Abstract / Summary
Background: The South African government has committed to achieving universal health coverage (UHC). Nevertheless, service delivery gaps in the public health care system persist. A central proposal of the NHI policy is the use of public-private partnerships (PPP) to bolster the provision of public health care services. This paper studied the institutional and ideological drivers for the adoption of PPP under the NHI policy. Methods: A purposive sample of seventeen key policy stakeholders were interviewed for this study. The stakeholders worked in the public, private and non-governmental sectors. In addition, a qualitative document analysis of key documents that relate to the NHI and South Africa’s health system reforms was also undertaken. An iterative framework analysis was applied to the interview data and the documents. Results: In terms of study results, there were four key drivers for the use of PPP which include: inequality between South Africa's public and private health care sectors; policy learning from the World Health Organization (WHO) under the NHI; scarcity of health resources driving calls for PPP; and neoliberal ideology influencing the NHI policy. Normative isomorphism working through professionals, international health policy organisations and the department of health constitute an important mechanism underlying the drivers of the NHI's pursuit of PPP. Conclusions: Neoliberal ideology and institutional isomorphism have constrained the diversity of policy options for achieving UHC in South Africa. A less circumscribed policy process may increase the space for more diverse debates and policies to emerge out of the UHC policy process in the country.