People-centeredness in health system reform. Public perceptions of private and public hospitals in South Africa

Lebogang Maseko, Bronwyn Harris




This study explores perceptions of the South African public about the country’s private and public hospitals in light of current health sector reforms aimed at achieving universal health coverage (UHC). A better understanding of perceptions can guide improvements in public sector services and strengthen confidence and trust in the health system.


Eight focus groups, delineated in terms of race (‘black’ and ‘white’ South Africans) and experience with public and private hospitals (recent or indirect), were run. The overarching research question focused on perceptions and experiences with public and private hospitals and which services participants would use in future. Key points of discussion included quality of care, cleanliness, patient satisfaction, staff attitudes, the extent to which views were shared and commonly held within the group, origins of perceptions, as well as recommendations for improving the state of public hospitals.


Transcripts were analysed thematically to reveal an almost-automatic perception that private hospitals are “better” than public hospitals but also, with further exploration, a much more nuanced set of perceptions around the expensiveness of private hospitals, the affordability of public sector care, and wider themes of  trust and acceptability of health services.


Currently within the context of UHC through the introduction of a National Health Insurance (NHI) system in South Africa, trust, quality and acceptability of health services are crucial determinants how much the public will buy-in to the planned changes. As NHI policy grapples with financing and logistics, this research serves as a reminder that health systems are also human systems, with personal encounters at their heart. In order to acceptably serve people and society, policy emphasis is also needed to build culture of people-centred care.

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ISSN 0038-2337 (print), ISSN 2310-3833 (online)

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