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Social Franchising

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					Social Franchising



    welcome

    introductions

    thanks

    review agenda
                 A few points in history
                                                                              NewStart, Lesotho

                                                  Dushishoze                                                          New Start, S.Africa
                   Well Family Midwife                                 ProFam, Cameroon
                                                  Centres, Rwanda
                   Clinic, Philippines                                                                                          PSI, Uganda
                                                                           ProFam, Benin
   GreenStar,                                                                                                                   Blue Star,
                              Janani, India   Top Reseau,                                         ProFam, Mali
   Pakistan                                                                                                                     Vietnam
                                              Madagascar                    Amua, Kenya
                                                                                                                                Blue Star,
                                                                                  Congo                                         Ethiopia

1994            1996            1998              2000                 2002                2004           2006                    2008




                                                      PSI,Cambodia

                                                            PSI,Togo                                 Smiling Sun Bangladesh

                                                       SEWA/PSSN/Sangini,                                  Blue Star, Ghana
                                                       PSI, Nepal
                                                                                                          Blue Star, Malawi
                           New Start, Zimbabwe                          New Start, Swaziland
                                                                                                       Blue Star, Philippines
                                                            MSI Honduras
                                                                                                     Blue Star, Sierra Leone

                                                 MSI Nicaragua                                          SkyHealth Centers (WHP), India
                             A few points in history
                                                                                                             The effect of social franchising on access to and
                                                               The Impact of Franchised Family
                                                                                                             quality of health services in low- and middle-income
                                                               Planning Clinics in Poor Urban Areas
                                                                                                             countries Koehlmoos, Gazi, Hossain, Zaman
                                                               of Pakistan; Hennink and Clements

                                                                  Franchising Reproductive Health Services                 Public policy and franchising
      Social Franchising as a Strategy for Expanding              Stephenson, Tsui, Sulzbach, Bardsley, Bekele,            reproductive health: Current
      Access to Reproductive Health Services                      Giday, Ahmed, Gopalkrishnan, and Feyesitan               evidence and future
      McBride, Ahmed                                                                                                       directions; WHO


     1994                 1996                 1998                 2000               2002                 2004                2006                 2008


                                                                Social Franchising Health Services:            Private Provider
                                                                WFMC Case Study. Jones and Moore               Networks; PSP-One

                                                                                        Private sector, human resources and
                                                     Franchising Health Services
                                                                                        health franchising in Africa Prata,
                                                     in Developing Countries.
                                                                                        Montagu, Jefferys
                                                     Montagu
                                                                                      Changes in preceptions of quality of, and access to,
                                                                                      services among clients of a fractional franchise network in
                                                                                      Nepal Agha, Gage and Balal
                                                                                      The impact of a reproductive health franchise on client
                                           Options EU Report on Social                satisfaction in rural Nepal Agha, Karim, Balal and Sosler
                                           Franchising; Smith
                                                                                      Social franchising of TB care through private GPs in
                                                                                      Myanmar Lonnroth, Aung, Maung, Kluge and Uplekar
                    MSI Report on Franchising FP and RH services                                          Reaching Youth through Franchise
                    Smith                                                                                 Clinics Decker and Montagu

                                                                                   Social Franchising to Improve Quality and Access in Private Health Care
http://homepage.mac.com/domdiep/FileSharing15.html
                                                                                   in Developing Countries; Bishai, Shah, Walker, Brieger, Peters
                             A few points in history
                                                                                                             The effect of social franchising on access to and
                                                               The Impact of Franchised Family
                                                                                                             quality of health services in low- and middle-income
                                                               Planning Clinics in Poor Urban Areas
                                                                                                             countries Koehlmoos, Gazi, Hossain, Zaman
                                                               of Pakistan; Hennink and Clements

                                                                  Franchising Reproductive Health Services                 Public policy and franchising
      Social Franchising as a Strategy for Expanding              Stephenson, Tsui, Sulzbach, Bardsley, Bekele,            reproductive health: Current
      Access to Reproductive Health Services                      Giday, Ahmed, Gopalkrishnan, and Feyesitan               evidence and future
      McBride, Ahmed                                                                                                       directions; WHO


     1994                 1996                 1998                 2000               2002                 2004                2006                 2008


                                                                Social Franchising Health Services:            Private Provider
                                                                WFMC Case Study. Jones and Moore               Networks; PSP-One

                                                                                        Private sector, human resources and
                                                     Franchising Health Services
                                                                                        health franchising in Africa Prata,
                                                     in Developing Countries.
                                                                                        Montagu, Jefferys
                                                     Montagu
                                                                                      Changes in preceptions of quality of, and access to,
                                                                                      services among clients of a fractional franchise network in
                                                                                      Nepal Agha, Gage and Balal
                                                                                      The impact of a reproductive health franchise on client
                                           Options EU Report on Social                satisfaction in rural Nepal Agha, Karim, Balal and Sosler
                                           Franchising; Smith
                                                                                      Social franchising of TB care through private GPs in
                                                                                      Myanmar Lonnroth, Aung, Maung, Kluge and Uplekar
                    MSI Report on Franchising FP and RH services                                          Reaching Youth through Franchise
                    Smith                                                                                 Clinics Decker and Montagu

                                                                                   Social Franchising to Improve Quality and Access in Private Health Care
http://homepage.mac.com/domdiep/FileSharing15.html
                                                                                   in Developing Countries; Bishai, Shah, Walker, Brieger, Peters
Geneva meeting on Franchising for
      Reproductive Health

          • Comparative studies of franchises with other types
           of health interventions

          • Reaching a consensus on uniform indicators, e.g.
           CYPs or disability adjusted life years (DALYs)

          • health-care provider behaviours ... motivational
           factors for joining and retaining membership in a
           franchise.


