Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
BMJ Open. 2023 Mar 1;13(3):e067663. doi: 10.1136/bmjopen-2022-067663.
Researching how public-private engagements may promote universal access to safe obstetric care including caesarean delivery is essential. The aim of this research was to document the utilisation of private general practitioners (GPs) contracted to provide caesarean delivery services in five rural district hospitals in the Western Cape, the profile and outcomes of caesarean deliveries. We also describe stakeholder experiences of these arrangements in order to inform potential models of public-private contracting for obstetric services.
We used a mixed-methods study design to describe rural district hospitals' utilisation of private GP contracting for caesarean deliveries. Between April 2021 and March 2022, we collated routine data from delivery and theatre registers to capture the profile of deliveries and maternal outcomes. We conducted 23 semistructured qualitative interviews with district managers, hospital-employed doctors and private GPs to explore their experiences of the contracting arrangements.
The study was conducted in five rural district hospitals in the Western Cape province, South Africa.
The use of private GPs as surgeon or anaesthetist for caesarean deliveries differed widely across the hospitals. Overall, the utilisation of private GPs for anaesthetics was similar (29% of all caesarean deliveries) to the utilisation of private GPs as surgeons (33% of all caesarean deliveries). The proportion of caesarean deliveries undertaken by private GPs as the primary surgeon was inversely related to size of hospital and mean monthly deliveries. Adverse outcomes following a caesarean delivery were rare. Qualitative data provided insights into contributions made by private GPs and the contracting models, which did not incentivise overservicing.
The findings of this study suggest that private GPs can play an important role in filling gaps and expanding quality care in rural public facilities that have insufficient obstetric skills and expertise. Different approaches to enable access to safe caesarean delivery are needed for different contexts, and contracting with experienced private GP's is one resource for rural district hospitals to consider.
研究公私合作如何促进普遍获得安全的产科护理，包括剖腹产，这是至关重要的。本研究旨在记录西开普省五家农村地区医院利用签约私营全科医生（GP）提供剖腹产服务的情况，包括剖腹产的利用情况和产妇结局。我们还描述了利益攸关方对这些安排的经验，以便为产科服务的公私合同提供潜在模式。
我们使用混合方法研究设计来描述农村地区医院利用私营 GP 签约提供剖腹产的情况。在 2021 年 4 月至 2022 年 3 月期间，我们从分娩和手术室登记处收集常规数据，以记录分娩情况和产妇结局。我们对区经理、医院雇用的医生和私营 GP 进行了 23 次半结构化定性访谈，以探讨他们对签约安排的经验。
该研究在南非西开普省的五家农村地区医院进行。
不同医院对私营 GP 作为外科医生或麻醉师进行剖腹产的利用情况差异很大。总体而言，私营 GP 用于麻醉的利用率（所有剖腹产的 29%）与私营 GP 作为外科医生的利用率（所有剖腹产的 33%）相似。私营 GP 作为主要外科医生进行剖腹产的比例与医院规模和每月平均分娩量成反比。剖腹产的不良结局很少见。定性数据提供了关于私营 GP 所做贡献和签约模式的见解，这些模式没有激励过度服务。
本研究结果表明，在产科技能和专业知识不足的农村公共设施中，私营 GP 可以在填补空白和扩大优质护理方面发挥重要作用。不同的方法需要在不同的背景下获得安全的剖腹产，与有经验的私营 GP 签约是农村地区医院考虑的一种资源。
