_[**Lauren Rawlings**](http://healthmarketinnovations.org/users/lauren-rawlings) is a consultant with CHMI partner BroadReach, living and working in Johannesburg, South Africa. She has completed projects across Africa and India for the International Finance Corporation (IFC), Development Bank of Southern Africa (DBSA), and Gatsheni Management Consulting._
**1. What is your background? What have you found most interesting in your work with CHMI thus far?**
LR: I have a blended background with early career experience in the development field followed by an MBA and several years as a management consultant focused on the health and life sciences sector. Working once again in development, the combination of skills and expertise in business, health, and development were a great fit for CHMI. This project is of great interest to me both personally and professionally – I’m very excited and stimulated by it and have been able to learn a great deal by getting out there and talking to extraordinary people who were the impetus behind everything from small community-based organizations, to large NGOs.
There are definitely a variety of personalities, inspirations and approaches involved in this space in South Africa, though the one thing I found quite surprising is the relatively muted private sector participation. There are interesting public-private partnerships, in hospital service delivery, through which improved health services are being offered to the poor. However, these arrangmentsfunction by contracting out services to the private sector. While this is a great way to leverage resources when faced with capital constraints, it doesn’t necessarily facilitate the transfer of knowledge and skills from one sector to the other. If developed further, however, this model presents a great opportunity for both the public and private spheres to contribute their strengths and form more engaged relationships for the benefit of the poor.
**2. In what ways do you think this can be improved? How can CHMI contribute?**
LR: Unfortunately, the quality of care in South Africa (as in many countries) varies greatly across income levels and geographic areas. A systemic approach is needed to improve this situation, specifically to improve quality and access for underserved communities. Today many of the gaps are filled by philanthropic initiatives which often provide much needed, high-impact services in the communities they reach. However, it seems to me that a systemic approach is required to ensure that all South Africans receive a basic level of care. Government is uniquely positioned to do this; NGOs, religious organization, community groups, and private companies all have roles to play in partnership with government. I think that there is a great opportunity here for cross-country learning. I remember reading a CHMI profile of a program in India where a private company started a rural ambulance service. Although district/provincial hospitals were fairly close, for a seriously ill patient, the time it took to bridge that last few kilometers was crucial. I think there is great benefit to organizations forming true partnerships and learning from one another through regular contact. One thing of real value that CHMI can do for South Africa is to make a proactive effort to disseminate information about particularly innovative and successful programs in other countries to key stakeholders in both the public and private sectors in order to stimulate creative thinking about what next generation public-private partnerships might look like.
**3. Do you think that the impetus for this needs to come more from the government, or should the private sector be encouraged to approach problems in more creative ways?**
LR: I think that both sides need to become equally invested in finding creative solutions to the country’s health care challenges. The main issue is really creating a significant shift in mindset. The public sector needs to better understand the value of its private counterparts, and the private sector needs to have a better sense of the challenges and capabilities of the public sector and how to work with the public sector appropriately and efficiently.
**4. What do you see as potential next steps for the work of CHMI in South Africa?**
LR: BroadReach has already had an initial discussion with the CHMI team about moving from a general landscaping exercise –identifying and documenting programs to more specific studies on how to improve the environment for public-private collaboration in South Africa. An initial step in this direction would be to encourage communication between the two sectors by bringing them together for a series of conversation about the current dynamic of cross-sector engagement. Do they see the same thing? What’s working well? What can be improved? This would be a safe space for individuals to share their views on public-private interaction as it exists today, and an opportunity to generate ideas about how it can evolve. There is a great deal to be gained simply from getting both sides in the same room to talk, building a basic understanding and trust based on a shared interest in what is best for South Africa.
The CHMI web platform is immensely helpful in looking at existing models that are able to effectively deliver health and financial protection for the poor, but CHMI is much more than a website. It has the opportunity to jumpstart thinking in South Africa by bringing people together in workshops to learn from each other and from programs that hold high potential for replication. The important thing is to get people thinking, get them excited about creating successful models in South Africa.