Tuberculosis treatment in high TB / HIV settings : evaluating public-private partnerships in South Africa.

Abstract

The aim of this thesis is to evaluate the perfonnance of different models of publicprivate partnerships in the provision of tuberculosis treatment, and explore incentive mechanisms for private sector participation. It makes recommendations to policymakers in South Africa and elsewhere on the best way to approach a policy on the enhanced role of private sector providers in tuberculosis treatment in light of the HIV/AIDS epidemic. A common framework is used to analyse the nature of the models, their perfonnance in tenns of cost, effectiveness and quality of care, and incentives for private participation. Multiple research methods are employed in order to fully investigate complex situations and to validate the findings. Both quantitative and qualitative methods are used. The study found that the quality of care is superior in both models of public-private partnerships when compared to the purely public sector model of delivery, and shows that increased collaboration with private providers through partnerships could potentially improve the quality of care and increase access to care. The results of the cost-effectiveness show that, in comparison with the purely public provision, the public-private partnership models could significantly reduce costs to both the public health sector and patient, and increase cost-effectiveness of tuberculosis treatment. Private providers in the existing and potential partnerships have both financial and non-financial motivations and incentives for participation in partnership. Overall, these pUblic-private partnerships show that there is a strong economic case for expanding the private sector involvement in tuberculosis treatment in South Africa. Expansion may require increased investment in the public-private partnerships, but they seem to be capable of delivering important improvements in the affordability and efficiency of tuberculosis treatment, and improving the South African health system's capacity to cope with the impact of the HIV/AIDS epidemic.