However, before we rush into implementing new public-private partnerships in South Africa, I believe we need to pause and consider the reasons behind this. What are the benefits and drawbacks of encouraging such interaction in greater numbers?
Kula and Fryatt recently published a paper in which they conduct a comprehensive and methodical analysis of the public-private interactions evidence in South Africa. However, the authors' definitions of what "success" means for such interactions and the reasons why they should be implemented on a larger scale are less clear. Kula and Fryatt acknowledge that significant concerns exist regarding expanding the role of the private sector in light of the acknowledged inequities that exist within the health system. For example, expenditures are six times higher for those who are primarily served by the private sector than for those who are served by the public sector. From the foundation of the current public-private mix in the health system, it is important to consider what needs to be done to ensure that the developing National Health Insurance system works toward creating a more equitable and high-quality health service, as they also point out. However, there are numerous public-private interactions that could occur; are they all worthwhile?
In speculation further it is generally critical to perceive:
1) The trade-offs between developing the capacity to manage the health system as a whole and the specific capacity needed to manage health agents from the private sector.
2) That private-for-profit sector agents are inevitably driven by commercial interests, if not entirely.
While the private sector in South Africa has a lot to teach us about contract management and reimbursement mechanisms, what does it have to offer in terms of managing the wide range of goals that citizens have for our health system as a whole? These goals are much more complex than those in the private sector. Or for directing the various forms of accountability and related actor relationships that public health managers are expected to manage? In addition, Kula and Fryatt point out that the high costs of private provider fees in South Africa are a clear reason to choose improving public services over expanding private sector services.
I believe that we should pause and consider whether and when to encourage public-private interactions in South Africa and elsewhere. Yes, there are opportunities to learn from private sector experiences and a willingness on the part of the private sector to engage further. However, we must ask more than just, "How can we do it better?" in addition to, "when should we do it at all?" furthermore 'if and while does empowering public-private connections limit the potential outcomes of reinforcing the public area that serves most of the populace?' South Africa ought to give careful and thoughtful consideration to the debates that are currently taking place in the United Kingdom regarding, for instance, the expanding role of the private sector within the NHS and, in particular, the evidence regarding the negative consequences of this (such as the fragmentation of primary health care services and risks for the financial viability of hospitals).
The justification is not provided by the existence of a thriving private sector or the general discussion about the need for the public and private sectors to collaborate at the national and international levels, both within and outside the health sector. Knowing more about what makes interactions work is also not enough. Government stewardship of the wellbeing framework in each setting is constantly founded on values and in quest for communicated and concurred political targets. In the process of making policies, evidence does not take the place of politics; rather, it is always merely one input. Therefore, the most important first question is undoubtedly not, "How do we scale up public-private engagements?" instead of "what kind of health system do we want in terms of access, coverage, and quality?" the second question is, "Can agents from the private sector support this goal?"
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