Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Department of Family and Emergency Medicine, Knysna Provincial Hospital, Western Cape Department of Health, Knysna.
S Afr Fam Pract (2004). 2023 Jan 23;65(1):e1-e11. doi: 10.4102/safp.v65i1.5641.
A major disparity exists in access to specialised healthcare between rural and urban areas. Specialist outreach programmes are one of the ways in which rural specialist healthcare inequality is being addressed. A number of rural district hospitals (RDH) employ local, private specialists (LPS) to supplement public specialist outreach. Limited research exists on private specialist outreach and support (PSOS) in sub-Saharan Africa or South Africa.
This was a descriptive, exploratory, qualitative study using thematic analysis of semi-structured interviews. Non-probability, purposive sampling was used to obtain a sample size of 16 participants. The audio recordings were transcribed verbatim and analysed with the framework method and ATLAS.ti version 8© software.
Four major themes emerged, namely roles of LPS, effects, sustainability and feasibility of PSOS. Overall PSOS was considered sustainable, feasible and had positive effects in and beyond the sub-districts. The value of PSOS was supported by improved access and timeliness of services, improved competency of RDH medical practitioners, improved coordination, comprehensiveness and continuity of care. Private specialist outreach and support was, however, associated with increased burden on the RDH resources and required a basic level of RDH infrastructure to function effectively.
The perceived contribution of private specialist outreach services was positive overall. Implementation in RDHs is feasible, but should involve consideration of factors in the hospital, town, sub-district and district prior to implementation.Contribution: This paper provides evidence that private specialist outreach and support services are feasible in the state health sector, provided that certain considerations are taken into account.
城乡之间的专业医疗服务获取存在显著差距。专科外展计划是解决农村专科医疗服务不平等问题的方法之一。一些农村地区医院（RDH）聘请当地私人专科医生（LPS）来补充公共专科外展服务。撒哈拉以南非洲或南非的私立专科外展和支持（PSOS）的相关研究有限。
本研究采用描述性、探索性、定性研究方法，对半结构化访谈进行主题分析。非概率、目的性抽样用于获得 16 名参与者的样本量。将音频记录逐字转录，并使用框架方法和 ATLAS.ti 版本 8©软件进行分析。
出现了四个主要主题，即 LPS 的角色、效果、PSOS 的可持续性和可行性。总体而言，PSOS 被认为是可持续的、可行的，并且在次区域内和之外都产生了积极的影响。PSOS 的价值得到了改善服务的可及性和及时性、提高 RDH 医疗从业者的能力、改善协调、全面性和连续性的支持。然而，私人专科外展和支持与 RDH 资源的负担增加有关，并且需要一定水平的 RDH 基础设施才能有效运作。
总体而言，私立专科外展服务的贡献是积极的。在 RDH 中实施是可行的，但在实施之前，应考虑医院、城镇、次区域和地区的因素。
本文提供了证据表明，私立专科外展和支持服务在国家卫生部门是可行的，前提是要考虑到某些因素。
