Complementarity crucial in health care delivery

Public and private hospitals can collaborate and complement to deliver healthcare.

This article examines one example of public–private complementarity in practice. 

Public hospitals are state owned while private hospitals are under private ownership.  

The relationship between Citimed Chitungwiza Hospital and Chitungwiza General Hospital is worth mentioning because of positive health outcomes it has given the Chitungwiza community of 1,2 million people.

The example illustrates the importance of shared goals, mutual understanding, and structured, ongoing communication to develop a strong working relationship between the public and private sectors when collaborating around health.

In-sector collaborations rather than competition to improve community healthcare confirms that players can make a bigger impact if they work collaboratively rather than independently and in competition by aligning efforts.

The dangers lie in perceptions of not just the general public but even the service providers themselves.

The public sector thinks that the private sector is only for profiteering. On the other hand the private sector thinks that the public sector is inefficient and unable to deliver a quality service. 

The two have been able to address barriers to access and use, tailor the service delivery mix to address the expectations and community health needs, including use of different types of service models that optimise the patient experience.

When all health facilities perform well and are effectively utilised, the overall performance of the health system improves.

While hospitals are social institutions in which people invest their trust they in fact are a dominant component of the health delivery system.

The services provided by Citimed hospitals have been growing since inception in 1999, particularly in the provision of day facilities.

The hospital is owned by a group of doctors and institutional investor.

The ability by Citimed to acknowledge the community in which it exists has improved accessibility by marginalised groups. 

Its services are both affordable and packages flexible.

In its maternity product it has created a midwifery scheme that offers subsidised rates that in some cases are even cheaper than public hospitals. 

The main objective is providing service at affordable user fees and offer integrated, innovative community centred healthcare solutions.

It offers solutions to Accident and emergency services and admission wards with 150 beds.  

Citimed Hospital has admission wards such as Surgical, Medical, Paediatric, ICU and a High Dependency Unit.

It also has 2 theatres and a Diagnostics Unit for Radiology and X-Rays. The hospital as from April 2019 shall be screening for breast cancer and shall be doing CT scans thus providing convenience to the community and beyond.

Even though the hospital is private the charges are within public user fees.

This has been done to provide healthcare access to the majority. 

This has resulted in a close working relationship with Chitungwiza General Hospital and has capacity to provide services to over 100 clients per day.    

It is one of the few private hospitals still accepting medical aid cover from almost all providers.

If one is on medical aid the hospital does not ask for a deposit or co-payment.

This is a major issue with other private hospitals. Innovation has been a key component of their service delivery and along with it comes a 24 hour service at affordable fees and 150 beds.

The institution also has its own pharmacy from which a wide range of drugs and medicines are dispensed. 

Other major various operations are conducted at the hospital for no charges as these are usually funded through cooperating partners both local and international. 

These include Cleft lip operations on children with 40 operations having been done in January this year, Cataract extraction for the senior citizens, there is a dental unit and a Family support clinic.

The hospital also offers free services and distribution of ARV drugs.

It launched on 22nd February 2019 free screening of cervical cancer and plans are underway to conduct Paediatric heinous operations in the immediate future.

The immediate plan is to target those on the waiting lists of public hospitals to ease the burden for patients and public hospitals. The target is to do 1 200 patients every year.

On the social responsibility and medical level the hospital has assisted persons living with Albinism and works with their representative organizations.

Apart from assisting with the provision of sun screen lotions the hospital has also conducted 90 successful skin cancer operations since the programme started in April 2018.

Patients have been drawn from places as far as Binga, Mberengwa and Chipinge and the target is to conduct about 1 200 skin operations a year.

Some of the directors who are qualified doctors who have a shareholding assist with various initiatives through their networks for the benefit of the community.

The progress by Citimed in Chitungwiza has resulted in opportunities to expand to Mbare. 

A facility is already under renovation and very soon Mbare residents will access their services.

With a resident doctor and almost 50 nurses and total staff complement of 140 the private hospital has delivered on their mandate at affordable fees. 

To demonstrate this it has won various accolades in recognition of these efforts among which are —

The most trusted brand, Hospital of the year and even leader of the year in recognition of the CEO and Board’s efforts.

It is commendable.

Challenges remain but the hospital has been able to refurbish. 

Other challenges of medicines and drugs supplies exist but these continue to be well managed to ensure patients are not compromised from both an availability and pricing perspective.  

Through complementing each other with Chitungwiza hospital there has been improvement in hospital performance and patient outcomes.

This has played an important role in our progress towards Universal Health Coverage.

These are positive outcomes derived from efforts of improving hospital planning and management and continual monitoring and adjustment.

Chitungwiza General Hospital is ISO Certified and Citimed is undergoing processes towards certification.

However, achieving and maintaining high-performing hospitals and health systems is a complex task as it requires capacity to set policy and lead actions for improved planning and management.

For many hospitals the perception is that a gap still exists between the approved standards of care and the actual quality of services provided. 

The complementary relationship between the two has assisted with closing this gap.

In health systems like ours the government must build and sustain collaborations with all health-care providers, including private ones.

There needs to be a clear understanding of the place of public and private providers within the national strategy, this to expand health services and advance equity at facility level as well as at the level of the health system. 

While perceptions are that public hospitals are less efficient than private hospitals and that patients with higher income capacity hold better access to private hospital provision the Chitungwiza-Citimed case confirms that even private hospitals can still offer services to vulnerable societal groups at competitive user fees at the same time offering a quality service.

The user fees being charged by Citimed Hospitals have contributed to realisation of affordability of health services within the community.

Service coverage and access to and use of hospital services often depends on a person’s socioeconomic status. 

The two hospitals remain the central focus of health care in the community offering training for health professionals, as well as referral services, and are often used as the benchmark for the overall health system.

The starting point of how this relationship keeps working to the advantage of the community is its alignment towards the overall health system goal of affordability.

Even if public hospitals are dominant in the system as is our case where public hospitals constitute 70 percent of health delivery against 30 percent of the private sector issues of aligning resources with population needs are still important in the context of both equity and quality. 

This case demonstrates that private hospitals can actually fill a gap if they chose to work ‘hand in glove’ with public health hospitals especially on user fees.

Overall, this observation contributes to conversations on the role of the private sector in providing hospital services and how different systems, institutions, and incentive structures positively affect outcomes in the public and private hospital sectors for the benefit of the public.

Private hospitals are a valuable component of our health delivery system and can add value to public hospitals in various ways if user fees are friendly. The two can complement each other.

l Gwinyai and Majongwe are from Health Decisions Consulting (Private) Limited.

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