Public-Private Contracting Models for Obstetric Services in South Africa

Tanya Doherty of the South African Medical Research Council will assess different contracting models for the National Health Insurance, which has been charged with providing universal health services purchased from both the public and private sectors across South Africa, to ensure that cesarean sections are only performed when appropriate and safe. Key challenges are to ensure that rural and over-loaded regional hospitals are able to meet service demands for obstetric care and that inappropriate care practices of the private sector, particularly the high cesarean section rate, are not applied to the entire population. They will perform case studies at four rural and urban district hospitals to evaluate different pricing and remuneration models, such as a global fee irrespective of mode of child delivery and contracting private practitioners for rural areas, and document their effects on the rates and safety of cesarean sections, and overall costs.