Article

Franchising of Health Services in Low-Income Countries

Authors:
To read the full-text of this research, you can request a copy directly from the author.

Abstract

Grouping existing providers under a franchised brand, supported by training, advertising and supplies, is a potentially important way of improving access to and assuring quality of some types of clinical medical services. While franchising has great potential to increase service delivery points and method acceptability, a number of challenges are inherent to the delivery model: controlling the quality of services provided by independent practitioners is difficult, positioning branded services to compete on either price or quality requires trade-offs between social goals and provider satisfaction, and understanding the motivations of clients may lead to organizational choices which do not maximize quality or minimize costs. This paper describes the structure and operation of existing franchises and presents a model of social franchise activities that will afford a context for analyzing choices in the design and implementation of health-related social franchises in developing countries.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the author.

... The study by Montagu (2002) in health service established the focus of the field. Despite the field's multidisciplinary nature, most of the literature focuses on health science. ...
... Other factors include market saturation, search for profit, and intense competition (Alon, 2004;. Though franchisors and franchisees may engage in corporate social responsibility activities (Calderon-Monge & Huerta-Zavala, 2015), the bottom line is profit maximization (Montagu, 2002). ...
... Social franchising is variously defined, but the consensus is on the intention to achieve social benefits (Du Toit, 2017). It is a contractual arrangement that uses the format of commercial franchising to achieve social goals in different locations and countries (Montagu, 2002). ...
Article
We present a comprehensive review of social franchising literature and an integrated framework highlighting factors and theories driving the concept. Bibliometric and content analysis are used to analyze 111 articles between 2002 and 2018 from ISI Web of Science and Scopus. The following three research streams are identified: motivations for social franchising, how social franchising work, and impact of social franchising. These are integrated into a conceptual framework of five factors providing insights into value creation, performance improvement, and minimization of failures among social franchises. The review responds to calls for theoretical explorations in the field and provides bases for further studies.
... Bir ülkede çalışan model, satın alma gücü, özel sağlık hizmeti sağlayıcılarının sayısı ve hizmetlere erişim gibi sosyal, kültürel, ekonomik ve politik farklılıklar nedeniyle başka bir ülkede işe yaramayabilir (LaVake, 2003). Montagu (2002), sosyal franchising programlarının amacını, sağlayıcı üyelerine fayda sağlamak için bir franchise ağının ticari ilişkisini kullanmak ve daha sonra bu faydaları sosyal olarak faydalı hizmetlere aktarmak olduğunu ifade etmiştir. Sosyal franchising'i göz ününde bulundurmanın yaygın olarak açıklanan nedenleri, bir sosyal girişimin erişimini genişletmek, mevcut faaliyetleri daha büyük bir coğrafi bölgeyi kapsayacak şekilde büyütmek ve daha fazla yararlanıcıya ulaşmak, kaliteyi korurken orijinal hedeflere odaklanmış olarak kuruluşun kapsamını genişletmektir (Asemota ve Chahine, 2017). ...
... Sosyal franchising'in uygulanması üç stratejik girişimi içerir: hizmet kalitesini artırma, hizmet kullanılabilirliğini artırma ve yeni franchise markasını aktif olarak tanıtmadır (Ngo vd., 2010). Her girişimde, franchise programlarının etkili olması sağlanmalıdır çünkü bir girişimdeki başarının diğerlerine yayılma etkisi vardır ve Şekil 1'de gösterildiği gibi her alanı sırayla güçlendirmektedir (Montagu, 2002). https://dergipark.org.tr/tr/pub/usaysad ...
... Kaynak: Montagu, D. (2002). Franchising of health services in low-income countries. ...
Article
Full-text available
Sosyal franchising, toplumsal fayda sağlamak amacıyla ticari franchise yapısını kullanan, sözleşmeye bağlı olarak oluşturulan bir sistemdir. Sağlık alanında franchising ise, hizmetlerin sunumundaki eşitsizlikler ve erişim problemlerini gidermek ve kaliteli hizmet sunumundan gelir düzeyi düşük bireylerin de faydalanmasına imkân veren bir uygulamadır. Sağlıkta sosyal franchising daha çok az gelişmiş ve gelişmekte olan ülkelerde yaşayan bireylerin sağlık hizmetlerinden, özellikle anne-çocuk sağlığı, üreme sağlığı, aile planlaması gibi, faydalanmalarını amaçlamaktadır. Franchising ve sosyal franchising tanımlarından yola çıkarak sağlık sektöründeki sosyal franchising örneklerini teorik çerçevede ele almak amaçlanmıştır. Çalışmada literatür taraması yapılmıştır. Sosyal franchising kavramı ve sağlık hizmetlerindeki uygulamaları ayrıntılı bir şekilde incelenmiştir. Sosyal franchising uygulamalarına bakıldığında, sosyal ihtiyaçların geniş kapsamlı ve optimal bir şekilde karşılandığı görülmektedir. Bu yüzden geleneksel franchise'lardan en önemli farkı, sosyal franchising'in nihai hedefidir. Sağlık alanında sosyal franchising, az gelişmiş ve gelişmekte olan ülkelerde kamunun sağlık konusundaki yükünü hafifleterek, sağlık hizmetlerinin iyileştirilmesi bakımından son derece önemlidir. Sosyal franchising sağlık hizmetlerine erişimde fırsat eşitliği sunmakla birlikte, kaliteli sağlık hizmetinden ekonomik durumu düşük olan kişilerin de faydalanmasına imkân sağlamaktadır. Sağlık alanına yönelik uygulamaların daha çok üreme-anne-çocuk sağlığı, bulaşıcı hastalıklar ile ilgili olduğu görülmektedir. Sosyal franchising marka tanıtımına katkı sağlamakla birlikte, sosyal sorumluluk bilincinde olan hekimlere yardıma muhtaç bireylere yardımcı olma imkânı da sunmaktadır. Abstract Social franchising is a contractually built system that uses the commercial franchise structure to provide social benefits. Franchising in the field of health is an application that allows individuals with low income levels to benefit from the provision of quality services and to eliminate inequalities and access problems in the provision of health services. Social franchising in health aims to enable individuals living in less developed and developing countries to benefit from health services, especially mother-child health, reproductive health, family planning. Based on the definitions of franchising and social franchising, it is aimed to deal with the examples of social franchising in the health sector in a theoretical framework. The literature was searched in the study. The concept of social franchising and its applications in health services have been reviewed in detail. Looking at social franchising practices, it is seen that social needs are met in a comprehensive and optimal way. Therefore, the most important difference from traditional franchises is the ultimate goal of social
... Main difference between micro franchising and social franchising is in orientation towards the profit. Social franchise will never (nor it is wanted to be) profitable for franchisee and franchisor while micro franchising pursues profit for both sides (Magleby, 2006 According to Montagu (2002) social franchising can be separated into following three areas: assuring the availability of services, assuring the quality of service and awareness of use and service. In the first area, potential franchisees need to see that there is enough benefit for them to be a part of network. ...
... First generation of social franchising systems was founded by United States Agency for International Development during early 1990-ties in Mexico (Montagu, 2002) and their goal was the growth of their market. After this initial social franchising system, many different non-government organizations and different social welfare programs started to consider possibility of using franchising as potential way of delivering social products and services around the world. ...
... Social franchising is mostly present in developing countries in in the health care area (Montagu, 2002;Smith, 2002 (Richardson, 2011) showed that there are more than 50 social franchises in Europe, but researchers have been able to collect data only for 23 networks. Those 23 franchises employ more than 6700 people and had almost 200 million EUR turn-over. ...
Conference Paper
Full-text available
Ten years after the global financial crisis, which particularly affected the transition countries, Croatia lags in solving basic social problems such as poverty and unemployment. The consequence of the failure of these problems is the population migration, especially the younger groups and ones with high education. Although there are different models of solving social problems, Croatian institution rarely recognize and support them, and it seems that they rarely fully understand their actions. This paper puts a special emphasis on two models: social entrepreneurship and franchising. Social entrepreneurship represents an innovative approach to the use of business principles for solving social problems (not exclusive for profit generation). As a new paradigm in business that emphasizes the mobilization of ideas, capacities and resources for the purpose of sustainable social development, social entrepreneurship is the answer to the needs of society that the competent institution is most often unable to solve due to its bureaucracy, slowness and inflexibility. On the other hand, franchising represents an increasingly popular way to launch new business ventures and/or business expansion. By using a proven business model and a well-known name, it is easier to enter the market and reduce the risk of a possible failure. The main purpose of this paper is to present the model that many countries have recognized as an innovative business concept which is aimed at two sides: the desire to launch a business venture and the ability to make a significant contribution to improving the quality of life in the community. In the first part, the paper gives an insight into the theoretical framework of the concept of social franchise, its characteristics, and the difference in relation to a social enterprise. The second part presents some of the world’s best examples of good social franchise practice and gives an overview of the possibilities of introducing a social franchise into Croatia. Attention will be given to the recommendations and implications for further research due to the author’s conviction that this new social business model has the potential to influence real social values.
... Therefore information about social franchising is in its infancy (Maciejewski et al.,2018). This makes the investors conscious about their investments of billions of dollars due to the non-availability of appropriate success/failure factor reports (Mumtaz, 2018 Initial works on social franchising such as Montagu (2002) are in the area of health service; however, those can be clustered into theoretical motivations, modus operandi, and the impact. This can be argued as a conceptual framework for social franchising. ...
... Motivation and Performance in Social Franchising Social entrepreneurs are attracted to the benefits of scalability (Zajko & Brada_cHojnik, 2018). Scalability factors include minimum agency cost, mobilization of cheap capital, and expertise (Montagu, 2002 ...
... Conceptual Frameworks of Social franchising An early framework of social franchising was presented by Montagu (2002), which was about the health sector. It indicated four aspects of social franchising namely availability of services, service quality, awareness of services and use of services. ...
... In addition, social franchising based on franchising concept in which the relationships of actors (franchisors-franchisees) are under franchise agreements (Montagu, 2002;Richardson & Berelowitz, 2012;Tracey & Jarvis, 2007;Zafeiropoulou & Koufopoulos, 2013). Franchising is an effective means for social franchises to expand their social impacts to beneficiaries (Berelowitz, 2012;du Toit, 2014;Richardson & Berelowitz, 2012;Tracey & Jarvis, 2007). ...
... According to Berelowitz (2012), Richardson and Berelowitz (2012), Tracey and Jarvis (2007) and Zafeiropoulou and Koufopoulos (2013), social franchisor is often a social organization with a proven model. It can also be an NGO (Montagu, 2002). ...
... The majority of clinical social franchising programs in developing countries aim at serving RHFP services (table 7 below presents some examples of RHFP social franchises in developing countries). In addition, social franchising has recently played an increasingly important role in these services (Montagu, 2002;Stephenson et al., 2004). ...
Thesis
Since the first industrial revolution, “innovation” has been mentioned in numerous occasions. This term has often been associated with "technological innovation".Recently, a new type of innovation, management innovation, and its adoption processhave been at the heart of attention. In numerous studies on organizational innovations, technological innovation is still adominant subject and there is a need to go outside the limit of technological innovation studies. Recently, diversified topics on management innovations have been studied, showing the particular attraction of management innovations for scholars in this field. Scholars in this field explored carefully management innovation processes, in particular the generation, diffusion and adoption process (with or without adaptation) of management innovation. However, the studies on management innovation adoption seem to be neglected. In addition, the mutual adaptation between management innovations and adopting organizations also need to be studied. In a more concrete way, it is essential to study the tension that can appear when introducing a management innovation into an organization as well as the mutual pressure between them during the adoptionprocess. Nonetheless, the empirical studies on this issue still remain deficient. Consequently, we focus on the adoption processes of a management innovation and the tensions between this management innovation and its adopting organizationduring the adoption process. Every management innovation comprises a management philosophy while every organization pertains to certain representations. Consequently, the potential tensions during the adoption process can be viewed as the imperfect harmony between the management innovation philosophy and the dominant representations within the “host”organization. From that, three important sub-questions emerge: (1) how to identify the management innovation philosophy and the organizational representations, (2) how to explain their agreements/disagreements of values during the adoption process and (3) how to avoid potential disagreements that can interrupt this process.
... In line with the conceptual framework for SF presented by Montagu (2002) (Figure 1), the RHF QA mechanism incorporates a feedback loop through which QA monitors share QA results with providers, and options for improvement are discussed. Improvement in quality is therefore driven, at least in part, by QA assessment visits by the franchisor after joining the SF network. ...
... Although there is mixed evidence on the actual impact of SF on improving health outcomes and addressing the unmet need for FP, SF of FP services is positively associated with increasing FP client volume at privately owned SF clinics [19,22,23,28]. Montagu's (2002) conceptual framework for SF suggests that, in addition to improving access to health services, improvements in quality of services at privately owned SF clinics mobilizes latent demand for the franchised health service, leading to increased uptake of services and subsequent improvements in health outcomes [17]. ...
Book
Full-text available
Family planning is a rich field that has evolved dramatically over the last 40 years, driven by attention to client-centered care, client rights and engagement, and data for evidence-based program management. We have set ambitious global targets for increasing contraceptive use under the Sustainable Development Goals (2016-2030) and the Family Planning 2020 initiative (2012-2020). Reaching these targets requires a focus on service quality: the development community recognizes that poor service quality inhibits contraceptive uptake and contributes to unacceptably high rates of discontinuation among women. Yet family planning quality measurement is not easy, consistent, or accurate, and it is certainly not cheap. Most quality assurance initiatives are created for and by individual programs, forcing each new implementer to relearn the same lessons of measuring family planning quality. None of the quality measures created at global, regional, or national levels have been standardized or adopted into common use across service delivery programs. In late 2015, a group of implementers, researchers, and policy makers came together at the Rockefeller Center in Bellagio, Italy. Their aim was to simplify the measurement of family planning service quality and make it easier to collect data critical for decision-making. They agreed that an effective measure must be credible, actionable, easy and inexpensive to use, facilitate comparison against national standards, and be valued by stakeholders. The papers included in this publication provide the background for the Bellagio meeting and the pilot to follow. The twelve papers address the past, present, and future of quality measurement: 1) The importance of quality to family planning and why more work is needed; 2) Experiences measuring family planning quality; and 3) Key considerations to make progress in quality measurement that will support the Sustainable Development Goals and Family Planning 2020 targets. Measuring quality is neither simple nor static, and will not on its own lead to quality improvement, but it is a critical first step.
... In line with the conceptual framework for SF presented by Montagu (2002) (Figure 1), the RHF QA mechanism incorporates a feedback loop through which QA monitors share QA results with providers, and options for improvement are discussed. Improvement in quality is therefore driven, at least in part, by QA assessment visits by the franchisor after joining the SF network. ...
... Although there is mixed evidence on the actual impact of SF on improving health outcomes and addressing the unmet need for FP, SF of FP services is positively associated with increasing FP client volume at privately owned SF clinics [19,22,23,28]. Montagu's (2002) conceptual framework for SF suggests that, in addition to improving access to health services, improvements in quality of services at privately owned SF clinics mobilizes latent demand for the franchised health service, leading to increased uptake of services and subsequent improvements in health outcomes [17]. ...
... Research has shown that social franchising has become an increasingly popular health system strengthening strategy in poor and underserved communities because of its ability to maximize the potential of the private sector and improve access to health care services. 13 Social franchises are comprised of a network of members who are private health care providers that use a commercial branding identity to achieve a social cause rather than a financial goal. 13 Private providers are organized in a contractual obligation to offer specific services within a specific network of providers. ...
... 13 Social franchises are comprised of a network of members who are private health care providers that use a commercial branding identity to achieve a social cause rather than a financial goal. 13 Private providers are organized in a contractual obligation to offer specific services within a specific network of providers. These franchisees are then provided training, branding, and monitoring with the aim of improving quality of care, increasing access to care, expanding the affordability of services, and rapidly increasing the number of delivery points for important public health services. ...
Article
Full-text available
Introduction: Quality of care is an important element in health care service delivery in low- and middle-income countries. Innovative strategies are critical to ensure that private providers implement quality of care interventions. We explored private providers' experiences implementing a package of interventions intended to improve the quality of care in small and medium-sized private health facilities in Kenya. Methods: Data were collected as part of the qualitative evaluation of the African Health Markets for Equity (AHME) program in Kenya between June and July 2018. Private providers were purposively selected from 2 social franchise networks participating in AHME: the Amua network run by Marie Stopes Kenya and the Tunza network run by Population Services Kenya. Individual interviews (N=47) were conducted with providers to learn about their experiences with a package of interventions that included social franchising, SafeCare (a quality improvement program), National Hospital Insurance Fund (NHIF) accreditation assistance, and business support. Results: Private providers felt they benefited from trainings in clinical methods and quality improvement offered through AHME. Providers especially appreciated the mentorship and guidelines offered through programs like social franchising and SafeCare, and those who received support for NHIF accreditation felt they were able to offer higher quality services after going through this process. However, quality improvement was sometimes prohibitively expensive for private providers in smaller facilities that already realize relatively low revenue and the NHIF accreditation process was difficult to navigate without the help of the AHME partners due to complexity and a lack of transparency. Conclusion: Our findings suggest that engaging private providers in a comprehensive package of quality improvement activities is achievable and may be preferable to a simpler program. However, further research that looks at the implications for cost and return on investment is required.
... In such arrangements, the franchisor typically provides training, commodities, and quality assurance, while the franchisees agree to provide franchised services, undergo audits, and adhere to price ceilings. 26 Both MSI and PSI provide extensive training and technical support to family planning providers in their networks to ensure a standard set of high-quality services. Both franchises also use robust quality assessment tools to monitor the performance of private medical practitioners. ...
... This study was conducted in collaboration with PSI's Ugandan partner PACE-Uganda, which operates the ProFam franchise, and Marie Stopes Society (MSS) in Pakistan, which operates the Suraj franchise. 26 By leveraging existing social franchises with high client volumes, we were able to quickly recruit a large number of women and to obtain data on quality of services delivered at health facilities in our sample. ...
