Establishing and Scaling-Up Clinical Social Franchise Networks: Lessons Learned From Marie Stopes International and Population Services International.

Sarah Thurston,Anna Mackay,Nirali M Chakraborty,Pierre Moon,Brendan Hayes

doi:10.9745/ghsp-d-15-00057

Sarah Thurston, Anna Mackay + Show 3 more

Open Access

https://doi.org/10.9745/ghsp-d-15-00057

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Abstract

In many low- and middle-income countries, a majority of people seek health care from the private sector. However, fragmentation, poor economies of scale, inadequate financing, political opposition, a bias toward curative services, and weak regulatory and quality control systems pose serious challenges for the private sector. Social franchising addresses a number of these challenges by organizing small, independent health care businesses into quality-assured networks. Global franchisors Marie Stopes International (MSI) and Population Services International (PSI) have rapidly scaled their family planning social franchising programs in recent years, jointly delivering over 10.8 million couple-years of protection (CYPs) in 2014-up 26% from 8.6 million CYPs just 1 year prior. Drawing on experience across MSI's 17 and PSI's 25 social franchise networks across Africa, Asia, and Latin America and the Caribbean, this article documents the organizations' operational approaches, challenges faced, and solutions implemented. The organizations provide intensive capacity building and support for private-sector providers, including clinical training, branding, monitoring quality of franchised services, and commodity support. In addition, franchising programs engage providers and clients through behavior change communication (BCC) and demand generation activities to raise awareness and to attract clients, and they implement initiatives to ensure services are affordable for the lowest-income clients. Social franchise programs offer the private sector a collective platform to better engage government in health policy advocacy and for integrating into new public health care financing and procurement mechanisms. The future of social franchising will require developing approaches to scale-up and sustain the model cost-effectively, selectively integrating other health services into the franchise package, and being responsive to evolving health care financing approaches with the potential to contribute to universal health coverage.

Highlights

Global Health: Science and Practice 2015 | Volume 3 | Number 2Southeast Asia, and 79% in South Asia sought health care in the private sector in response to children’s illness,[1] without meaningful differences between the rich and poor.Patients often prefer the private sector over public hospitals or clinics for their perceived availability, including shorter waiting times and better customer service orientation.[2]
Marie Stopes International (MSI) and Population Services International (PSI) play an important support role, namely to target key underserved groups with health information and ensure communities are aware that quality, affordable services are available at their local franchisee clinic
Clinical social franchise networks may have opportunities for greater or full domestic autonomy, as seen with the Well Family network in the Philippines[25], and the need for donor subsidy is likely to decline in countries where domestic financing systems are able to cover health care costs for the poor while a growing middle class may increase the number of clients willing and able to pay for services

Summary

Introduction

Global Health: Science and Practice 2015 | Volume 3 | Number 2Southeast Asia, and 79% in South Asia sought health care in the private sector in response to children’s illness,[1] without meaningful differences between the rich and poor.Patients often prefer the private sector over public hospitals or clinics for their perceived availability, including shorter waiting times and better customer service orientation.[2]. Under the social franchising model, the franchisor is the entity that organizes private clinics into quality-assured networks while providing a comprehensive support package, ranging from training, quality monitoring, and commodities to branding, marketing, behavior change communication (BCC), and demand generation support.

Results

Conclusion