low uptake of national contarct related mostly to lack of effective communication and consultation between them and national government which created mistrust and apprehension amongst local private doctors. Paradoxically, these general practitioners expressed satisfaction with other existing state contracts. An analysis of the national contract showed that there were likely to benefit more from it given the relatively higher payment rates and the guaranteed nature of this income. Proposed key requisites to enhanced uptake of the national contract related to the type of the contract, payment arrangements and flexibility of the work regime, and prospects for continuous training and clinical improvements. Low uptake of the national General Practitioner contract was due to variety of factors related to lack of understanding of contract details. Such misunderstandings between potential contracting parties created mistrust and apprehension, which are fundamental antitheses of any effective contractual arrangement. The idea of a contract was probably inappropriate.
低收入和中等收入国家正在通过各种方式努力实现全民健康覆盖。实现这一目标需要公共部门和私营部门提供者的参与。该研究旨在评估初级保健中独立全科医生签约的现有能力、政府国家合同采用率低的原因以及全科医生对这种合同安排的期望。这是一项在南非一个农村地区进行的案例研究。该研究采用了定量和定性的数据收集方法。使用全科医生和诊所概况工具以及结构化问卷收集数据。共采访了42名全科医生并对他们的诊所进行了概况分析。与观察到的国家全科医生合同采用率低的情况相反，90%尚未签署该合同的私人医生实际上对其感兴趣。大量证据表明，私人医生有能力为公立患者提供高质量的护理。然而，国家合同采用率低主要与他们和国家政府之间缺乏有效的沟通和协商有关，这在当地私人医生中造成了不信任和担忧。矛盾的是，这些全科医生对其他现有的国家合同表示满意。对国家合同的分析表明，鉴于相对较高的支付率和这种收入的保障性，他们可能会从该合同中受益更多。提高国家合同采用率的拟议关键要求涉及合同类型、支付安排和工作制度的灵活性，以及持续培训和临床改善的前景。国家全科医生合同采用率低是由于与对合同细节缺乏理解相关的多种因素。潜在签约方之间的这种误解造成了不信任和担忧，而这是任何有效合同安排的根本对立面。合同的想法可能并不合适。
