Towards developing new private sector maternity care models in South Africa: results from a deliberative stakeholder dialogue.

backgroundPublic-private partnerships are a key strategy in many middle-income countries to promote universal access to quality health care and reduce inequities. In maternity care, addressing inappropriate patterns of care within the private sector is essential for these partnerships to succeed. Caesarean rates are rising globally, four of the five countries with the highest caesarean rates are middle-income countries and private hospital care is a strong predictor of caesarean birth. Maternal health care in South Africa faces major challenges in both the public and private sectors. In the public sector, overburdened services and limited skilled staff contribute to poor outcomes. In the private sector, a caesarean birth rate of 77% reflects widespread inappropriate care. Improving equity and outcomes requires leveraging private sector resources, but only if quality issues are addressed. This calls for the development and implementation of new private sector maternity care models. We proposed an alternative model as a starting point for stakeholder engagement. A deliberative dialogue was convened in 2024 to discuss the proposed model. Stakeholders were purposively selected to provide input. The session was audio-recorded and analysed using thematic content analysis. This paper presents a thematic analysis of the issues and responses that emerged from the dialogue.

resultsKey themes that emerged included the need for: a common set of protocols and clinical guidelines for maternity care; a clearly defined benefits package covering antenatal, intrapartum, and postnatal care; a multidisciplinary maternity care team; targeted education to address fears and misperceptions about midwife-led vaginal birth; legislative reforms to allow women-centred team-based birthing units to function as contracting entities. While there was strong support for further development of alternative maternity care models, follow-up discussions revealed the need for a broader coordination process to advance these proposals.

conclusionsHigh caesarean birth rates in South Africa’s private sector indicate inappropriate care. The proposed maternity care model emphasizes women-centred, team-based approaches. Stakeholders at the dialogue expressed support for legislative reforms to allow for the creation of multi-disciplinary birthing units. The need for large-scale, innovative behaviour change communication to reduce fears of spontaneous labour and vaginal births, should not be underestimated. Maternity care presents an ideal opportunity to develop public private-partnerships critical towards an integrated, equitable health system in South Africa. CLINICAL TRIAL NUMBER: Not applicable.