Public-Private Partnership Model: Sustainability of the ZuziMpilo Clinic in Johannesburg, South Africa

Background: South Africa has the highest number of people living with HIV in the world and receives the most U.S. President's Emergency Plan for AIDS Relief (PEPFAR) than any other country. With support from PEPFAR, ZuziMpilo Medical Centre was established in October 2006 in Johannesburg, South Africa to address the existing disparity in the quality of health care services between the public health and private sectors. ZuziMpilo's mission is to provide high quality comprehensive HIV care and treatment at an affordable price accessible to all. The objective of this research is to examine the business model of the clinic to assess the feasibility of providing high quality care while charging clients only fraction of the private-sector fees and the clinic's sustainability without external aid. Methods: We analyzed financial statement for 2009 to calculate revenue received from patient fees and expenses to run ZuziMpilo clinic. We examined de-identified patient medical records to assess patient clinical outcomes and characteristics. The costs of HIV service provision were calculated from a health-care system perspective. Costs were converted from South African Rand to US Dollars using the average exchange rate for 2010 (US Dollars = 7.30 Rand). Results and recommendation: In 2009, 2,267 individuals came to the ZuziMpilo clinic for medical care or ARV visits. The mean age is 34 years and the mean baseline CD4 cell count is 305 cells/µl. Individuals are expected to pay from $20 to $60 depending on the type of services required, resulting in a revenue of $563,796 or an average of $26 per visit. The total cost to run ZuziMpilo in 2009 was approximately $1.4 million. The difference of $840,428 was subsidized by PEPFAR. In order to sustain the clinical function without external support, the cost per patient visit would have to be $65 or $52 per month. Opuni et al. found that the probability of purchase was around 50% for an antiretroviral treatment clinic at the price of $12 per month. From a convenience sample survey, 90% of the patient had completed at least the seventh grade level of education. Sixty-seven percent were employed. Out-of-pocket payments for clinic fees were paid primarily by patients. Other payers were employer or family members. Approximately 50% of the patients reported earnings between $0 to $400 per month. This analysis shows that it would be challenging for the clinic to continue solely relying on patient fee, thus, external support is still required.