The willingness of private-sector doctors to manage public-sector HIV/AIDS patients in the eThekwini metropolitan region of KwaZulu-Natal

Background: South Africa is severely affected by the AIDS pandemic and this has resulted in an already under-resourced public sector being placed under further stress, while there remains a vibrant private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness of private-sector doctors in the eThekwini Metropolitan (Metro) region of KwaZulu-Natal, South Africa to manage public-sector HIV and AIDS patients. Objectives: To gauge the willingness of private-sector doctor to manage public-sector HIV and AIDS patients and to describe factors that may influence their responses. Method: A descriptive cross-sectional study was undertaken among private-sector doctors, both general practitioners (GPs) and specialists, working in the eThekwini Metro, using an anonymous, structured questionnaire to investigate their willingness to manage public-sector HIV and AIDS patients and the factors associated with their responses. Chi-square and independent t-tests were used to evaluate associations. Odds ratios were determined using a binary logistic regression model. A p value < 0.05 was considered statistically significant. Results: Most of the doctors were male GPs aged 30–50 years who had been in practice for more than 10 years. Of these, 133 (77.8%) were willing to manage public-sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling, was the distance from public-sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public-sector HIV and AIDS patients, compared with only 24 (17.4%) of the 138 GPs (p < 0.01). Conclusion: Many private-sector doctors are willing to manage public-sector HIV and AIDS patients in the eThekwini Metro, potentially removing some of the current burden on the public health sector. Vol. 2 No. 1 Page 1 of 5 INTRODUCTION Health systems in developing countries are in crisis; the deficits include a lack of sufficient health professionals, inadequate finance and poor quality of service, together with poor infrastructure, which includes a lack of reliable water, sanitation and electricity.1 Without adequate infrastructure, doctors and nurses cannot provide quality care even when they are available. Underlying this is a serious shortage of skilled, trained managers and the deficit is greatest in sub-Saharan Africa, where 17% of the total health workforce is employed as managers, compared to 33% globally. Many countries are now engaging the private sector in partnerships with the public sector as a means of rebuilding their infrastructure and improving access to services.1 To address some of the resource and personnel shortages facing the public health sector in South Africa, partnerships between the public and private health sectors are slowly being forged. In May 2006, the Minister of Health launched the National Consultative Health Forum2 to discuss key strategic health issues, including tuberculosis, HIV and AIDS, recruitment and retention of health professionals, and transformation of the health sector.3 South Africa has an extensive antiretroviral treatment programme: 371 731 patients were initiated on antiretroviral treatment in 2007, whilst approximately 76 217 (22%) received treatment funded by medical schemes, private-sector and development partners for 2006, a number which increased to 28% in 2007.4 Governments and donors are increasingly considering the private sector as a potential partner in addressing the growing demand for sustainable HIV and AIDS treatment. Given the weaknesses and strengths of both sectors, a partnership between the public and private sectors has became a viable policy option since neither the public nor the private sector alone can deliver competent, accessible and affordable health care.5 The AIDS pandemic has severely affected South Africa, with an estimated 5.7 million South Africans living with HIV and AIDS in 2007.6 HIV and AIDS thus constitutes the major part of the South African burden of disease.7 High levels of internalised stigma encourage people to hide their condition8 and many HIV and AIDS patients prefer to consult a private-sector doctor in order to avoid the stigma.9 However, little is known about willingness of private-sector doctors to manage public-sector HIV and AIDS patients. This study investigated the issue in the eThekwini Metropolitan (Metro) area of KwaZuluNatal (KZN) and described possible factors that could influence doctors’ responses. METHOD Study design, study area and sample population This descriptive cross-sectional study of private general practitioners and specialists was undertaken in the eThekwini Metro of KZN. This province has the largest provincial population in South Africa, with Original Research Naidoo, Jinabhai & Taylor PHCFM http://www.phcfm.org A fri ca n Jo ur na l o f P rim ar y H ea lth C ar e & F am ily M ed ic in e