Innovative Service Delivery in Primary Health Care: Evaluating Unjani Clinics, Retail Health, and Public-Private Partnerships

This study investigates the contributions of private-sector innovations to strengthening primary health care (PHC) in South Africa through a systematic literature review. Grounded in the health systems strengthening framework and the primary health care approach, the review critically analyses key private initiatives, including nurse-led Unjani Clinics, retail pharmacy-based health services, and public-private partnerships (PPPs). These models demonstrate significant potential in improving accessibility, scalability, and efficient resource use within the PHC system, particularly in underserved urban and rural communities. The findings highlight how private-sector involvement can complement public health efforts by extending service reach, empowering frontline health workers, and optimising limited health resources. Despite these positive contributions, the study identifies equity, policy coherence, and long-term sustainability challenges. Private-sector models sometimes risk exacerbating health disparities if not fully aligned with universal health coverage goals and national health strategies. Moreover, the sustainability of PPPs and retail services depends heavily on regulatory oversight, clear quality standards, and robust governance frameworks. To maximise the impact of private-sector participation, the study recommends enhanced policy integration, strengthened collaboration between public and private actors, and rigorous monitoring to ensure alignment with South Africa’s national health priorities and the overarching principles of equity and social justice in PHC delivery.