The utilisation of public-private partnership: Fiscal responsibility and options to develop intervention strategies for HIV/AIDS in South Africa

Abstract

Strengthening health care systems in government meant cost containment and improved equity. Escalating costs and poorly constructed strategies are weakening the efficiency and effectiveness of service delivery in health care. This has a negative impact on value creation and internal processes as critical elements such as human capital, information and organisational capital are not aligned with strategies and roll-out plans for HIV/Aids interventions. This research study therefore questioned the extent to which these strategies have impacted on the roll-out plans for HIV/Aids interventions, and investigated if the utilisation of public-private partnerships (PPP) resulted in applying fiscal reponsible mechanisms in health care reforms (effectively, efficiently, economically and equitably (4Es)). Trends in the new public management (NPM) movement inspired a shift towards business-like reforms and saw PPP as a mechanism that improved efficiency and effectiveness in service delivery as it offered the promise to strengthen the capacity of government policy. The study aimed to put forward value-creating strategies and develop a best practice model that strengthened government’s policy capacity by providing efficient, effective, economical and quitable service in health care and thereby improving strategies that impact on the roll-out plans for HIV/Aids. This comparative study comprised four international case studies (developed and developing countries) which presented benchmarks against which the performance of the national case study was measured. A better understanding of the influence which different ideologies had on the architecture of international and global governance structures was gained as it highlighted and compared the key issues that influenced strategies for HIV/Aids intervention between the developed and developing countries. Results of the study indicated that there are conflicting views between government departments in how to achieve value-for-money outcomes and their application of risk allocation. The conflicting views widened the gap between public and private governance structures and relations. The focus of the PPP definition as applied in the national context of health care is not percieved as being health-specific or effective as it excludes some forms of interactions occurring in the health sector. PPP goals emphasised efficiency, affordability and value-for-money approaches, while health care goals emphasised the interest of the “patient” and public health.