Article
Full-text available
Background: The quality of contraceptive counseling that women receive from their provider can influence their future contraceptive continuation. We examined (1) whether the quality of contraceptive service provision could be measured in a consistent way by using existing tools from 2 large-scale social franchises, and (2) whether facility quality measures based on these tools were consistently associated with contraceptive discontinuation. Methods: We linked existing, routinely collected facility audit data from social franchise clinics in Pakistan and Uganda with client data. Clients were women aged 15-49 who initiated a modern, reversible contraceptive method from a sampled clinic. Consented participants completed an exit interview and were contacted 3, 6, and 12 months later. We collapsed indicators into quality domains using theory-based categorization, created summative quality domain scores, and used Cox proportional hazards models to estimate the relationship between these quality domains and discontinuation while in need of contraception. Results: The 12-month all-modern method discontinuation rate was 12.5% among the 813 enrolled women in Pakistan and 5.1% among the 1,185 women in Uganda. We did not observe similar associations between facility-level quality measures and discontinuation across these 2 settings. In Pakistan, an increase in the structural privacy domain was associated with a 60% lower risk of discontinuation, adjusting for age and baseline method (P<.001). In Uganda, an increase in the management support domain was associated with a 33% reduction in discontinuation risk, controlling for age and baseline method (P=.005). Conclusions: We were not able to leverage existing, widely used quality measurement tools to create quality domains that were consistently associated with discontinuation in 2 study settings. Given the importance of contraceptive service quality and recent advances in indicator standardization in other areas, we recommend further effort to harmonize and simplify measurement tools to measure and improve contraceptive quality of care for all.
... Tracey and Jarvis (2007), in their case study on a social franchise in the UK noted that its failure was in large part due to becoming a social franchise too early, without becoming a stable franchisor first, then undertaking the necessary reviews to ensure that franchisees were compatible with their vision and ensuring that they were able to provide the necessary support to a new franchisee. In the social franchising model of service provision, NGOs require a significant amount of investment in terms of financial and human resources (Montagu, 2002), and there is a high level of economic risk for social franchises (Zafeiropoulou & Koufopoulos, 2013) when significant outcomes are also dependent on donations and work is being conducted by volunteers. Thus, a careful alignment of franchisor vision and the capability of a potential franchisor is critical to consider. ...
... The final stage is evaluation which should ensure equal contributions from the franchisor and franchisees and to appraise the social impact of the franchise. Further, evaluation is important due to the costs inherent in the social franchise model (Montagu, 2002) and the responsibility to report to funders what the impact of their gifts were, as well as to develop a strong performance record to attract further funding. NGO funding is dependent on donors (Bies, 2010), and accountability and transparency both with respect to the projects and activities is important, as well as the transparency of the organization itself (Cabedo, Fuertes-Fuertes, Maset-LLaudes, & TiradoBeltran, 2016). ...
Article
Full-text available
Research Question: This paper investigates how the social franchising approach may enhance the sustainability and capability of Foster Home NGOs in the Global South. Motivation: While many programmes exist to address issues such as poverty and lack of education for children in nations of the Global South, many operate in isolation, and are grassroots and/or stand-alone operations. Little research has been undertaken to understand how various approaches to organizational sustainability may be enacted for non-governmental organizations (NGOs) seeking to provide care for children in foster care homes. Our goal was to apply franchising and social franchising concepts as a framework for NGOs and non-profit organizations to use as a way of enhancing both the capability of achieving their mission as well as a method of organizational sustainability. Idea: Much of the literature on social franchising has been in the area of providing health care and services – however, this model may be useful to enhance the sustainability for NGOs and non-profit organizations that provide other critical services as well, such as foster care homes in the Global South. Findings: The social franchising model offers a concrete and actionable business model to foster home organizations with multiple homes to standardize care delivery as well as develop a strong core organization. Contribution: This paper explores how applying the social franchising model could enhance sustainability of NGOs with foster care home programmes, as well as some of the opportunities and challenges in applying this model to such NGOs and non-profit organizations.
... Social franchising is a related mechanism for linking private providers to provide and market socially desirable goods [159]. Social franchising has been successfully employed in a number of settings whereby networks of private sector providers are connected through formal agreements, the end result of which is social in addition to financial gain [97,159,160]. ...
... Social franchising is a related mechanism for linking private providers to provide and market socially desirable goods [159]. Social franchising has been successfully employed in a number of settings whereby networks of private sector providers are connected through formal agreements, the end result of which is social in addition to financial gain [97,159,160]. In this mechanism individual providers are incentivized to join a network of franchises through the creation of brand identity, mass marketing campaigns, access to commodities below market rates and trainings. ...
Article
Full-text available
Background In malaria elimination settings, all malaria cases must be identified, documented and investigated. To facilitate complete and timely reporting of all malaria cases and effective case management and follow-up, engagement with private providers is essential, particularly in settings where the private sector is a major source of healthcare. However, research on the role and performance of the private sector in malaria diagnosis, case management and reporting in malaria elimination settings is limited. Moreover, the most effective strategies for private sector engagement in malaria elimination settings remain unclear. Methods Twenty-five experts in malaria elimination, disease surveillance and private sector engagement were purposively sampled and interviewed. An extensive review of grey and peer-reviewed literature on private sector testing, treatment, and reporting for malaria was performed. Additional in-depth literature review was conducted for six case studies on eliminating and neighbouring countries in Southeast Asia and Southern Africa. Results The private health sector can be categorized based on their commercial orientation or business model (for-profit versus nonprofit) and their regulation status within a country (formal vs informal). A number of potentially effective strategies exist for engaging the private sector. Conducting a baseline assessment of the private sector is critical to understanding its composition, size, geographical distribution and quality of services provided. Facilitating reporting, referral and training linkages between the public and private sectors and making malaria a notifiable disease are important strategies to improve private sector involvement in malaria surveillance. Financial incentives for uptake of rapid diagnostic tests and artemisinin-based combination therapy should be combined with training and community awareness campaigns for improving uptake. Private sector providers can also be organized and better engaged through social franchising, effective regulation, professional organizations and government outreach. Conclusion This review highlights the importance of engaging private sector stakeholders early and often in the development of malaria elimination strategies. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1901-1) contains supplementary material, which is available to authorized users.
... 3,9 In the mid-1990s, concerns over the quality of private-sector care led to the creation of social franchising-the application of commercial franchising concepts to deliver socially beneficial products and services in underserved communities worldwide. 10 When applied to clinical care, social franchising connects a network of health care providers through formal agreements to deliver health services under a common franchise brand and to improve overall quality. 11 The social franchising industry has grown from just a few clinical franchises in the mid-1990s to more than 90 franchises in 40 countries around the globe. ...
... 12 Costs associated with starting and maintaining social franchises have historically been covered through large donor grants, and while social franchise programs can differ in their scale and scope of services offered, most have the common goal of serving the poor. 10,13 To implement strategies that best reach the poor, social franchisors must first accurately capture the socioeconomic profile of the people they serve. This information allows them to understand if the right clients are benefiting from subsidized services and to subsequently make decisions about where to scale-up or modify programs to reach those most in need. ...
Article
Full-text available
Background: Social franchising programs in low- and middle-income countries have tried using the standard wealth index, based on the Demographic and Health Survey (DHS) questionnaire, in client exit interviews to assess clients’ relative wealth compared with the national wealth distribution to ensure equity in service delivery. The large number of survey questions required to capture the wealth index variables have proved cumbersome for programs. Methods: Using an adaptation of the Delphi method, we developed shortened wealth indices and in February 2015 consulted 15 stakeholders in equity measurement. Together, we selected the best of 5 alternative indices, accompanied by 2 measures of agreement (percent agreement and Cohen’s kappa statistic) comparing wealth quintile assignment in the new indices to the full DHS index. The panel agreed that reducing the number of assets was more important than standardization across countries because a short index would provide strong indication of client wealth and be easier to collect and use in the field. Additionally, the panel agreed that the simplified index should be highly correlated with the DHS for each country (kappa ≥ 0.75) for both national and urban-specific samples. We then revised indices for 16 countries and selected the minimum number of questions and question options required to achieve a kappa statistic ≥ 0.75 for both national and urban populations. Findings: After combining the 5 wealth quintiles into 3 groups, which the expert panel deemed more programmatically meaningful, reliability between the standard DHS wealth index and each of 3 simplified indices was high (median kappa = 0.81, 086, and 0.77, respectively, for index B that included only the common questions from the DHS VI questionnaire, index D that included the common questions plus country-specific questions, and index E that found the shortest list of common and country-specific questions that met the minimum reliability criteria of kappa ≥ 0.75). Index E was the simplified index of choice because it was reliable in national and urban contexts while requiring the fewest number of survey questions—6 to 18 per country compared with 25 to 47 in the original DHS wealth index (a 66% average reduction). Conclusion: Social franchise clinics and other types of service delivery programs that want to assess client wealth in relation to a national or urban population can do so with high reliability using a short questionnaire. Future uses of the simplified asset questionnaire include a mobile application for rapid data collection and analysis.
... • Social franchising, where a network of private providers is contracted to provide services under a common brand. Most often operated by NGOs, social franchises 'attempt to use franchising methods to achieve social rather than financial goals.' (Montagu 2002) A central goal of franchising private providers is that it allows rapid scaling up of service delivery points, and builds upon pre-existing infrastructure (Viswanathan et al. 2014). • Commodity social marketing, where commercial marketing techniques are used to create demand for products, such as contraceptives, mosquito nets, malaria medicines and vitamins that have high public-health value. ...
