Towards developing new private sector maternity care models in South Africa

Results from a deliberative stakeholder dialogue

Bibliographic Data

ID19534271
AuthorsTanya Doherty (0000-0003-1592-0080, South African Medical Research Council), Sue Fawcus (0000-0002-1818-7171, University of Cape Town), Vishal Brijlal, Geetesh Solanki (0000-0002-8512-3119, South African Medical Research Council)
Year2025
Volume21
Issue1
Pages50-50
Publication date2025-08-20
Open AccessYes
TypeARTICLE
VenueGlobalization and Health (JOURNAL)
Journal identifiersISSN: 1744-8603 • E-ISSN: 1744-8603
PublisherSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1186/s12992-025-01145-0
PMID40836341
OpenAlexW4413356753
LanguageEN
References cited23

Public-private partnerships are a key strategy in many middle-income countries to promote universal access to quality health care and reduce inequities. In maternity care, addressing inappropriate patterns of care within the private sector is essential for these partnerships to succeed. Caesarean rates are rising globally, four of the five countries with the highest caesarean rates are middle-income countries and private hospital care is a strong predictor of caesarean birth. Maternal health care in South Africa faces major challenges in both the public and private sectors. In the public sector, overburdened services and limited skilled staff contribute to poor outcomes. In the private sector, a caesarean birth rate of 77% reflects widespread inappropriate care. Improving equity and outcomes requires leveraging private sector resources, but only if quality issues are addressed. This calls for the development and implementation of new private sector maternity care models. We proposed an alternative model as a starting point for stakeholder engagement. A deliberative dialogue was convened in 2024 to discuss the proposed model. Stakeholders were purposively selected to provide input. The session was audio-recorded and analysed using thematic content analysis. This paper presents a thematic analysis of the issues and responses that emerged from the dialogue. Key themes that emerged included the need for: a common set of protocols and clinical guidelines for maternity care; a clearly defined benefits package covering antenatal, intrapartum, and postnatal care; a multidisciplinary maternity care team; targeted education to address fears and misperceptions about midwife-led vaginal birth; legislative reforms to allow women-centred team-based birthing units to function as contracting entities. While there was strong support for further development of alternative maternity care models, follow-up discussions revealed the need for a broader coordination process to advance these proposals. High caesarean birth rates in South Africa’s private sector indicate inappropriate care. The proposed maternity care model emphasizes women-centred, team-based approaches. Stakeholders at the dialogue expressed support for legislative reforms to allow for the creation of multi-disciplinary birthing units. The need for large-scale, innovative behaviour change communication to reduce fears of spontaneous labour and vaginal births, should not be underestimated. Maternity care presents an ideal opportunity to develop public private-partnerships critical towards an integrated, equitable health system in South Africa. Not applicable

Developing country · Economic growth · Economics · Health care · Health services research · Political science · Private sector · Public relations · Public sector · Social policy · Stakeholder · Global Health Workforce Issues · Global Maternal and Child Health · Healthcare Policy and Management

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