Stakeholders’ views on public-private partnerships for rehabilitation services in South Africa ahead of National Health Insurance

Abstract

Background: Quality rehabilitation services are limited in rural South African areas, such as KwaZulu-Natal (KZN). Public-private partnerships (PPPs) are increasingly valued as an effective model for public health delivery in developing countries; yet, their application in South Africa’s rehabilitation sector, especially with the upcoming National Health Insurance (NHI) for universal health coverage, remains unclear. This study examined perspectives on using PPPs for rehabilitation services within the District Health System in KZN in preparation for the NHI.

Methods: A qualitative study in eThekwini, Amajuba and King Cetshwayo districts of KZN included 57 participants, selected through purposive sampling. Participants were rehabilitation practitioners, managers and social development representatives. Data were collected via focus groups and interviews and analysed using thematic analysis.

Results: Participants noted that the NHI’s strategy of incorporating the private sector is designed to alleviate government pressure and provide financial incentives. Challenges mentioned include service availability, patient care and tariff disputes. Discrepancies between public and private sectors and the private sector’s financial sensitivities pose significant challenges to NHI implementation. A knowledge gap exists regarding the role of PPPs in the NHI context for rehabilitation services. Practitioners emphasised the necessity of adequate government funding for private sector partnerships to strengthen public health infrastructure.

Conclusion: Stakeholders express varied views on PPPs for rehabilitation, highlighting the need for clear guidelines and funding support as South Africa nears NHI implementation.

Contribution: This study provides insights into stakeholders’ views on PPPs for rehabilitation, identifying key benefits and challenges to inform effective NHI-aligned implementation strategies.