Abstract
BackgroundSocial franchising is the fastest growing market-based approach to organising and improving the quality of care in the private sector of low- and middle-income countries, but there is limited evidence on its impact and cost-effectiveness. The “Sky” social franchise model was introduced in the Indian state of Uttar Pradesh in late 2013.Methods/designDifference-in-difference methods will be used to estimate the impact of the social franchise programme on the quality and coverage of health services along the continuum of care for reproductive, maternal and newborn health. Comparison clusters will be selected to be as similar as possible to intervention clusters using nearest neighbour matching methods. Two rounds of data will be collected from a household survey of 3600 women with a birth in the last 2 years and a survey of 450 health providers in the same localities. To capture the full range of effects, 59 study outcomes have been specified and then grouped into conceptually similar domains. Methods to account for multiple inferences will be used based on the pre-specified grouping of outcomes. A process evaluation will seek to understand the scale of the social franchise network, the extent to which various components of the programme are implemented and how impacts are achieved. An economic evaluation will measure the costs of setting up, maintaining and running the social franchise as well as the cost-effectiveness and financial sustainability of the programme.DiscussionThere is a dearth of evidence demonstrating whether market-based approaches such as social franchising can improve care in the private sector. This evaluation will provide rigorous evidence on whether an innovative model of social franchising can contribute to better population health in a low-income setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0269-2) contains supplementary material, which is available to authorized users.
Highlights
Social franchising is the fastest growing market-based approach to organising and improving the quality of care in the private sector of low- and middle-income countries, but there is limited evidence on its impact and cost-effectiveness
There is a dearth of evidence demonstrating whether market-based approaches such as social franchising can improve care in the private sector
This evaluation will provide rigorous evidence on whether an innovative model of social franchising can contribute to better population health in a low-income setting
Summary
The social franchising model in Uttar Pradesh seeks to increase access to and use of basic obstetric care, emergency obstetric care and family planning services. The approach is novel in its focus on maternal health services, its effort to engage with low level and, in some cases, informal healthcare providers and its use of technology such as telemedicine Whether such an approach to social franchising represents the way forward to improving utilisation and quality of maternal health services is unclear. The evaluation of this model will provide an important contribution to the existing literature. There is a critical need for robust evaluations of different social franchising models in a wide range of settings to understand whether they contribute to better population health.
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