... We conducted a systematic review of the literature to identify evaluations of programmes that met definitions for social franchising, commodity social marketing, contracting, accreditation and vouchers (Montagu 2002;Evans and Haiderm 2008;Loevinsohn and Harding 2005, Montagu 2003, Sandiford 2002. We restricted our study to programmes operating in LMICs as defined by the World Bank in 2014 (World Bank 2014), and to interventions that directly address healthcare supply of either commodities or services. ...
Article
Full-text available
The private sector provides the majority of health care in Africa and Asia. A number of interventions have, for many years, applied different models of subsidy, support and engagement to address social and efficiency failures in private health care markets. We have conducted a review of these models, and the evidence in support of them, to better understand what interventions are currently common, and to what extent practice is based on evidence. Using established typologies, we examined five models of intervention with private markets for care: commodity social marketing, social franchising, contracting, accreditation and vouchers. We conducted a systematic review of both published and grey literature, identifying programmes large enough to be cited in publications, and studies of the listed intervention types. 343 studies were included in the review, including both published and grey literature. Three hundred and eighty programmes were identified, the earliest having begun operation in 1955. Commodity social marketing programmes were the most common intervention type, with 110 documented programmes operating for condoms alone at the highest period. Existing evidence shows that these models can improve access and utilization, and possibly quality, but for all programme types, the overall evidence base remains weak, with practice in private sector engagement consistently moving in advance of evidence. Future research should address key questions concerning the impact of interventions on the market as a whole, the distribution of benefits by socio-economic status, the potential for scale up and sustainability, cost-effectiveness compared to relevant alternatives and the risk of unintended consequences. Alongside better data, a stronger conceptual basis linking programme design and outcomes to context is also required.
... While our study design could not disaggregate which component(s) of the model contributed most to the increased uptake of ORS and zinc and which should be improved or removed, this type of systems package of interventions has a theoretical basis for being stronger than its component parts. 69 Recent research focused on improving access to diarrhoea treatments in Nigeria, for example, also found that shaping the market system for ORS and zinc was effective in equitably improving coverage of the combination therapy. 70 Future research may be conducted to assess the specific contributions of individual components of such an approach. ...
Article
Full-text available
Introduction Oral rehydration salts (ORS) and zinc comprise the globally recommended treatment for diarrhoea in children aged <5 years. However, limited access contributes to low uptake of this treatment and subsequently high rates of morbidity and mortality among this age group in low-income and middle-income countries. We adopted approaches used for private-sector value-chains of fast-moving consumer-goods, involving the simultaneous stimulation of supply and demand. These approaches were applied to the introduction of an innovative co-packaged diarrhoea-treatment kit (ORSZ co-pack) to increase ORS and zinc coverage at the community level in Zambia. Methods We tested our approach using an observational pre–post test study design in two intervention districts in rural Zambia (Kalomo and Katete), each with a matched comparator (Monze and Petauke, respectively). We assessed the effect on coverage, of ORS and zinc as well as ORS alone, by conducting household surveys of a total of 2458 and 2477 caregivers of children aged <5 years at baseline and endline, respectively, across the four districts. We also assessed whether the source of ORS (public or private sector) changed following the intervention. Results Both intervention districts experienced significant increases in coverage of ORS and zinc from <1% at baseline to 46.9% and 46.3% in Kalomo and Katete, respectively. Uptake in the comparator districts remained low at 1.7% and 0.6% in Monze and Petauke, respectively. For the secondary outcome examining ORS coverage (with or without zinc), the intervention was associated with a significant increase in Kalomo versus Monze, but not in Katete versus Petauke. There was a clear shift from the public to the private sector, and specifically to the use of the ORSZ co-pack. Conclusion Implementation of a value-chain creation approach for an innovative, over-the-counter, co-packaged diarrhoea-treatment kit can significantly improve the coverage of ORS and zinc.
... The brand name serves as a guarantee of the availability of a defi ned package of high quality services at clearly determined prices. Some networks evolve into 'franchising' programmes in which there is a controlling organization, the 'franchiser' who provides ongoing monitoring and technical support to the franchised providers (67). ...
... Trust is a key dimension in the relationships between providers and patients, its importance varying proportionally with the degree of asymmetry of information. Providers often adopt strategies to build trust and maintain a reputation for high expertise and ethics (Montagu, 2002(Montagu, , 2003Mills et al., 2002;Prata et al., 2005). ...
... Standardization, in theory, allows each outlet to offer consistently high-quality (non-counterfeit) drugs, and lowers costs by exploiting economies of scale within the franchise. The franchise clinic model plays an increasingly important role in many low-income countries, usually through via small-scale non-governmental organizations (NGOs), and particularly among reproductive health clinics (3,15,16). Yet, despite its potential effectiveness and increasing prevalence in low-income contexts, no study, to our knowledge, has examined the impact of the franchise clinic model in terms of enabling better access to disease treatment and prevention. In this paper, we examine the impact of The HealthStore Foundation's (HSF) network of franchise health clinics in Kenya on households' access to treatment for acute illnesses and basic vaccinations. ...
... One intervention designed to improve provision of services in the private sector is social franchising [11][12][13]. Worldwide, there are at least 64 franchised networks in 35 countries, providing branded, quality-assured services from 39,000 providers [14]. The evidence base for franchising has been building over time, with many studies focusing on outcomes based upon 5 goals agreed upon by a global community of practice for social franchising: quality, health impact, equity, cost-effectiveness, and market expansion [14,15]. ...
Article
Full-text available
Background In Kenya, as in many low-income countries, the private sector is an important component of health service delivery and of providing access to preventive and curative health services. The Tunza Social Franchise Network, operated by Population Services Kenya, is Kenya’s largest network of private providers, comprising 329 clinics. Franchised clinics are only one source of family planning (FP), and this study seeks to understand whether access to a franchise increases the overall use or provides another alternative for women who would have found FP services in the public sector. Methods A quasi-experimental study compared 50 catchment areas where there is a Tunza franchise and no other franchised provider with 50 purposively matched control areas within 20 km of each selected Tunza area, with a health facility, but no franchised facility. Data from 5609 women of reproductive age were collected on demographic and socioeconomic status, FP use, and care-seeking behavior. Multivariate logistic regression, with intervention and control respondents matched using coarsened exact matching, was conducted. Results Overall modern contraceptive use in this population was 53 %, with 24.8 % of women using a long-acting or permanent method (LAPM). There was no significant difference in odds of current or new FP use by group, adjusted for age. However, respondents in Tunza catchment areas are significantly more likely to be LAPM users (adj. OR = 1.49, p = 0.015). Further, women aged 18–24 and 41–49 in Tunza catchment areas have a significantly higher marginal probability of LAPM use than those in control areas. Conclusions This study indicates that access to a franchise is correlated with access to and increased use of LAPMs, which are more effective, and cost-effective, methods of FP. While franchised facilities may provide additional points of access for FP and other services, the presence of the franchise does not, in and of itself, increase the use of FP in Kenya.
... A new initiative of training CMWs on family planning service provision in rural settings is discussed by Hameed et al. [27], by comparing the CMW delivery model to one involving a network of private providers who became franchises of a local brand, supported by training and advertising. 'Social franchising' similar to 'business franchising' is a method of expanding service delivery points for social goals by influencing private sector providers [28]. Using a quasi-experimental study design, the study demonstrated that the two delivery models were able to achieve high continuation rates of intra-uterine contraceptive devices, a long-acting reversible contraceptive that is underutilised in Pakistan. ...
Article
Full-text available
Policy and decision making should be based on evidence, but translating evidence into policy and practice is often sporadic and slow. It is recognised that the relationship between research and policy uptake is complex and that dissemination of research findings is necessary, but insufficient, for policy uptake. Political, social, and economic context, use of (credible) data and dialogues between and across networks of researchers and policymakers play important roles in evidence uptake. Advocacy is the process of mobilising political and public opinions to achieve specific aims and its role is crucial in mobilising key actors to push for policy uptake. Advocacy and research groups (i.e. those who would like to see research evidence used by policymakers) may use different approaches and tools to stimulate the diffusion of research findings. The use of mass- and social media, communication with study participants, and the involvement of stakeholders at the early stages of research development are examples of the approaches that can be employed to stimulate diffusion of evidence and increase evidence uptake. The Research and Advocacy Fund (RAF) for Maternal and Newborn Health (MNH) worked within the health system context in Pakistan with the aim of espousing the principles of evidence, advocacy, and dissemination to improve MNH outcomes. The articles included in this special issue are outputs of RAF and highlight where RAF's approaches contributed to MNH policy reforms. The papers discuss critical health system issues facing Pakistan, including service delivery components, demand creation, equitable access, transportation interventions for improved referrals, availability of medicines and equipment, and health workforce needs. In addition to these tangible elements, the health system 'software', i.e. the power and the political and social contexts, is also represented in the collection. These articles highlight three considerations for the future: the growing importance of implementation research, the crucial need for participation and ownership, and the recognition that policymaking can be 'informed' by rather than 'based-on' evidence. The future challenge will be to continue the momentum RAF has created and to welcome a new era of health, wealth, and growth for Pakistan.
