A social franchising approach to strengthening infant and young child feeding (IYCF) counseling improves the quality of services at health facilities in Vietnam

Abstract

A network of social franchises was established in 780 government health facilities in Vietnam under the Alive & Thrive initiative to provide a standardized package of IYCF counseling services with upgraded physical spaces, educational materials, and specialized training of health staff. We studied the quality of care at franchise facilities (FF) compared to standard facilities (SF) across 3 dimensions: structure, process and outcome. A mixed methods approach was used to study quality of care in the context of a process evaluation. Data collection included facility inventories, staff surveys, observations of counseling sessions and client exit interviews. Compared to SF, FF had better physical infrastructure and materials (structure), service delivery (process), and client satisfaction (outcome). FF counselors had greater interpersonal communication skills than SF counselors (score 14.2 vs. 9.0, range 0–22), and better knowledge of optimal breastfeeding practices (score 11.5 vs. 9.8 range 0–13). Smaller differences were observed for counseling on complementary feeding between FF and SF (score 5.5 vs. 4.3, range 0–9). In conclusion, a social franchise approach enables the provision of higher quality nutrition counseling services within government health facilities and has potential to improve IYCF practices. Impact will depend upon high utilization and adherence to counseling recommendations.Funded by Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI360