Public and Private Sector Collaboration to Create and Sustain Care Work in South Africa

Abstract

Background: South Africa faces a dual challenge of high unemployment and a growing demand for care for older persons within a constrained fiscal environment. These pressures highlight the need for innovative approaches to delivering and funding care solutions. However, limited research exists on how public-private partnerships can be leveraged to create and sustain care work in South Africa. Aims: This study aims to address the research question of "How can public and private sectors collaborate to create and sustain care work in South Africa?" by assessing the literature gap, capturing learnings from public and private sector key informants and developing recommendations to operationalize the research findings, informed by an institutional logics lens to make sense of the logics of the state (public sector) and the market (private sector). Methods: Semi-structured, in-depth interviews were conducted with 22 key informants from public, private (for-profit and nonprofit) sectors. The interviews were analyzed using inductive thematic analysis, and themes were structured using the framework method. Institutional logics of the state and market guided the interpretation of findings and informed the recommendations. Findings: Key informants outlined an imperative for the creation and sustainability of care work; the evolving nature of care work (including the economic impact of care work, the intersection between health and social care, and the role and importance of care in communities); challenges (related to the socioeconomic context, fragmented systems, and contracting and funding considerations), shared lessons learnt from initiatives and policies and made recommendations that could inform policies and interventions. Discussion and recommendations: Informed by institutional logics, this section contrasts the primary goals of public (state) and private (market) logics, examining tensions and intersections regarding the role and value of creating and sustaining care work. It also explores how the professionalization of care work, procurement, contracting, and funding practices influence the creation and sustainability of care work to inform recommendations.