Emergence of three general practitioner contracting-in models in South Africa: a qualitative multi-case study

Table 1 Key characteristics of case study districts

	DISTRICT A	DISTRICT B	DISTRICT C
Contracting model
Contracting model(s)	Decentralized-purchaser	Contracted-purchaser Centralized-purchaser	Contracted-purchaser Centralized-purchaser
Demographics
Total population	595,542	3,165,745	718,549
Uninsured population	493,389	2,115,620	674,771
Percentage uninsured (%)	82.85	66.83	93.91
Population density	26 people/km²	503 people/km²	22 people/km²
Socio-economic
Socio-economic quintile (SEQ)^a	4	5	3
Rural vs. urban	Rural	Urban	Rural
Health status
Crude death rate (per 1000 population)	3.6	4.7	4.6
HIV antenatal prevalence (15–49 years)	15.6	23.4	30.1
Incidence of TB (per 100,000 population)	806	351	511
Health service
PHC utilization rate^b	2.41	1.64	2.78
PHC nurse clinical workload^c	25.3	36.7	34.6
PHC doctor clinical workload	26.5	29.1	34.5
No. of GPs contracted through model as of June 2016	14	87	29
Number of PHC health facilities	50	70	73

^aThe SEQ is derived from the South African Index of Multiple Deprivation (SAIMD). SAIMD is a composite indicator of socio-economic status developed from census data. It encompasses material, employment, educational and living environment deprivation. There are five SEQs based on a numeric SAIMD value with SEQ 1 representing the most deprived and 5 the least deprived
^bPHC utilization rate is the rate at which PHC services are utilized by the catchment population. It represents the average number of visits per person per year in the catchment population with the denominator being a census-derived estimate. It is useful in determining the overall PHC utilization patterns and could be specifically relevant in tracking equity in health service utilization
^cThe PHC clinical workload is the average number of patients seen per health care worker (professional nurse or doctor) per clinical work day. These represent health care workers employed within the public sector as opposed to those contracted-in to provide services

ISSN: 1475-9276