Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
Honorary Research Associate: Health Economic Unit, University of Cape Town, Cape Town, South Africa.
Glob Health Action. 2023 Dec 31;16(1):2241811. doi: 10.1080/16549716.2023.2241811.
Harnessing of private sector resources could play an important role in efforts to promote universal access to safe obstetric care including caesarean delivery in low- and middle-income countries especially in rural contexts but any such attempt would need to ensure that the care provided is appropriate and patterns of inappropriate care, such as high caesarean delivery rates, are not reproduced for the entire population.
To examine the contracting arrangements for using private general practitioners to provide caesarean delivery services in rural district hospitals in South Africa.
We utilised a mixed-method study design to examine the contracting models adopted by five rural district hospitals in the Western Cape, South Africa. Between April 2021 and March 2022, we collected routine data from delivery and theatre registers to capture the profile of deliveries and utilisation of contracted private GPs. We also conducted 23 semi-structured qualitative interviews with key stakeholders to explore perceptions of the contracting arrangements.
All five hospitals varied in the level of use of private general practitioners and the contracting models (three private in-sourcing models - via locum agencies, sessional contracts, and tender contracts) used to engage them. Qualitative interviews revealed insights related to the need for flexibility in the use of contractual models to meet local contextual needs, cost implications and administrative burden.
Structured appropriately, private public partnerships can fill important gaps in human resources in rural district hospitals. Policy makers should look to developing a 'contracting framework' which requires compliance with a set of underlying principles but allows for flexibility in developing context specific contracting arrangements. These underlying principles should include a 'risk' based delivery model, adherence to public sector- evidence-based protocols, time-based rather than per delivery/type of delivery remuneration models, group liability arrangements, and processes to monitor outcomes.
在努力促进所有人都能获得安全的产科护理，包括在中低收入国家，特别是在农村地区进行剖宫产的过程中，利用私营部门资源可以发挥重要作用。但任何此类尝试都需要确保所提供的护理是合适的，并且不会在整个人群中复制不适当的护理模式，例如剖宫产率过高。
研究南非农村地区县级医院利用私人全科医生提供剖宫产服务的承包安排。
我们采用混合方法研究设计，研究了南非西开普省五所农村县级医院采用的承包模式。在 2021 年 4 月至 2022 年 3 月期间，我们从分娩和手术室登记册中收集了常规数据，以了解分娩情况和签约私人全科医生的使用情况。我们还对 23 名利益攸关方进行了 23 次半结构化定性访谈，以探讨对承包安排的看法。
所有五所医院在私人全科医生的使用水平和所采用的承包模式（通过临时机构、定期合同和招标合同的三种私人内部承包模式）方面存在差异。定性访谈揭示了与灵活使用合同模式以满足当地背景需求、成本影响和行政负担相关的见解。
结构合理的公私伙伴关系可以填补农村县级医院人力资源的重要空白。政策制定者应寻求制定一个“承包框架”，该框架要求遵守一系列基本原则，但允许在制定具体背景的承包安排方面具有灵活性。这些基本原则应包括基于风险的分娩模式、遵守公共部门基于证据的协议、基于时间而非每次分娩/分娩类型的报酬模式、集体责任安排以及监测结果的流程。
