Abstract
BackgroundClinical social franchising is a rapidly growing delivery model in private healthcare markets in low- and middle-income countries. Despite this growth, little is known about providers’ perceptions of the benefits and challenges of social franchising or clients’ reasons for choosing franchised facilities over other healthcare options. We examine these questions in the context of three social franchise networks in Ghana and Kenya.MethodsWe conducted in-depth interviews with a purposive sample of providers from the BlueStar Ghana, and Amua and Tunza networks in Kenya. We also conducted qualitative exit interviews with female clients who were leaving franchised facilities after a visit for a reproductive or child health reason. The total sample consists of 47 providers and 47 clients across the three networks.ResultsProviders perceived the main benefits of participation in a social franchise network to be training opportunities and access to a consistent supply of low-cost family planning commodities; few providers mentioned branding as a benefit of participation. Although most providers said that client flows for franchised services increased after joining the network, they did not associate this with improved finances for their facility. Clients overwhelmingly cited the quality of the client-provider relationship as their main motivation for attending the franchise facility. Recognition of the franchise brand was low among clients who were exiting a franchised facility.ConclusionsThe most important benefit of social franchise programs to both providers and their clients may have more to do with training on business practices, patient counseling and customer service, than with subsidies, technical input, branding or clinical support. This finding may lead to a reconsideration of how franchise programs interact with both their member clinics and the larger health-seeking communities they serve.
Highlights
Clinical social franchising is a rapidly growing delivery model in private healthcare markets in low- and middle-income countries
The objective of this study was to understand experiences with clinical social franchising, from both the provider and client perspective, in the context of three large networks affiliated with international non-governmental organizations (NGOs) in Ghana and Kenya
The national context of social franchising is quite different in the two countries; to the best of our knowledge, BlueStar is the only social franchise network currently operating in Ghana, whereas there are at least four networks in Kenya [1]
Summary
Clinical social franchising is a rapidly growing delivery model in private healthcare markets in low- and middle-income countries. Despite this growth, little is known about providers’ perceptions of the benefits and challenges of social franchising or clients’ reasons for choosing franchised facilities over other healthcare options. The few Sieverding et al BMC Health Services Research (2015) 15:49 studies that have addressed provider motivations to join or maintain membership in a franchise network have found that providers cite a number of factors, including access to medicines [7,8,9], social responsibility [7,8,9], technical improvement [7,8,9,10], improved client relationship management [11] and opportunities for networking [7,9]. In Myanmar, franchised providers experienced increases in income [9], another study on the same network found that finances were not a main motivation for joining the network and providers were concerned that their revenues might decline due to network limits on profit margins [8]
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