Fig. 2.

Contracted-purchaser model.The purchaser is an independent Service Provider (SP) contracted to manage implementation of the GPCI on behalf of the MOH. The SP - a large South African health not-for-profit organization with a national footprint – sub-contracts a variety of organizations which assume different roles in the contract management process. These organizations act as a Consortium, which is responsible for advertisement, recruitment, contracting, supervision, monitoring and payment. Recruited GPs are contracted directly by the SP, and their contracts are signed by the GP and an authorized signatory of the SP. Once a GP is appointed, the SP liaises with the DHO to determine a facility for placement. A district-based support partner (DSP) in each district – a sub-contracted district-based organization which is funded to support local health system strengthening – is then responsible for orientation, training, supervision, monitoring and performance management of the GPs. At a facility level, the FM is responsible for overseeing daily activities. GPs are paid monthly upon submission of a timesheet that is verified and co-signed by the FM, an authorized representative of the DSP and the SP’s project manager at the national office. The timesheets are then submitted to the SP’s finance department for verification and payment. The SP submits monthly and quarterly performance reports to the NDOH