Abstract
ABSTRACTBackgroundSouth Africa is severely affected by the AIDS pandemic and this has resulted in an already under-resourced public sector being placed under further stress, while there remains a vibrant private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness of private-sector doctors in the eThekwini Metropolitan (Metro) region of KwaZulu-Natal, South Africa to manage public-sector HIV and AIDS patients.ObjectivesTo gauge the willingness of private-sector doctor to manage public-sector HIV and AIDS patients and to describe factors that may influence their responses.MethodA descriptive cross-sectional study was undertaken among private-sector doctors, both general practitioners (GPs) and specialists, working in the eThekwini Metro, using an anonymous, structured questionnaire to investigate their willingness to manage public-sector HIV and AIDS patients and the factors associated with their responses. Chi-square and independent t-tests were used to evaluate associations. Odds ratios were determined using a binary logistic regression model. A p value < 0.05 was considered statistically significant.ResultsMost of the doctors were male GPs aged 30–50 years who had been in practice for more than 10 years. Of these, 133 (77.8%) were willing to manage public-sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling, was the distance from public-sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public-sector HIV and AIDS patients, compared with only 24 (17.4%) of the 138 GPs (p < 0.01).ConclusionMany private-sector doctors are willing to manage public-sector HIV and AIDS patients in the eThekwini Metro, potentially removing some of the current burden on the public health sector.
Highlights
Health systems in developing countries are in crisis; the deficits include a lack of sufficient health professionals, inadequate finance and poor quality of service, together with poor infrastructure, which includes a lack of reliable water, sanitation and electricity.[1]
South Africa has an extensive antiretroviral treatment programme: 371 731 patients were initiated on antiretroviral treatment in 2007, whilst approximately 76 217 (22%) received treatment funded by medical schemes, private-sector and development partners for 2006, a number which increased to 28% in 2007.4 Governments and donors are increasingly considering the private sector as a potential partner in addressing the growing demand for sustainable HIV and AIDS treatment
The results provided a demographic profile of the doctors (Table 1), their willingness to manage public-sector patients (Table 2), and their reported resources of time, knowledge and infrastructure (Table 3)
Summary
Health systems in developing countries are in crisis; the deficits include a lack of sufficient health professionals, inadequate finance and poor quality of service, together with poor infrastructure, which includes a lack of reliable water, sanitation and electricity.[1] Without adequate infrastructure, doctors and nurses cannot provide quality care even when they are available. Underlying this is a serious shortage of skilled, trained managers and the deficit is greatest in sub-Saharan Africa, where 17% of the total health workforce is employed as managers, compared to 33% globally. Little is known about the willingness of private-sector doctors in the eThekwini Metropolitan (Metro) region of KwaZulu-Natal, South Africa to manage public-sector HIV and AIDS patients
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