          • Cost-effectiveness and cost-benefit studies

          • Operational research studies for:
             - optimal mix of services
             - cross-subsidization of different services within a
               franchise
             - diversification of funding sources
Clinical Service Franchises
   Chemonics International             Bangladesh (Smiling Sun)
   Janani/DKT International            India (Surya Clinic)
   Marie Stopes International          Ethiopia (BlueStar)
                                       Ghana (BlueStar)
                                       Kenya (AMUA)
                                       Malawi (BlueStar)
                                       Philippines (BlueStar)
                                       Sierra Leone (BlueStar)
                                       Vietnam (BlueStar)
   Population Services International   Benin (ProFam)
                                       Burma
                                       Cambodia (Sun Quality Health)
                                       Cameroon (ProFam)
                                       Congo
                                       India
                                       Lesotho (New Start)
                                       Madagascar (Top Reseau)
                                       Mali (ProFam)
                                       Nigeria
                                       Pakistan (GreenStar)
                                       Rwanda (Dushishoze Centres)
                                       South Africa (New Start)
                                       Swaziland (New Start)
                                       Togo
                                       Uganda
                                       Zambia
                                       Zimbabwe (New Start)
   World Health Partners               India (SkyHealth Centres and SkyCare Centres)
Health Franchise Programs




                  Current
                  None
                  Unknown status
Type   Location   Referrals-in
Services
Number of Clinics   2500
                           Financing

Gov't reimbursement




          Insurance




      Direct Subsidy




            Voucher




      Out-of-pocket




                       0   5   10   15   20   25
                               Quality Control

Government Accreditation




                                     Benin
                                     Burma
         Mystery Clients
                                     Cameroon
                                     MadagascarMali
                                     Rwanda
                                     Sierra-Leone
                                     Togo


  Franchisor Assessment




      Franchisee Reports




                           0     5      10            15   20   25
                                              Outcomes
                                                                    CYP Year-to-Date   DALYs Year-to-Date

Chemonics International             Bangladesh (Smiling Sun)
Janani/DKT International            India (Surya Clinic)
Marie Stopes International          Ethiopia (BlueStar)                  1486
                                    Ghana (BlueStar)                     10121
                                    Kenya (AMUA)                        165600
                                    Malawi (BlueStar)                    3952
                                    Philippines (BlueStar)               5246
                                    Sierra Leone (BlueStar)                0
                                    Vietnam (BlueStar)                   20294
Population Services International   Benin (ProFam)
                                    Burma
                                    Cambodia (Sun Quality Health)
                                    Cameroon (ProFam)
                                    Congo                                69391
                                    India
                                    Lesotho (New Start)                                      60106
                                    Madagascar (Top Reseau)
                                    Mali (ProFam)
                                    Nigeria
                                    Pakistan (GreenStar)                1400000
                                    Rwanda (Dushishoze Centres)
                                    South Africa (New Start)                                 72009
                                    Swaziland (New Start)                                    6007
                                    Togo                                 1340
                                    Uganda
                                    Zambia
What makes a franchise?

   one possible definition


   –Outlets are operator-owned

   –Fee for service delivered

   –Standardization
Clinical Service Franchises
   Chemonics International             Bangladesh (Smiling Sun)
   Janani/DKT International            India (Surya Clinic)
   Marie Stopes International          Ethiopia (BlueStar)
                                       Ghana (BlueStar)
                                       Kenya (AMUA)
                                       Malawi (BlueStar)
                                       Philippines (BlueStar)
                                       Sierra Leone (BlueStar)
                                       Vietnam (BlueStar)
   Population Services International   Benin (ProFam)
                                       Burma
                                       Cambodia (Sun Quality Health)
                                       Cameroon (ProFam)
                                       Congo
                                       India
                                       Lesotho (New Start)
                                       Madagascar (Top Reseau)
                                       Mali (ProFam)
                                       Nigeria
                                       Pakistan (GreenStar)
                                       Rwanda (Dushishoze Centres)
                                       South Africa (New Start)
                                       Swaziland (New Start)
                                       Togo
                                       Uganda
                                       Zambia
                                       Zimbabwe (New Start)
   World Health Partners               India (SkyHealth Centres and SkyCare Centres)
Clinical Service Franchises
   Chemonics International             Bangladesh (Smiling Sun)
   Janani/DKT International            India (Surya Clinic)
   Marie Stopes International          Ethiopia (BlueStar)
                                       Ghana (BlueStar)
                                       Kenya (AMUA)
                                       Malawi (BlueStar)
                                       Philippines (BlueStar)
                                       Sierra Leone (BlueStar)
                                       Vietnam (BlueStar)
   Population Services International   Benin (ProFam)
                                       Burma
                                       Cambodia (Sun Quality Health)
                                       Cameroon (ProFam)
                                       Congo                                           all free services
                                       India
                                       Lesotho (New Start)
                                       Madagascar (Top Reseau)
                                       Mali (ProFam)
                                       Nigeria
                                                                                       all free services
                                       Pakistan (GreenStar)
                                       Rwanda (Dushishoze Centres)
                                       South Africa (New Start)                        all free services
                                       Swaziland (New Start)
                                       Togo
                                       Uganda
                                       Zambia
   SHEF/CFW                            Kenya (HealthStore)                             may meet our
                                       Zimbabwe (New Start)
   ProRedesSalud                       Peru (ProRedesSalud)                            franchise
   World Health Partners               India (SkyHealth Centres and SkyCare Centres)
   AED                                 Nepal                                           definition
           Goals for today


1. Prioritize research needed to improve franchise
   operations

2. Commit to collaborate across programs to answer
   these questions

3. Begin defining how a study can be put into
 operation

				
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