Towards developing new private sector obstetric care and contracting models in South Africa: Insights from public hospitals using private general practitioners to provide caesarean deliveries

Authors

  • G C Solanki Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; NMG Consultants and Actuaries, Cape Town, South Africa
  • T Doherty Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa
  • V Brijlal Clinton Health Access Initiative, Pretoria, South Africa
  • E Daviaud Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
  • S Fawcus Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa

DOI:

https://doi.org/10.7196/SAMJ.2024.v114i4.1531

Keywords:

Obstetric care, public-private partnership, national health insurance, universal health coverage

Abstract

Maternal healthcare in South Africa faces huge private and public health systems challenges. A key challenge for policy makers is how to address the inappropriate patterns of obstetric care in the private sector and how to mobilise private sector resources to serve the broader population dependent on the public sector, without replicating those patterns of inappropriate care. Developing and implementing new obstetric care models that address these challenges and lend themselves to public private engagements could play a vital role in efforts to improve obstetric care in the country. Drawing on insights from research we carried out on the care and contracting models used by five rural district hospitals in the Western Cape Province to contract private general practitioners to provide caesarean delivery services, this article outlines a potential alternative private sector obstetric care model with the aim of stimulating discussion by all relevant stakeholders on the development of new obstetric models for improving obstetric care in the country.

Author Biographies

  • T Doherty, Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa

    T Doherty (MPH, PhD). Chief Specialist Scientist, Health Economics, Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.   Honorary Professor, Department of Paediatric and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa.

  • V Brijlal, Clinton Health Access Initiative, Pretoria, South Africa

     V Brijlal (BCom (Law, Economics), MSc (Economics)),Senior Director, Clinton Health Access Initiative, Pretoria, South Africa. 

  • E Daviaud, Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa

    E Daviaud, MSc (Economics, Health Economics),Ex Senior Specialist Scientist (now retired), Health Economics, Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa

  • S Fawcus, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa

    S Fawcus,  MA, MB BCh, FRCOG, Senior Scholar and Professor Emeritus, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa

References

World Bank. World Development Indicators. Jun 18, 2020. https://databank.worldbank.org/home.aspx (accessed 12 March 2024).

Competition Commisssion of South Africa. Health Market Inquiry Final Findings and Recommendations Report. 2019. http://www.compcom.co.za/wp-content/uploads/2020/01/Final- Findings-and-recommendations-report-Health-Market-Inquiry.pdf (accessed 12 March 2024).

Econex. Health Reform Note 4. Integration of the public and private sectors under a National Health Insurance (NHI) system in SA. July 2010. Stellenbosch: Econex, 2009.

National Department of Health. Saving Mothers 2017 - 2019. Seventh report on confidential enquiries into maternal deaths in South Africa. Pretoria: NDoH, 2020.

Human Rights Watch. South Africa. ‘Stop Making Excuses’. Accountability for maternal health care in South Africa. 2011. https://www.hrw.org/report/2011/08/08/stop-making-excuses/accountability- maternal-health-care-south-africa (accessed 12 March 2024).

Sobhy S, Arroyo-Manzano D, Murugesu N, et al. Maternal and perinatal mortality and complications associated with caesarean section in low-income and middle-income countries: A systematic review and meta-analysis. Lancet 2019;393(10184):1973-1982. https://doi.org/10.1016/S0140-6736(18)32386-9

Solanki G, Fawcus S, Daviaud E. A cross sectional analytic study of modes of delivery and caesarean section rates in a private health insured South African population. PloS ONE 2019;14(6):e0219020. https://doi.org/10.1371/journal.pone.0219020

Council for Medical Schemes. Epidemiology and trends of caesarean section births in the medical schemes’ population, 2015 - 2018. Policy, Research and Monitoring. Research Brief 1 of 2020. February 2020. https://www.medicalschemes.com/files/Research%20Briefs/Caesarean%20section%20 births%20-%20Research%20Brief%201%20of%202020.pdf (accessed 12 March 2024).

Solanki GC, Cornell JE, Daviaud E, Fawcus S. Caesarean section rates in South Africa: A case study of the health systems challenges for the proposed National Health Insurance. S Afr Med J 2020;110(8):747-750. https://doi.org/10.7196/SAMJ.2020.v110i8.14699.

