Characteristic | Public 1 | Public 2 | Private 1 | Private 2 | Private 3 |
---|---|---|---|---|---|
Abbreviation | Pub1 | Pub2 | Prv1 (NGO) | Prv2 (GP) | Prv3 (Nurse) |
Model description | Nurse led; full-service primary health clinic run by the Department of Health (DoH). | Comprehensive PHC services provided by nurses and doctors in a large urban non-governmental organization. Largely integrated into the DoH. | A partnership between general practitioners (GPs), DoH and the private administrator. Private GPs were organized into an HIV disease management network and paid a capitated annual fee at the point of enrolling uninsured, treatment naïve patients who are not reached by the public sector. | Nurse-led ownership model. Clinics were owned and operated by a professional nurse and organized as an non-profit company and followed a franchise model with a network fee. | |
Target population | Served an urban population in Gauteng province seeking health care services in the public sector. | Served an urban population of a township in Gauteng province seeking health care services in the public sector. | The majority of beneficiaries were from surrounding informal settlements. A large proportion were foreign migrants. Most were employed but low income. | Employed, low income (‘the working poor’) in and around a Gauteng district. Aimed to target uninsured people living with HIV currently missed by the public sector owing to access barriers and who were cash-paying customers in the private sector. | Under-served communities. Employed (80%), unemployed (20%), i.e., elderly grant earners, but all low income and uninsured (LSM 1–4). Primarily targeted people seeking privacy, working mothers needing to vaccinate their children and STI treatment. |
Financial model | Free at the point of care. All costs (medicines, laboratory services, visit costs) services were covered by the DoH. | Combination of private, donor and DoH funds (provided essential medicines, NHLS), as well as user fees to a small extent. | A donor funded the annual GP consult fee, dispensing fee and admin fee. DoH funded medicines, labs and test kits. | User fees covered operational costs. Upfront infrastructure funding and working capital donations (for first 2 years) provided by donors and National Treasury (Jobs Fund). Nurse required 250 patients per month to break even. | |
Volumea / scalability | Standard government, primary health clinic. Served ~ 5100 patients per month. | Standard government, primary health clinic. Served ~ 6000 patients per month. | 1 facility (and 1 mobile). Served ~ 7600 patients each month. | 6 GPs currently contracted in one district (~ 640 patients during study period) but plans to expand nationally. | Currently has 41 sites but plans to expand to 70 by 2019. Each clinic served on average 1700 patients per month. |