Abstract
IntroductionThis paper examines the cost of quality improvements in Population Services International (PSI) Myanmar’s social franchise operations from 2007 to 2009.MethodsThe social franchise commodities studied were products for reproductive health, malaria, STIs, pneumonia, and diarrhea. This project applied ingredients based costing for labor, supplies, transport, and overhead. Data were gathered seven during key informant interviews with staff in the central Yangon office, examination of 3 years of payroll data, examination of a time motion study conducted by PSI, and spreadsheets recording the costs of acquiring and transporting supplies.ResultsIn 2009 PSI Myanmar’s social franchise devoted $2.02 million towards a 94% reduction in commodity prices offered to its network of over 1700 primary care providers. These providers retained 1/3 of the subsidy as revenue and passed along the other 2/3 to their patients in the course of offering subsidized care for 1.5 million health episodes. In addition, PSI Myanmar devoted $2.09 million to support a team of franchise officers who conducted quality assurance for the private providers overseeing service quality and to distributing medical commodities.ConclusionIn Myanmar, the social franchise operated by PSI spends roughly $1.00 in quality management and retailing for every $1.00 spent subsidizing medical commodities. Some services are free, but patients also pay fees for other lines of service. Overall patients contribute 1/6 as much as PSI does. Unlike other NGO’s, health services in social franchises like PSI are not all free to the patients, nor are the discounts uniformly applied. Discounts and subsidies evolve in response to public health concerns, market demand, providers’ cost structures as well as strategic objectives in maintaining the network and its portfolio of services.
Highlights
This paper examines the cost of quality improvements in Population Services International (PSI) Myanmar’s social franchise operations from 2007 to 2009
In areas where government stewardship is lacking, non-governmental organizations (NGOs) find themselves assuming a role in improving health service quality
Typical medical NGOs in low income countries hire most of their medical care providers and keep them on a payroll and directly supervise service quality
Summary
This paper examines the cost of quality improvements in Population Services International (PSI) Myanmar’s social franchise operations from 2007 to 2009. Private health care markets will reliably disappoint social expectations for service quality and their accessibility to the poor [1]. Competitive forces and the absence of insurance programs in Myanmar make it plausible that the equilibrium prices for private medical care observed in Myanmar reflect what patients are willing to pay to purchase medical care episodes and what suppliers can comfortably afford to sell them for. This market solution to medical care provision succeeds in balancing supply with demand. The social franchising solution used by PSI/ Myanmar is to use the commodity distribution network to serve as way to monitor and improve the quality of service
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