... The first examples of social franchising emerged in the 1990s. [4] There are now more than 83 social franchising programmes in 40 countries, which include over 75 000 franchisees and over 60 000 points of service delivery. [5,6] This rapid rise is proving sustainable, and should be seen in the context of the emergence of a socioeconomic shift from 'self-interest' towards greater social responsibility. ...
Article
Full-text available
This article describes the first government social franchise initiative in the world to deliver a ‘brand’ of quality primary healthcare (PHC) clinic services. Quality and standards of care are not uniformly and reliably delivered across government PHC clinics in North West Province, South Africa, despite government support, numerous policies, guidelines and in-service training sessions provided to staff. Currently the strongest predictor of good-quality service is the skill and dedication of the facility manager. A project utilising the social franchising business model, harvesting best practices, has been implemented with the aim of developing a system to ensure reliably excellent healthcare service provision in every facility in North West. The services of social franchising consultants have been procured to develop the business model to drive this initiative. Best practices have been benchmarked, and policies, guidelines and clinic support systems have been reviewed, evaluated and assessed, and incorporated into the business plan. A pilot clinic has been selected to refine and develop a working social franchise model. This will then be replicated in one clinic to confirm proof of concept before further scale-up. The social franchise business model can provide solutions to a reliable and recognisable ‘brand’ of quality universal coverage of healthcare services. © 2015, South African Medical Association. All rights reserved.
... The franchisor, typically an international NGO with an in-country office, recruits and supports network members through branding private clinics and purchasing drugs in bulk at wholesale prices. The primary advantage of this model is the potential for fast, low-risk expansion via pre-existing clinics and pharmacies, backed by a recognized brand with well-established attributes desired by consumers [24,25]. ...
Article
Full-text available
This study evaluates the effectiveness of a training programme for improving the diagnostic and treatment quality of the most complex service offered by Sun Primary Health (SPH) providers, paediatric malaria. The study further assesses whether any quality improvements were sustained over the following 12 months. The study took place in 13 townships in central Myanmar between January 2011 and October 2012. A total of 251 community health workers were recruited and trained in the provision of paediatric and adult malaria diagnosis and treatment; 197 were surveyed in all three rounds: baseline, 6 and 12 months. Townships were selected based on a lack of alterative sources of medical care, averaging 20 km from government or private professional health care treatment facilities. Seventy percent of recruits were assistant nurse midwives or had other basic health training; the rest had no health training experience. Recruits were evaluated on their ability to properly diagnosis and treat a simulated 5-year-old patient using a previously validated method known as Observed Simulated Patient. A trained observer scored SPH providers on a scale of 1–100, based on WHO and Myanmar MOH established best practices. During a pilot test, 20 established private physicians operating in malaria-endemic areas of Myanmar scored an average of 70/100. Average quality scores of newly recruited SPH providers prior to training (baseline) were 12/100. Six months after training, average quality scores were 48/100. This increase was statistically significant (p < 0.001). At 12 months after training, providers were retested and average quality scores were 45/100 (R3–R1, p < 0.001). The SPH training programme was able to improve the quality of paediatric malaria care significantly, and to maintain that improvement over time. Quality of care remains lower than that of trained physicians; however, SPH providers operate in rural areas where no trained physicians operate. More research is needed to establish acceptable and achievable levels of quality for community health workers in rural communities, especially when there are no other care options.
... Social franchising refers to using a commercial franchising system for social purposes instead of generating profit [53]. This model would allow individual community-based organisations to join into a franchise network to provide HIVST in accordance with quality and other standards. ...
Article
Full-text available
To review methods for measuring HIV self-testing (HIVST) among key populations, including both conventional approaches and implementation science approaches. We reviewed the literature on evaluating HIVST among key populations. Simple HIV self-tests have already entered markets in several regions, but metrics required to demonstrate the benefits and costs of HIVST remain simplistic. Conventional measurements of sensitivity, specificity, acceptability, and behavioural preferences must be supplemented with richer implementation science measurement tools and innovative research designs in order to capture data on the following components: how self-testing affects subsequent linkage to confirmatory testing, preventive services and onward steps in the HIV continuum of care; how self-testing can be marketed to reach untested subpopulations; and how self-testing can be sustained based on overarching organisational and financial models. We outline an implementation science research agenda that incorporates these components, drawing from evaluation study designs focused on HIVST and testing in general. HIVST holds great promise for key populations, but must be guided by implementation research to inform programmes and scale up.
... The social franchises are a form of fractional franchising, where services or products (in this case, specific sexual and reproductive health services) are added or strengthened within an existing business (in this case, private medical clinics) to provide a social benefit. (9,10) This arrangement promotes the availability, quality and use of services, and benefits the franchisee (the clinic) by generating additional income and training opportunities from the franchisor (MSI).(9) Often social franchises involve the provision of subsidised services to increase service uptake. ...
... In this article, we report findings from Vietnam, where an innovative social franchise model (18) embedded into government health facilities was used to deliver interventions to improve CF and child growth. Social franchising applies commercial franchising concepts so that a brand identity is equated with quality services (in this case, through standardized operating procedures, support, and training) that help achieve social and health benefits (19). Studies on the ability to deliver and ensure quality of services for nutrition in health facilities are few (20,21). ...
Article
Full-text available
Background: Rigorous evaluations of health system-based interventions in large-scale programs to improve complementary feeding (CF) practices are limited. Alive & Thrive applied principles of social franchising within the government health system in Vietnam to improve the quality of interpersonal counseling (IPC) for infant and young child feeding combined with a national mass media (MM) campaign and community mobilization (CM). Objective:We evaluated the impact of enhanced IPC + MM+ CM (intensive) compared with standard IPC + less-intensive MM and CM (nonintensive) on CF practices and anthropometric indicators. Methods: A cluster-randomized, nonblinded evaluation designwith cross-sectional surveys (n =500 children aged 6-23.9mo and;1000 children aged 24-59.9mo/group) implemented at baseline (2010) and endline (2014)was used.Difference-in-difference estimates (DDEs) of impact were calculated for intent-to-treat (ITT) analyses and modified per-protocol analyses (MPAs; mothers who attended the social franchising at least once: 62%). Results: Groups were similar at baseline. In ITT analyses, there were no significant differences between groups in changes in CF practices over time. In the MPAs, greater improvements in the intensive than in the nonintensive group were seen for minimum dietary diversity [DDE: 6.4 percentage points (pps); P < 0.05] and minimum acceptable diet (8.0 pps; P < 0.05). Significant stunting declines occurred in both intensive (7.1 pps) and nonintensive (5.4 pps) groups among children aged 24-59.9 mo, with no differential decline. Conclusions: When combined with MM and CM, an at-scale social franchising approach to improve IPC, delivered through the existing health care system, significantly improved CF practices, but not child growth, among mothers who used counseling services at least once. A greater impact may be achieved with strategies designed to increase service utilization.
... But despite widespread donor support for these PPPs in SRH there appears to be little evidence to support this. For example, despite claims that social franchising can improve access to and the quality of family planning services (Montagu, 2002), reviewers find it difficult to draw firm conclusions about their effect (Agha, Mehryar Karim, Balal, & Sosler, 2007;Koehlmoos et al., 2009). Advocates suggest that social franchises could extend coverage to areas which are under-served, but in practice the franchises tend to operate in areas that are already covered by services and where private providers wish to live and work. ...
Article
The past few decades have seen the growing popularity of public-private partnerships (PPPs) across the health sector – a catch all term used to encompass diverse activities involving both public and private sector entities in areas of global and domestic health. In the article we consider the factors that have led to this proliferation of PPPs in the healthcare delivery field and consider the link to the process of ‘scientization’ of healthcare. With a focus on sexual and reproductive health the article also considers two commonly used mechanisms employed in SRH service delivery that have been used in PPPs – social franchise and health voucher schemes. We then reprise key points from the existing critical literature on gendered health systems and go on to consider their application to such service provision-oriented PPPs, using an exploratory analysis of a case study of the use of maternal health vouchers in India.
... The coordinating body (the 'franchisor') in a franchise model forms a partnership with the providers (the 'franchisees') to help them improve their operations through training, quality control, trade-marking and branding (Bishai et al, 2008). Social franchising has been used to increase the coverage and quality of health services and products in several developing countries (Montagu, 2002;Prata et al, 2005). Although it has most often been used for reproductive health services (Stephenson et al, 2004;Agha et al, 2007) 22 , TB services were recently franchised in Myanmar alongside a reproductive health franchise, with promising results (Lonnroth et al, 2007). ...
Technical Report
Full-text available
The paper is co-authored by April Harding, World Bank (formerly of the Center for Global Development); Henrik Axelson, PMNCH; and Dr. Bustreo. The paper will be published eventually as a chapter in Harding's forthcoming book, "Private Patients: Why Health Aid Reaches So Few, and What We Can Do about It", that examines the role of the private sector in the delivery of health services and products in low- and middle-income countries. The book will be published in 2015 by the Center for Global Development, and will include chapters on child health, family planning, tuberculosis, and malaria programs. The target audience of the book is bilateral and multilateral donors. The objective of the book is to increase the understanding of the scale and scope of the private sector and its potential to contribute to improved health outcomes in order to inform donors' funding and programming priorities as they work with national policy makers and other partners to design, implement and monitor programs in the health sector.
