Social Franchising

welcome

introductions

thanks

review agenda

Amua, Kenya

ProFam, Benin

ProFam, Cameroon

NewStart, Lesotho

Blue Star, Ethiopia

Blue Star,Vietnam

20021994 1998 2006

A few points in history

20042000 20081996

GreenStar, Pakistan Janani, India

Well Family Midwife Clinic, Philippines

Smiling Sun Bangladesh

Blue Star, Ghana

Blue Star, Malawi

Blue Star, Philippines

Blue Star, Sierra Leone

Top Reseau, Madagascar

ProFam, Mali

Dushishoze Centres, Rwanda

New Start, S.Africa

New Start, Swaziland

PSI,Togo

New Start, Zimbabwe

SkyHealth Centers (WHP), India

SEWA/PSSN/Sangini, PSI, Nepal

Congo

PSI,Cambodia

PSI, Uganda

MSI Nicaragua

MSI Honduras

20021994 1998 2006

A few points in history

20042000 20081996

MSI Report on Franchising FP and RH servicesSmith

Options EU Report on Social Franchising; Smith

Franchising Health Services in Developing Countries. Montagu

Private sector, human resources and health franchising in Africa Prata, Montagu, Jefferys

Social franchising of TB care through private GPs in Myanmar Lonnroth, Aung, Maung, Kluge and Uplekar

Social Franchising to Improve Quality and Access in Private Health Care in Developing Countries; Bishai, Shah, Walker, Brieger, Peters

The Impact of Franchised Family Planning Clinics in Poor Urban Areas of Pakistan; Hennink and Clements

Social Franchising as a Strategy for Expanding Access to Reproductive Health ServicesMcBride, Ahmed

Franchising Reproductive Health Services Stephenson, Tsui, Sulzbach, Bardsley, Bekele, Giday, Ahmed, Gopalkrishnan, and Feyesitan

Public policy and franchising reproductive health: Current evidence and future directions; WHO

Private Provider Networks; PSP-One

Reaching Youth through Franchise Clinics Decker and Montagu

The effect of social franchising on access to and quality of health services in low- and middle-income countries Koehlmoos, Gazi, Hossain, Zaman

Social Franchising Health Services: WFMC Case Study. Jones and Moore

The impact of a reproductive health franchise on client satisfaction in rural Nepal Agha, Karim, Balal and Sosler

Changes in preceptions of quality of, and access to, services among clients of a fractional franchise network in Nepal Agha, Gage and Balal

http://homepage.mac.com/domdiep/FileSharing15.html  

http://homepage.mac.com/domdiep/FileSharing15.html  

20021994 1998 2006

A few points in history

20042000 20081996

MSI Report on Franchising FP and RH servicesSmith

Options EU Report on Social Franchising; Smith

Franchising Health Services in Developing Countries. Montagu

Private sector, human resources and health franchising in Africa Prata, Montagu, Jefferys

Social franchising of TB care through private GPs in Myanmar Lonnroth, Aung, Maung, Kluge and Uplekar

Social Franchising to Improve Quality and Access in Private Health Care in Developing Countries; Bishai, Shah, Walker, Brieger, Peters

The Impact of Franchised Family Planning Clinics in Poor Urban Areas of Pakistan; Hennink and Clements

Social Franchising as a Strategy for Expanding Access to Reproductive Health ServicesMcBride, Ahmed

Franchising Reproductive Health Services Stephenson, Tsui, Sulzbach, Bardsley, Bekele, Giday, Ahmed, Gopalkrishnan, and Feyesitan

Public policy and franchising reproductive health: Current evidence and future directions; WHO

Private Provider Networks; PSP-One

Reaching Youth through Franchise Clinics Decker and Montagu

The effect of social franchising on access to and quality of health services in low- and middle-income countries Koehlmoos, Gazi, Hossain, Zaman

Social Franchising Health Services: WFMC Case Study. Jones and Moore

The impact of a reproductive health franchise on client satisfaction in rural Nepal Agha, Karim, Balal and Sosler

Changes in preceptions of quality of, and access to, services among clients of a fractional franchise network in Nepal Agha, Gage and Balal

•Comparative studies of franchises with other types of health interventions

•Reaching a consensus on uniform indicators, e.g. CYPs or disability adjusted life years (DALYs)

•health-care provider behaviours ... motivational factors for joining and retaining membership in a franchise.

•Cost-effectiveness and cost-benefit studies

•Operational research studies for:

- optimal mix of services

- cross-subsidization of different services within a franchise

-diversification of funding sources

Geneva meeting on Franchising for Reproductive Health

Clinical Service FranchisesChemonics International Bangladesh (Smiling Sun)

Janani/DKT International India (Surya Clinic)

Marie Stopes International Ethiopia (BlueStar)

Ghana (BlueStar)

Kenya (AMUA)

Malawi (BlueStar)

Philippines (BlueStar)

Sierra Leone (BlueStar)

Vietnam (BlueStar)

Population Services International Benin (ProFam)

Burma

Cambodia (Sun Quality Health)

Cameroon (ProFam)

Congo

India

Lesotho (New Start)

Madagascar (Top Reseau)

Mali (ProFam)

Nigeria

Pakistan (GreenStar)

Rwanda (Dushishoze Centres)

South Africa (New Start)

Swaziland (New Start)

Togo

Uganda

Zambia

Zimbabwe (New Start)

World Health Partners India (SkyHealth Centres and SkyCare Centres)

Health Franchise Programs

Current

None

Unknown status

Type Location Referrals-in

0 5 10 15 20

FP (IUD, Injectable, implants)

