Abstract
Despite the rapid growth of social franchising, there is little evidence on its population impact in the health sector. Similar in many ways to private-sector commercial franchising, social franchising can be found in sectors with a social objective, such as health care. This article evaluates the World Health Partners (WHP) Sky program, a large-scale social franchising and telemedicine program in Bihar, India. We studied appropriate treatment for childhood diarrhea and pneumonia and associated health care outcomes. We used multivariate difference-in-differences models to analyze data on 67,950 children ages five and under in 2011 and 2014. We found that the WHP-Sky program did not improve rates of appropriate treatment or disease prevalence. Both provider participation and service use among target populations were low. Our results do not imply that social franchising cannot succeed; instead, they underscore the importance of understanding factors that explain variation in the performance of social franchises. Our findings also highlight, for donors and governments in particular, the importance of conducting rigorous impact evaluations of new and potentially innovative health care delivery programs before investing in scaling them up.
Highlights
We found that the World Health Partners (WHP)-Sky program did not improve rates of appropriate treatment or disease prevalence
In this study we evaluated the impact of the World Health Partners (WHP) Sky program, a prominent social franchising program operating in twelve districts across the Indian state of Bihar, on the appropriate treatment and prevalence of childhood diarrhea and pneumonia
When we examined program intensity, we found no evidence of a dose-response relationship to appropriate treatment
Summary
The private sector delivers a large share of primary health care services in many low-income countries, in rural areas, where public-sector providers are scarce.[1,2,3,4,5,6] In India, the private sector provides about 70–80 percent of these services, and the vast majority of private services are provided by unqualified informal-sector providers.[4,7,8] Health care service quality in rural settings is often poor.[5,9,10] Partly as a result, preventable childhood illnesses cause persistently high rates of mortality across India despite being inexpensive to treat.[11]. Strategies to improve the quality of health care services in low-resource settings increasingly focus on new organizational models and technologies that are scalable and financially sustainable. Within this landscape, social franchising models have become prominent. New technologies are often an integral part of efforts to improve health service delivery in low-resource settings These technologies include telemedicine, which enables patients in remote areas to consult directly with highly trained clinicians in distant locations.[16] mobile decision support technologies can help health workers who may have gaps in their training deliver timely and appropriate care, raising the quality of the care
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
