The place of private care governance in the <scp>S</scp>outh <scp>A</scp>frican health care system

Fusheini, Adam; Eyles, John; Goudge, Jane

doi:10.1002/hpm.2578

Cited by 2 publications

(2 citation statements)

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“…With debilitating or persistent symptoms, women eventually presented to a private or public clinic for advice (where we met them). Choice of clinic depended on income and whether or not they had private health insurance, the latter factor determining the quality of care in the private sector that was available to employed middle class patients, compared with resort to the public sector by the majority of the population, most on a low income or unemployed (Ataguba & Goudge, 2012;Fusheini et al, 2018;Girdwood et al, 2019). Those without health insurance or sufficient money to pay out-of-pocket presented to a community health clinic or hospital outpatient department, often leaving home early in the morning to be in a queue by eight am with hope of being seen by midday (see, for example, Sastry et al, 2015).…”

Section: Methodsmentioning

confidence: 99%

Prescribing, care and resistance: antibiotic use in urban South Africa

Manderson

2020

Humanit Soc Sci Commun

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patients' and providers' expectations of transactions in health services converge in consultations for acute respiratory tract infections with the prescription of antibiotics. To explore this, a qualitative study was undertaken at community health centres and private general practice surgeries in four areas of metropolitan South Africa, selected purposively to allow for wide variability in terms of socioeconomic status and ethnicities/race of patient populations. With permission, clinic waiting rooms and patient/provider consultations were observed, and 65 in-depth interviews were undertaken with patients or parents or guardians presenting with children. These interviews were complemented by interviews with health providers (26) and key informants (12). All interviews were recorded, transcribed and imported into NVivo 12 for management. Data were open coded, with individual interviews and observational data compared and contrasted to highlight understandings and practices of care, antibiotic precription and use. In this article, I illustrate how the social context of patient and provider interactions in primary care settings influenced treatment. Community health centres and clinics were (and are) stretched for resources, and there were long wait times before patients can be seen; consultations were brief, with relatively little verbal exchange on the management of coughs and colds. Providers' decisions of treatment were informed by clinical assessment, concern about the risks of bacterial infection, and perceptions of patient ability to seek further care and advice-a mix of clinical and social considerations. While patients did not always request antibiotics and were willing to discuss how to manage acute conditions without them, doctors in private practice still often provided a prescription, sometimes postdated to discourage use but with the option for medication if needed. In the public sector, the provision of a prescription also reflected clinicans' appreciation of economic constraint and vulnerability. As described, patients understood principles of the appropriate use and storage of antibiotics, in contrast to other medications, and they were largely open to discussions with their providers about whether or not to use an antibiotic. However, their own and their prescribing providers had varied understandings of the mechanisms of resistance to antibiotics and so the need for antibiotic stewardship.

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Section: Methodsmentioning

confidence: 99%

Prescribing, care and resistance: antibiotic use in urban South Africa

Manderson

2020

Humanit Soc Sci Commun

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“…These policy issues resulted in a shoring of academic literature revolving around the same topics [13][14][15][16]. Despite of this increasing interest, a recent case study in South Africa still remark that "While much is known about how the public system operates, little work has been conducted on the private sector, perhaps not surprisingly in a profit-oriented, proprietary system" [17]. The situation is hardly different about most of Sub-Saharan countries [18][19], in particular when it comes to private biomedical practice in colonial time.…”

Section: Introductionmentioning

confidence: 99%

Private Biomedical Practice in Black Africa before the French Colonial Occupation

Sawadogo

2022

Sociology

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African medical historians have tended to focus their interest on colonial state organized medicine, at the expense of colonial private provision of medical services. This situation opens up the need for exploring the private practice as a contribution not only to shedding new light on the official account of French colonial medical assistance in Africa, but also to understanding the current challenges of health systems in former French colonies. In France, the movement for the occupational control of labor of professionalism in the area of health began in early nineteenth century, and was authorized around the end of the same century. This process could not ignore medical practice outside France, from the time of overseas territories up to the colonial occupation at the end of the nineteenth century. It is known from travelers' accounts, the literature on the French empire as well as from some incidental mentions in historical accounts on the development of health system in French overseas, that private practice initiated French medicine overseas, and that it was lucrative. It is also known that competition between different occupational groups for status in the area of health was fierce in France until the end of the nineteenth century, and even beyond. Surprisingly, archives on private medical practice in French African colonies are virtually unavailable.

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The place of private care governance in the South African health care system

Abstract: The study findings establish that shareholders and managers goals converge resulting in the institutionalization and consolidating of relational governance practices in the hospital. Yet other stakeholders appeared to be sidelined.

Cited by 2 publications

References 28 publications

Prescribing, care and resistance: antibiotic use in urban South Africa

Prescribing, care and resistance: antibiotic use in urban South Africa

Private Biomedical Practice in Black Africa before the French Colonial Occupation

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