Public–private interactions on health in South Africa: opportunities for scaling up

Abstract

South Africa has long recognized partnerships between the public and private sectors as a policy objective in health, but experience is still limited and poorly documented. The objectives of this article are to understand the factors that increase the likelihood of success of public-private interactions in South Africa, and identify and discuss opportunities for them to be scaled up. There is a strong legislative framework and a number of guidelines and tools that have been developed by the Treasury for managing partnerships. The review of literature confirmed the need for the state to have effective regulations in order to oversee quality and standards and to provide stewardship and oversight. The public sector requires sufficient capacity not only to manage relationships with the private sector but also to enable innovation and experimentation. Evaluation is an integral part of all interactions not only to learn from successes but also to identify any perverse incentives that may lead to unintended consequences. Four case studies show that the private for-profit sector is already engaged in a number of projects that are closely aligned to current health system reform priorities. Factors that increase the likelihood of interactions being successful include: increasing the government's capacity to manage public-private relationships; choosing public-private interactions that are strategically important to national goals; building a knowledge base on what works, where and why; moving from pilots to large scale initiatives; harnessing the contracting expertise in private providers; and encouraging innovation and learning.

Working the Conundrum in Public-Private Partnerships (PPPs) for Community Benefit in South Africa

“…On the other hand, the infrastructure assets available are, in many cases, poorly maintained which also increase costs and reduce benefits leading to escalated service delivery protests. In the wake of political promises in South Africa, Kula and Fryatt (2014) argue that service delivery of basic municipal services such as water, electricity and toilets coupled with high levels of poverty and the lack of housing has added to the growing dissatisfaction in the poor communities. With this often disappointing infrastructure delivery, the government has slowly been engaging the private sector to meet the perennial funding gap through Public-Private Partnerships (PPPs) (Akyeampong, 2009).…”

Exploring the barriers to implementing National Health Insurance in South Africa: The people's perspective

“…[16] The NHI plans to purchase services from accredited and contracted private specialists and private hospitals.…”

“…[17] Furthermore, the high cost of private-provider fees is currently a barrier to expanding partnerships with the NHI, resulting in the need for the current Competition Commission enquiry into the drivers of prices in the private health sector. [16] PPPs will require a close, transparent relationship between government and private providers. [16] The SA health system will need to develop skilled management, and the capacity to choose PPPs that are strategically important to national goals.…”

“…[16] PPPs will require a close, transparent relationship between government and private providers. [16] The SA health system will need to develop skilled management, and the capacity to choose PPPs that are strategically important to national goals. [16] …”

“…[16] The SA health system will need to develop skilled management, and the capacity to choose PPPs that are strategically important to national goals. [16] …”