 This study examined the use of private general practitioners, GPS, in five rural district hospitals in the western Cape province, South Africa. It found that the use of private GPS varied widely between hospitals, with some relying heavily on them while others had few or no private GPS. The study also found that the proportion of caesarean deliveries performed by private GPS was inversely related to the size of the hospital and the number of monthly deliveries. Additionally, the study found that private GPS contributed positively to the provision of quality care in the hospitals, but that the contracting model did not incentivize over-servicing. This suggests that different approaches to accessing safe caesarean delivery should be considered depending on the context. This article was authored by Tanya Doherty, Emanuel Davio, Sue Fawcus, and others.