... In this model the franchisor may provide the infrastructure, equipment, training, subsidized products or simply products at a lower cost due to volume discounts, while the franchisees deliver the services or products. The other model is the fractional social franchise; here individuals operating an existing venture add a franchised service or product to their business for added income (Montagu, 2002). Alter (2007) suggests social enterprises may exist on a continuum between those that are mission centric to those that are commercially driven. ...
Article
Full-text available
Social franchising is starting to garner more interest among researchers and practitioners as a replication approach used to help address a growing array of societal issues in both developed countries and emerging economies. While there has been a proliferation of experimentation with social franchising that is occurring on the global stage, the knowledge base remains fragmented. A comprehensive review of the empirical and practitioner literature has not been done. This article fills the void by reviewing the past decade of literature and will be of interest to governments, non-governmental organizations (NGOs), philanthropists, social impact investors, corporations devoted to social goals, and other key players who support the scaling up or replication of ventures that strive to address societal ills by creating pathways to health and prosperity.
... On the one hand, kite marks and quality standards scaling strategy is implemented by social enterprises through setting quality standards for other NGOs to follow in their service provision, and thus help in reaching more beneficiaries with elevated quality through other organisations (Lyon and Fernandez 2012). On the other hand, social franchising is an institutional arrangement in the field of social entrepreneurship (Toit 2014;Lyon and Fernandez 2012;Tracey and Jarvis 2007;Montagu 2002), which enables organisations to access various resources in conditions of limited local market knowledge, managerial skills, and capital (Gillis and Castrogiovanni 2012;Combs and Ketchen 2003;Caves and Murphy 1976;Oxenfeldt and Kelly 1969). Social franchising is derived from the classical business franchising strategy, and is described as licencing the entire set of product and service provision, brand identity, and delivery models to a franchisee using a contractual agreement encompassing royalty fees, quality assurance, and monitoring (Yin and Zajac 2004;Sen 1993;Lafontaine 1992;Hoffman and Preble 1991). ...
Article
Full-text available
Social entrepreneurs face the challenge of resource constraints that affect their ability to scale social impact and expand in various geographical locations. In order to overcome resource barriers and to scale up social impact, social ventures deploy resources currently owned, and form distinct partnerships to acquire new resources, and hence implement unique strategies to achieve a pre-determined social impact. Through the lens of the Resource Based View (RBV) and Resource Dependency Theory (RDT), this paper explores the current discourse on social venture growth and scale-up strategies, and employs a grounded theory approach on 20 social ventures in Egypt to further develop a matrix for social ventures’ scale-up strategies based on resources’ availability. In addition, the paper introduces a typology of social impact scaling strategies given social ventures’ social impact objectives.
... Usually run by non-governmental organizations (NGOs), the model recognizes the role of the private sector and uses a commercial franchise approach to achieve social goals alongside financial goals (Volery and Hackl 2010). According to a popular definition, the core programmatic areas of social franchises are assuring: 1) the availability of services; 2) the quality of services; 3) the awareness and use of services (Montagu 2002). Many social franchises (including MUM) are fractional franchises, meaning that the program only supports a part of the business (such as maternal health). ...
Article
Full-text available
Global health programs are compelled to demonstrate impact on their target populations. We study an example of social franchising – a popular healthcare delivery model in low/middle-income countries – in the Ugandan private maternal health sector. The discrepancies between the program’s official profile and its actual operation reveal the franchise responded to its beneficiaries, but in a way incoherent with typical evidence production on social franchises, which privileges simple narratives blurring the details of program enactment. Building on concepts of not-knowing and the production of success, we consider the implications of an imperative to maintain ambiguity in global health programming and academia.
... Improving quality together with application of affordable and/or sliding scale service fees based on income, which are less costly than those from private doctors or hospitals, is a viable option. Experiments with the government social franchise business model, 30 which increases service utilisation and patient perceptions of quality through branding and social marketing programmes, quality improvement, formalisation of user fees and staff incentive schemes have been successful in some CHS system trials in Viet Nam. 31,32 Revenues generated by user fees can be used to improve and sustain service quality. ...
Article
This paper presents a qualitative study conducted in 2009 of provider and patient perceptions of primary level reproductive health services provided by commune health stations (CHSs), and the implications for Viet Nam's 2011–2020 National Strategy for Reproductive Health Care. In the three provinces of Thai Nguyen, Thua Thien Hue, and Vinh Long, we interviewed the heads of CHSs, held focus group discussions with midwives and women patients, and observed facilities. Half the 30 CHSs visited were in poor physical condition; the rest were newly renovated. However, the model of service delivery was largely unchanged from ten years before. Many appeared to fall short in meeting patient expectations in terms of modern medical equipment and technology, range of drug supplies, and levels of staff expertise. As a result, many women were turning to private doctors and public hospitals, at least in urban areas, or seeking medication from pharmacies. To make CHS clinics sustainable, promotion of access to reproductive health services should be undertaken concurrently with quality improvement. A responsive payment scheme must also be developed to generate revenues. Efforts should be made to reduce the unnecessary use of more costly services from private clinics and higher level public facilities. Résumé Cet article présente une étude qualitative réalisée en 2009 sur les perceptions chez les prestataires et les patients des services de santé génésique de niveau primaire assurés par les centres de santé communaux (CSC) et leurs conséquences pour la Stratégie nationale de soins de santé génésique 2011–2020 du Viet Nam. Dans les trois provinces de Thai Nguyen, Thua Thien Hue et Vinh Long, nous avons interrogé les chefs des CSC, organisé des discussions par groupe d'intérêt avec des sages–femmes et des patientes, et observé les installations. La moitié des 30 CSC visités étaient en mauvais état ; les autres venaient d'être rénovés. Néanmoins, lemodèle de prestation de services n'avait presque pas changé depuis dix ans. Beaucoup de CSC ne semblaient pas répondre aux attentes des patientes du point de vue de la modernité de l'équipement médical et de la technologie, du choix de médicaments disponibles et du niveau de compétence du personnel. Beaucoup de femmes s'adressaient donc à des médecins privés et des hôpitaux publics, au moins dans les zones urbaines, ou demandaient des médicaments dans les pharmacies. Pour que les CSC deviennent viables, la promotion de l'accès aux services de santé génésique doit être entreprise conjointement avec l'amélioration de la qualité. Un plan de paiement réactif doit aussi être mis au point pour créer des recettes. Il faut s'efforcer de réduire le recours inutile aux services coûteux de médecins et de centres privés ou d'installations publiques de niveau supérieur. Resumen En este artículo se presenta un estudio cualitativo realizado en 2009 de las percepciones del personal de salud y pacientes en cuanto a los servicios de salud reproductiva proporcionados en el primer nivel de atención por estaciones de salud comunitarias (CHS por sus siglas en inglés) y las implicaciones para la Estrategia Nacional de Servicios de Salud Reproductiva en Vietnam, del 2011 al 2020. En las tres provincias de Thai Nguyen, Thua Thien Hue y Vinh Long, entrevistamos la dirección de las CHS, realizamos discusiones en grupos focales con parteras profesionales y mujeres pacientes y observamos las unidades de salud. La mitad de las 30 CHS visitadas se encontraban en malas condiciones físicas; el resto había sido renovado recientemente. Sin embargo, hubo muy pocos cambios en el modelo de prestación de servicios creado diez años atrás. En muchas de las CHS hubo considerable insatisfacción por parte de las pacientes en cuanto al equipo médico moderno y la tecnología, la variedad de medicamentos y los niveles de conocimientos y experiencia del personal. Por consiguiente, muchas mujeres estaban acudiendo a médicos particulares y hospitales públicos, por lo menos en las zonas urbanas, o buscando medicamentos en las farmacias. Para lograr la sostenibilidad de las CHS, se debe promover el acceso a los servicios de salud reproductiva a la vez que se mejora la calidad. Además, se debe elaborar un esquema de pago receptivo para generar ingresos y se deben realizar esfuerzos por reducir el uso innecesario de servicios costosos proporcionados por médicos y clínicas particulares y unidades públicas de nivel superior.
... Mexico with the aim of expanding markets for clinical family planning services (10). ...
Thesis
Background: Social franchising is an increasingly popular health service delivery model in low-and middle-income countries. It is theorised to improve the quality of services, but evidence was found to be scarce by previous literature reviews. Objectives: To identify, summarise and critically appraise existing evidence of the impact of social franchising on health service quality in low-and middle-income countries as well as to identify the methods used by researchers. Methods: A systematic review of the academic literature and a grey literature review were conducted. For inclusion, academic papers needed to meet our eligibility criteria and to score as moderate to high upon critical appraisal (1). Grey literature was also included if meeting the eligibility criteria. Findings were categorised according to Maxwell's six dimensions of quality (2). Results: 227 academic papers and 233 grey literature documents were retrieved. 12 academic papers and 4 grey literature documents were included in the review. Evidence was available on three dimensions of quality: 'Access', 'Acceptability' and 'Effectiveness'. The evidence was mixed, not generalisable and insufficiently rigorous to draw firm conclusions. Only 3 of the academic papers reviewed explicitly stated using specific methodological frameworks to assess the quality of services. Conclusions: The need for more rigorous evidence persists and should be prioritised by policy makers. Future research should be conducted using robust designs and should assess quality in a more comprehensive manner. Evidence-based methodological guidance tailored to the social franchising context should be developed to support future research.