EC

Abortion

VSC / Sterilization

Male Circumcision

VCT & Condoms

STI

TB

Ob/Gyn and ANC

PAC

Commodities (Vitamins, LLTNs)

Immunization

Pediatric care

EMOC

PMTCT

Lab / Pap Smear / TB test Bangladesh (Smiling Sun)

India (Surya Clinic)

Ethiopia (BlueStar)

Ghana (BlueStar)

Kenya (AMUA)

Malawi (BlueStar)

Philippines (BlueStar)

Sierra Leone (BlueStar)

Vietnam (BlueStar)

Benin (ProFam)

Burma

Cambodia (Sun Quality Health)

Cameroon (ProFam)

Congo

India

Lesotho (New Start)

Madagascar (Top Reseau)

Mali (ProFam)

Nigeria

Pakistan (GreenStar)

Rwanda (Dushishoze Centres)

South Africa (New Start)

Swaziland (New Start)

Togo

Uganda

Zambia

Zimbabwe (New Start)

India (SkyHealth Centres and SkyCare Centres)

Services

40

564

107102144

60 66 0 32 36

846

25 78 6155

33 4 11 16 13 41 0

279

500

10042 240

434

250235

47 90

100

200

300

400

500

600

700

800

900

Bangladesh (Smiling Sun)

India (Surya Clinic)Ethiopia (BlueStar)Ghana (BlueStar)

Kenya (AMUA)Malawi (BlueStar)

Philippines (BlueStar)Sierra Leone (BlueStar)

Vietnam (BlueStar)Benin (ProFam)

Burma

Cambodia (Sun Quality Health)

Cameroon (ProFam)

CongoIndia

Lesotho (New Start)

Madagascar (Top Reseau)

Mali (ProFam)

Nigeria

Pakistan (GreenStar)

Rwanda (Dushishoze Centres)

South Africa (New Start)Swaziland (New Start)

TogoUgandaZambia

Zimbabwe (New Start)

India (SkyHealth Centres and SkyCare Centres)

Planned Additional

Existing

Number of Clinics 2500

Financing

0 5 10 15 20 25

Out-of-pocket

Voucher

Direct Subsidy

Insurance

Gov't reimbursement

0 5 10 15 20 25

Franchisee Reports

Franchisor Assessment

Mystery Clients

Government Accreditation

Quality Control

BeninBurma CameroonMadagascarMaliRwandaSierra-LeoneTogo

CYP Year-to-DateCYP Year-to-Date DALYs Year-to-DateDALYs Year-to-Date

Chemonics International Bangladesh (Smiling Sun)

Janani/DKT International India (Surya Clinic)

Marie Stopes International Ethiopia (BlueStar) 1486

Ghana (BlueStar) 10121

Kenya (AMUA) 165600

Malawi (BlueStar) 3952

Philippines (BlueStar) 5246

Sierra Leone (BlueStar) 0

Vietnam (BlueStar) 20294

Population Services International Benin (ProFam)

Burma

Cambodia (Sun Quality Health)

Cameroon (ProFam)

Congo 69391

India

Lesotho (New Start) 60106

Madagascar (Top Reseau)

Mali (ProFam)

Nigeria

Pakistan (GreenStar) 1400000

Rwanda (Dushishoze Centres)

South Africa (New Start) 72009

Swaziland (New Start) 6007

Togo 1340

Uganda

Zambia

Zimbabwe (New Start) 20833

World Health Partners India (SkyHealth Centres and SkyCare Centres)

Outcomes

What makes a franchise?

one possible definition

–Outlets are operator-owned

–Fee for service delivered

–Standardization

Clinical Service FranchisesChemonics International Bangladesh (Smiling Sun)

Janani/DKT International India (Surya Clinic)

Marie Stopes International Ethiopia (BlueStar)

Ghana (BlueStar)

Kenya (AMUA)

Malawi (BlueStar)

Philippines (BlueStar)

Sierra Leone (BlueStar)

Vietnam (BlueStar)

Population Services International Benin (ProFam)

Burma

Cambodia (Sun Quality Health)

Cameroon (ProFam)

Congo

India

Lesotho (New Start)

Madagascar (Top Reseau)

Mali (ProFam)

Nigeria

Pakistan (GreenStar)

Rwanda (Dushishoze Centres)

South Africa (New Start)

Swaziland (New Start)

Togo

Uganda

Zambia

Zimbabwe (New Start)

World Health Partners India (SkyHealth Centres and SkyCare Centres)

Clinical Service FranchisesChemonics International Bangladesh (Smiling Sun)

Janani/DKT International India (Surya Clinic)

Marie Stopes International Ethiopia (BlueStar)

Ghana (BlueStar)

Kenya (AMUA)

Malawi (BlueStar)

Philippines (BlueStar)

Sierra Leone (BlueStar)

Vietnam (BlueStar)

Population Services International Benin (ProFam)

Burma

Cambodia (Sun Quality Health)

Cameroon (ProFam)

Congo

India

Lesotho (New Start)

Madagascar (Top Reseau)

Mali (ProFam)

Nigeria

Pakistan (GreenStar)

Rwanda (Dushishoze Centres)

South Africa (New Start)

Swaziland (New Start)

Togo

Uganda

Zambia

Zimbabwe (New Start)

World Health Partners India (SkyHealth Centres and SkyCare Centres)

SHEF/CFW Kenya (HealthStore)

ProRedesSalud Peru (ProRedesSalud)

AED Nepal

all free services

all free services

all free services

may meet our franchise definition

1. Prioritize research needed to improve franchise operations

2. Commit to collaborate across programs to answer these questions

3. Begin defining how a study can be put into operation

Goals for today