Barber SL, Kumar A, Roubal T, Colombo F, Lorenzoni L. Harnessing the private health sector by using prices as a policy instrument: Lessons learned from South Africa. Health Policy 2018;122(5):558-564. https://doi.org/10.1016/j.healthpol.2018.03.018

South Africa. National Health Insurance Bill. 2019. (B 11-2019). https://www.gov.za/sites/default/files/ gcis_document/201908/national-health-insurance-bill-b-11-2019.pdf (accessed 22 January 2022).

OpiyoN,YoungC,RequejoJH,ErdmanJ,BalesS,BetránAP.Reducingunnecessarycaesareansections:

Scoping review of financial and regulatory interventions. Reprod Health 2020;17(1):133. https://doi. org/10.1186/s12978-020-00983-y

Doherty T, Fawcus S, Daviaud E, Bartmann Y, Solanki G. Experiences of public-private contracting for caesarean delivery in rural district public hospitals: A qualitative interview study. PLOS Glob Pub Health 2023;3(5):e0001335. https://doi.org/10.1371/journal.pgph.0001335

Solanki G, Daviaud E, Fawcus S, Brijlal V, Doherty T. Models using private general practitioners to provide caesarean deliveries at five South African district public hospitals: Insights for public-private contracting for obstetric care in rural areas. Glob Health Act 2023;16(1):2241811. https://doi.org/10. 1080/16549716.2023.2241811

Doherty T, Solanki G, Daviaud E, Bartmann Y, Hawkridge A, Fawcus S. Utilisation of private general practitioners to provide caesarean deliveries in five rural district public hospitals in South Africa: A mixed-methods study. BMJ Open 2023;13(3):e067663. https://doi.org/10.1136/bmjopen-2022-067663

Elaraby S, Altieri E, Downe S, et al. Behavioural factors associated with fear of litigation as a driver for the increased use of caesarean sections: A scoping review. BMJ Open 2023;13(4):e070454. https://doi. org/10.1136/bmjopen-2022-070454

KwaZulu-Natal Department of Health. Licensing of Private Health Care Facilities. Public Notice (22/11/2022) Non-payment of annual re-licensing fees. List of licensed facilities. 13 April 2023. https:// www.kznhealth.gov.za/Licensing_pvt_health_care_facilities.htm (accessed 12 March 2024).

Life Healthcare. Genesis Maternity Clinic Closure. 23 February 2023. https://www.lifehealthcare.co.za/ media/3739/webstatement_genesis-closure_feb2023.pdf (accessed 12 March 2024).

Daniels NM. Obstetric-risk objects: a multi-site, feminist ethnography of private-sector obstetric, maternal and unborn caring concerns in Cape Town. Doctoral dissertation. University of Cape Town, 2021. https://open.uct.ac.za/handle/11427/35491 (accessed 12 March 2024).

Mosam A. Regulating the employment of doctors within the private sector in South Africa. A policy analysis. Research report to Faculty of Health Sciences, University of the Witwatersrand in partial fullfillment for the degree of Master of Public Medicine in field of Public Health. Johannesburg: University of the Witwatersrand, 15 October 2018. https://wiredspace.wits.ac.za/server/api/core/ bitstreams/41d756e1-284f-43ba-b24a-6b079df0ca49/content (accessed 12 March 2024).

Solanki G, Cornell J, Crisp N, et al. Insights from contracting the private sector for critical care. In: Govender K, George G, Padarath A, Moeti T, eds. South African Health Review 2021. Durban: Health Systems Trust, 2021. https://www.hst.org.za/publications/South%20African%20Health%20Reviews/ Chapter8_SAHR21_04022022_OD.pdf (accessed 12 March 2024).

Downloads

Published

2024-04-18

Issue

SAMJ Vol. 114 no. 4

Section

Research

License

Copyright (c) 2024 G C Solanki, T Doherty, V Brijlal, E Daviaud, S Fawcus

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Licensing Information

The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited. 

Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository. 

Publishing Rights

Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.

 

How to Cite

1.
Solanki GC, Doherty T, Brijlal V, Daviaud E, Fawcus S. Towards developing new private sector obstetric care and contracting models in South Africa: Insights from public hospitals using private general practitioners to provide caesarean deliveries. S Afr Med J [Internet]. 2024 Apr. 18 [cited 2025 May 23];114(4):e1531. Available from: https://samajournals.co.za/index.php/samj/article/view/1531