... 2.Due to the delimitation of article length, the theological and missional foundations of the projects are limited in this article. The authors, however, follow the views described in Buys (2013): 'A missional response to poverty and social justice', in particular, the definitions mentioned on pages 16, 17 and 19 and references to Bruwer (1994) and Chester (2004;2004a and2002). The explanations of Myers (2011:60ff) on the complexity of understanding the root causes of poverty were also kept in mind in developing this project. ...
Article
Full-text available
In many parts of South Africa, mission work is being done in communities living in desperate poverty. There is a great need for integral mission, bringing word and deed together in the proclamation of the gospel to equip Christians to have hope and engage in the fullness of community life to become responsible Christian stewards in the midst of a broken world. This article evaluates a relatively successful poverty alleviation project as an example of an integral mission project that the researcher initiated in 2016 in Northern KwaZulu-Natal, South Africa. In order to analyse the context, measure, manage and share the progress of the project, an app called ‘The Impact app’ was developed and used to collect data. The empirical research in this article comes from data collected over a period of four years primarily from this app and other sources. The main system structure that the researcher used for this integral project is called ‘Franchising as Mission’. It takes the best attributes of primary and secondary coops yet, enables governance and a fair share in the value chain. Poverty alleviation and gospel proclamation have been integrated in the whole project. Therefore, this entire project was regarded as Evangelical Christian Integral Mission as described in the Lausanne Covenant and elaborated on by Melba Padilla Maggay. It is these three core attributes that have led to a 92% higher uptake to that envisaged (Figure 14). This article hopes to point out what integral mission looks like in practice.
... During the late 1970s, social entrepreneurship programmes proliferated as a means to stimulate social development through an entrepreneurial approach (Mair and Martí, 2006). Such programmes mainly centred around social marketing, social franchising and micro-entrepreneurship as modes to achieve 'social goals', including improved health and well-being (Montagu, 2002;Koehlmoos et al., 2009;Beyeler et al., 2013;Firestone et al., 2017). A quasiexperimental study by Khurram Azmat et al. (2013) showed that social franchising combined with vouchers effectively increased contraceptive knowledge and use. ...
Article
Full-text available
The purpose of the current study was to explore the association between community health entrepreneurship and the sexual and reproductive health status of rural households in West-Uganda. We collected data using digital surveys in a cluster-randomized cross-sectional cohort study. The sample entailed 1211 household members from 25 randomly selected villages within two subcounties, of a rural West-Ugandan district. The association between five validated sexual and reproductive health outcome indicators and exposure to community health entrepreneurship was assessed using wealth-adjusted mixed-effects logistic regression models. We observed that households living in an area where community health entrepreneurs were active reported more often to use at least one modern contraceptive method [odds ratios (OR): 2.01, 95% CI: 1.30-3.10] had more knowledge of modern contraceptive methods (OR: 7.75, 95% CI: 2.81-21.34), knew more sexually transmitted infections (OR: 1.86, 95% CI: 1.14-3.05), and mentioned more symptoms of sexually transmitted infections (OR: 1.83, 95% CI: 1.18-2.85). The association between exposure to community health entrepreneurship and communities' comprehensive knowledge of HIV/AIDS was more ambiguous (OR: 1.27, 95% CI: 0.97-1.67). To conclude, households living in areas where community health entrepreneurs were active had higher odds on using modern contraceptives and had more knowledge of modern contraceptive methods, sexually transmitted infections and symptoms of sexually transmitted infections. This study provides the first evidence supporting the role of community health entrepreneurship in providing rural communities with sexual and reproductive health care.
... In return, the franchiser markets the brand and supports the provider to adhere to quality stand ards through training, clinical protocols, drugsupply management, and new technologies such as telemedicine. 13 In 2014, franchises reached almost 30 million people in lowincome and middleincome countries (LMICs), with most funding coming from international donors. 14 Although considerable resources are being channelled to social franchising in LMICs, evidence from rigorous studies on the effectiveness of clinical social franchising is scarce, [15][16][17] and this gap in knowledge urgently needs to be addressed. ...
Article
Full-text available
Background: How to harness the private sector to improve population health in low-income and middle-income countries is heavily debated and one prominent strategy is social franchising. We aimed to evaluate whether the Matrika social franchising model-a multifaceted intervention that established a network of private providers and strengthened the skills of both public and private sector clinicians-could improve the quality and coverage of health services along the continuum of care for maternal, newborn, and reproductive health. Methods: We did a quasi-experimental study, which combined matching with difference-in-differences methods. We matched 60 intervention clusters (wards or villages) with a social franchisee to 120 comparison clusters in six districts of Uttar Pradesh, India. The intervention was implemented by two not-for-profit organisations from September, 2013, to May, 2016. We did two rounds (January, 2015, and May, 2016) of a household survey for women who had given birth up to 2 years previously. The primary outcome was the proportion of women who gave birth in a health-care facility. An additional 56 prespecified outcomes measured maternal health-care use, content of care, patient experience, and other dimensions of care. We organised conceptually similar outcomes into 14 families to create summary indices. We used multivariate difference-in-differences methods for the analyses and accounted for multiple inference. Findings: The introduction of Matrika was not significantly associated with the change in facility births (4 percentage points, 95% CI -1 to 9; p=0·100). Effects for any of the other individual outcomes or for any of the 14 summary indices were not significant. Evidence was weak for an increase of 0·13 SD (95% CI 0·00 to 0·27; p=0·053) in recommended delivery care practices. Interpretation: The Matrika social franchise model was not effective in improving the quality and coverage of maternal health services at the population level. Several key reasons identified for the absence of an effect potentially provide generalisable lessons for social franchising programmes elsewhere. Funding: Merck Sharp and Dohme Limited.
... One of the privatization concepts being tested globally is social franchising. Franchising is a concept from the commercial industry in which a franchisor, usually a large business, contracts a franchisee, usually a small business, to produce, market or provide its successful service or brand according to a blueprint developed or owned by the franchisor [10]. The goal of social franchising is to offer a better service than the available service at a low price with increased availability through the use of a commercial relationship between the franchisor and franchisee. ...
Article
Full-text available
Introduction Although HIV testing services (HTS) have been successfully task‐shifted to lay counsellors, no model has tested the franchising of HTS to lay counsellors as independent small‐scale business owners. This paper evaluates the effectiveness of a social franchisee (SF) HTS‐managed pilot project compared to the Foundation for Professional Development (FPD) employee‐managed HTS programme in testing and linking clients to care. Methods Unemployed, formally employed or own business individuals were engaged as franchisees, trained and supported to deliver HTS services under a common brand in high HIV‐prevalent communities in Tshwane district between 2016 and 2017. SFs were remunerated per‐HIV test and received larger payments per‐HIV‐positive client linked to care. In the standard HTS, FPD employed counsellors received similar training and observed similar standards as in the SF HTS, but were remunerated through the normal payroll. We assessed the proportion of clients tested, HIV positivity, linkage to care and per‐counsellor cost of HIV test and linkage to care in the two HTS groups. Results The SF HTS had 19 HIV counsellors while FPD HTS employed 20. A combined total of 84,556 clients were tested by SFs (50.5%: 95% confidence interval (CI) 50.2 to 50.8)) and FPD (49.5%: 49.2 to 49.8). SFs tested more females than FPD (54.1%: 53.6 to 54.6 vs. 48%: 47.7 to 48.7). SFs identified more first‐time testers than FPD (21.5%: 21.1 to 21.9 vs. 8.9%: 8.6 to 9.1). Overall, 8%: 7.9 to 8.2 tested positive with more clients testing positive in the SF (10.2%: 9.9 to 10.5) than FPD (5.9%: 5.6 to 6.1) group. The SFs identified more female HIV‐positive clients (11.1%: 10.7 to 11.6) than FPD (6.5%: 6.2 to 6.9). The SFs linked fewer clients to HIV care and treatment (60.0%: 58.5 to 61.5) than FPD (80.3%: 78.7 to 81.9%). It cost four times less to conduct an HIV test using SFs ($3.90 per SF HIV test) than FPD ($13.98) and five times less to link a client to care with SFs ($62.74) than FPD ($303.13). Conclusions SF HTS was effective in identifying more clients, first‐time HIV testers and more HIV‐positive people, but less effective in linking clients to care than FPD HTS. The SF HTS model was cheaper than the FPD‐employee model. We recommend strengthening SFs particularly their linkage to care activities.
... Yet, social franchisors usually possess enough knowledge and ability to assess the performance of franchisees (Stanworth and Curran, 1999). There are two broad types of social franchising; one as a means to generate profit (Netting and Kettner, 1987), and another one to increase impact (Montagu, 2002;Volery and Hackl, 2010). ...
