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Table 2 Description of included models (Adapted from Girdwood et al. [10] Table 2)

From: Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa

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.

  1. aVolume refers to total patient headcount and is not specific to patients living with HIV