Public Private Partnerships for the reduction of surgical backlogs
1
Public Health Medicine, Steve Biko Academic Hospital, Pretoria, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Surgical backlogs, driven by limited weekday theatre-time and human resource shortages, represent health system failures. Backlogs have significant political, economic, and equity implications, particularly in state-funded facilities. In South Africa, prolonged elective surgery waiting times undermine universal health coverage goals, exacerbate preventable morbidity, and erode public trust. Public Private Partnerships (PPPs) are a pragmatic policy instrument to mobilise resources and improve efficiency. This study presents a policy-oriented business case for a targeted PPP to reduce surgical backlogs at an academic hospital in Gauteng Province.
METHODS:
Descriptive health systems and economic analyses were undertaken using routinely collected hospital data and operational modelling. Two PPP scenarios developed: weekend surgical marathons utilising public sector theatres and surgeons, supplemented by contracted nursing staff and volunteer anaesthesiologist from the private sector; secondly use of donated private sector theatre-time staffed by public sector staff. Cost estimates were generated, projected surgical throughput and backlog reduction were modelled over a six-month pilot period. Governance, risk-mitigation, and monitoring frameworks were incorporated to align with public sector accountability requirements. Potential partners were identified and engaged. Support was obtained from the Provincial leadership.
RESULTS:
With an elective surgery backlog of approximately 6,000 patients, modelling showed that 600 additional procedures could be completed over six-months at an estimated nursing agency cost of R 1.2 million, with further efficiency gains achievable through selective case diversion to private facilities, and overall cost-efficiency favourable relative to the opportunity costs of delayed surgery. Blended financing was successfully secured through a commercial bank and a non-governmental organisation, private sector anaesthesiologists committed on a volunteer rotational basis to cover weekend theatre lists.
CONCLUSIONS:
In this resource-constrained environment, strategically designed PPPs offer a politically feasible and economically rational mechanism to address backlogs. When supported by clear governance, transparent contracting, and robust monitoring, PPPs can improve access and efficiency.
Surgical backlogs, driven by limited weekday theatre-time and human resource shortages, represent health system failures. Backlogs have significant political, economic, and equity implications, particularly in state-funded facilities. In South Africa, prolonged elective surgery waiting times undermine universal health coverage goals, exacerbate preventable morbidity, and erode public trust. Public Private Partnerships (PPPs) are a pragmatic policy instrument to mobilise resources and improve efficiency. This study presents a policy-oriented business case for a targeted PPP to reduce surgical backlogs at an academic hospital in Gauteng Province.
METHODS:
Descriptive health systems and economic analyses were undertaken using routinely collected hospital data and operational modelling. Two PPP scenarios developed: weekend surgical marathons utilising public sector theatres and surgeons, supplemented by contracted nursing staff and volunteer anaesthesiologist from the private sector; secondly use of donated private sector theatre-time staffed by public sector staff. Cost estimates were generated, projected surgical throughput and backlog reduction were modelled over a six-month pilot period. Governance, risk-mitigation, and monitoring frameworks were incorporated to align with public sector accountability requirements. Potential partners were identified and engaged. Support was obtained from the Provincial leadership.
RESULTS:
With an elective surgery backlog of approximately 6,000 patients, modelling showed that 600 additional procedures could be completed over six-months at an estimated nursing agency cost of R 1.2 million, with further efficiency gains achievable through selective case diversion to private facilities, and overall cost-efficiency favourable relative to the opportunity costs of delayed surgery. Blended financing was successfully secured through a commercial bank and a non-governmental organisation, private sector anaesthesiologists committed on a volunteer rotational basis to cover weekend theatre lists.
CONCLUSIONS:
In this resource-constrained environment, strategically designed PPPs offer a politically feasible and economically rational mechanism to address backlogs. When supported by clear governance, transparent contracting, and robust monitoring, PPPs can improve access and efficiency.
| eISSN: | 2654-1459 |
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