Extending the Reach: Contracting Out HIV Services to the Private Health Sector in Gauteng, South Africa

Over the past decade, the South African government—in partnership with a number of international donors and local nongovernmental organizations (NGOs)—has made enormous strides in turning the tide of the national HIV epidemic. Yet with 18 percent of the adult population and an estimated 410,000 children living with the virus, South Africa continues to experience the world‘s greatest HIV and AIDS disease burden (UNAIDS, 2012). The United States President‘s Emergency Plan for AIDS Relief (PEPFAR) has invested in South Africa‘s AIDS response since 2004, supporting an unprecedented expansion in HIV prevention, care, and treatment services, including lifesaving antiretroviral therapy (ART). Given the challenge in meeting HIV treatment needs through government sources alone, PEPFAR directed significant support to NGOs and private health sector general practitioners (GPs). Many of these NGOs and private GPs became among the most robust sources of HIV and AIDS treatment during a period when the public sector was limited in its capacity.

This study focuses on the experience of Right to Care Health Services (RTCHS), a South African private company that manages HIV and AIDS services on behalf of several clients, including PEPFAR, through the United States Agency for International Development (USAID), the South African government, employers, and medical aid schemes. The experience of RTCHS demonstrates how a private health care institution can partner with donor and government stakeholders to deliver HIV and AIDS care at a large scale. However, it also illustrates that financing the implementation of service contracts raises a variety of challenges. When either donors or country governments consider contracting out strategies for HIV and AIDS care, they need to consider the full range of associated advantages and disadvantages.

Source: USAID
Year: 2014