Article
Full-text available
Purpose Building on the resource-based view of the firm the purpose of this paper is to study the intangible resources available for social ventures, and presents a typology of growth strategies based on the intangible resources possessed by those enterprises. Design/methodology/approach This research applies a multiple case study technique for ten social enterprises in Egypt listed on Ashoka and Schwab Foundation websites. The research employs a purposive sampling technique. Data triangulation is used based on reports, websites, and interviews with social entrepreneurs and employees. Findings The study has three main findings: describing the intangible resources needed by social ventures to grow; detailing the growth strategies adopted by social ventures and corresponding funding mechanisms; explaining how intangible resources affect the selection of growth strategies, and how these interact with the context to produce expected outcomes. Overall, a typology for growth strategies of social ventures is presented. Research limitations/implications This paper is an original attempt to advance research on social enterprises in relation to the RBV and the domain of venture growth and impact scale-up. Practical implications This research is beneficial for social ventures and venture philanthropists who wish to learn about the specific resources important for venture growth, and understand the suitable strategies and context for organizational growth and impact scale-up. Originality/value This research is one of the few attempts to study and explain the types of intangible resources in social ventures and the role of different resource bundles in deciding social venture growth strategy.
Article
The private for-profit sector's prominence in health-care delivery, and concern about its failures to deliver social benefit, has driven a search for interventions to improve the sector's functioning. We review evidence for the effectiveness and limitations of such private sector interventions in low-income and middle-income countries. Few robust assessments are available, but some conclusions are possible. Prohibiting the private sector is very unlikely to succeed, and regulatory approaches face persistent challenges in many low-income and middle-income countries. Attention is therefore turning to interventions that encourage private providers to improve quality and coverage (while advancing their financial interests) such as social marketing, social franchising, vouchers, and contracting. However, evidence about the effect on clinical quality, coverage, equity, and cost-effectiveness is inadequate. Other challenges concern scalability and scope, indicating the limitations of such interventions as a basis for universal health coverage, though interventions can address focused problems on a restricted scale.
Article
Purpose Although previous research has examined the role of franchising for the economic development of countries, no empirical study to date has investigated the importance of franchising for social, infrastructural, and institutional development. The authors address this research gap by applying research results from the field of sustainable entrepreneurship and highlight that franchising has a positive impact on economic, social, institutional and infrastructural development. Design/methodology/approach This study uses a fixed-effects model on a panel dataset for 2006–2015 from 49 countries to test the hypothesis that franchising positively influences various dimensions of country development such as economic social institutional and infrastructural development. Findings The findings highlight that franchising has a positive impact on the economic, social, infrastructural, and institutional development of a country. Specifically, the results show that the earlier and the more franchising systems enter a country, the stronger the positive impact of franchising on the country's economic, social, institutional, and infrastructural development. Research limitations/implications This study has several limitations that provide directions for further research. First, the empirical investigation is limited by the characteristics of the data, which are composed of information from 49 countries (covering a period of 10 years). Because franchising is not recognized as a form of entrepreneurial governance in many emerging and developing countries, the available information is mainly provided by the franchise associations in the various countries. Hence, there is a need to collect additional data in each country and to include additional countries. Second, although the authors included developed and developing countries in the analysis, the authors could not differentiate between developed and developing countries when testing the hypotheses, because the database was not sufficiently complete. Third, future studies should analyze the causality issue between franchising and development more closely. The role of franchising in development may be changing depending on different unobserved country factors, economic sector characteristics, or development stages. Practical implications What are the practical implications of this study for the role of franchising in the development of emerging and developing economies? Because public policy in emerging and developing countries suffers from a lack of financial resources to improve the social, infrastructural and institutional environment, entrepreneurs, such as franchisors who expand into these countries, play an important role for these countries' development. In addition to their entrepreneurial role of exploring and exploiting profit opportunities, they are social, institutional, and political entrepreneurs who may positively influence country development (Schaltegger and Wagner, 2011; Shepard and Patzelt, 2011). Specifically, the findings highlight that countries with an older franchise sector (more years of franchise experience) may realize first-mover advantages and hence larger positive spillover effects on their economic, social, institutional and infrastructural development than countries with a younger franchise sector. Hence, governments of emerging and developing countries have the opportunity and responsibility to reduce potential market entry barriers and provide additional incentives for franchise systems in order to trigger these positive spillover effects. The authors expect that the spillover effects from the franchise sector on the economic, institutional, social and infrastructural development of a country are stronger in emerging and developing countries than in developed countries. Originality/value Previous research has focused on the impact of franchising on the economic development of a country, such as its growth of gross domestic product (GDP), employment, business skills, innovation and technology transfer. This study extends the existing literature by going beyond the impact of franchising on economic development: the results show that franchising as an entrepreneurial activity offers opportunities for economic, social, institutional, and infrastructural development, all of which are particularly important for emerging and developing economies. The findings of this study contribute to the international franchise and development economics literature by offering a better understanding of the impact of franchising on country development.
Purpose This paper, using a case study on Jibu, a water distribution chain that distributes bottled water in Africa, aims to underline the importance of social relationships and communication within franchise chains operating in the social sector in developing countries and their contribution to the clarification of the concept of social franchising. Design/methodology/approach The research is based on a case study of Jibu, a water distribution chain composed of 122 franchised units and 2,100 independent retailers. The primary data were gathered through an analysis of in-depth interviews with 67 people (Jibu co-founder, headquarters staff, franchisees, micro-franchisees and customers) in Uganda and Rwanda. Findings The findings showed that the extent and richness of social relationships and communication existing within the Jibu chain are not limited to top-down and build a feeling of belonging to a family. These social relationships and communication are key characteristics of social franchising. Practical implications This research can assist franchise experts, franchisors and franchisees to better assess the importance of social relationships and communication in social franchise chains in developing countries and help national and local governments better understand how franchising works in the social sector. Social implications Franchising is not limited to hotels, restaurants and retail businesses. Franchising can be applied to businesses that have social goals, in addition to profit goals. For example, the Jibu franchise is a relevant and efficient solution to providing the African people with access to drinking water at an affordable resale price. This paper, thus, contributes to increasing the awareness of this franchising phenomenon in social sectors in developing countries and in Africa, in particular. Originality/value Access to drinking water is an important issue in many developing countries, above all in African countries. Franchised water services are an innovation in terms of a business model in developing countries with micro-treatment plants run by franchisees and small units run by micro-franchisees or retailers, both franchisees and micro-franchisees being local entrepreneurs.
Article
Auntie Anne's Pretzels, the American Red Cross, and IKEA are franchises for a social benefit, but are they social franchises? There is a diversity of perceptions of what is meant by the term social franchising but no consensus on the precise meaning. Given that social franchising is a relatively new area of research and that a crucial first step in research on any topic is to define its parameters, this article derives a set of indicators for the phenomenon of social franchising by bringing together three strands of scholarship: social franchising, commercial franchising, and social enterprise.
Article
Partnerships, using the basic principles of social franchising, could address many challenges in the operation and/or maintenance of water services. Development of this concept is in South Africa moving from research, through pilots, into practice. Under the guidance of a franchisor, trainee franchisees undertook the routine servicing of the on-site sanitation facilities at 400 schools in the Eastern Cape, paid by the provincial Department of Education (DoE) from the normal departmental budgets for operation and maintenance. Despite difficulties arising directly from DoE inefficiencies, the pilot project has proven the value of social franchising partnerships for this kind of work - the DoE now has a model it intends to roll out to most of the more than 6000 schools across the province. Meantime, the franchisees have undertaken the routine servicing of several hundred household toilets, and much more of the same type of work for municipalities, is being lined up.
Article
Full-text available
Purpose The following paper presents proposed solutions and interventions to some of the major barriers to providing adequate access to healthcare in Kenya. Specific business models are proposed to improve access to quality healthcare in low- and middle-income countries. Finally, strategies are developed for the retail clinic concept (RCC). Design/methodology/approach Google Scholar, PubMed, and Ebscohost were among the databases used to collect articles relevant to the purpose in Kenya. Various governmental and news articles were collected from Google searches. Relevant business models from other sectors were considered for potential application to healthcare and the retail clinic concept. Findings After review of current methodologies and approaches to business and franchising models in various settings, the most relevant models are proposed as solutions to improving quality healthcare in Kenya through the RCC. For example, authors reviewed physician recruitment strategies, insurance plans, and community engagement. The paper is informed by existing literature and reports as well as key informants. Research limitations/implications This paper lacks primary data collection within Kenya and is limited to a brief scoping review of literature. The findings provide effective strategies for various business and franchising models in healthcare. Originality/value The assembling of relevant information specific to Kenya and potential business models provides effective means of improving health delivery through business and franchising, focusing on innovative approaches and models that have proven effective in other settings.
Article
This paper presents a review and synthesis of resources available to social entrepreneurs considering social franchising as an option for scale. We identified 20 publications produced by organizations supporting social franchising and four peer-reviewed journal manuscripts. Commonalities and differences between social and commercial franchising are discussed, with a focus on capacities and considerations needed to undertake social franchising. Based on our synthesis, we propose a seven-stage approach to guide social entrepreneurs in considering this option and to inform future research on social franchising as one potential mechanism for scaling impact.
Article
Full-text available
Pilot projects in South Africa have demonstrated how the institutionally innovative and very practical social franchising partnership approach can be used as an alternative approach to more commonly encountered options, for the routine maintenance of low-technology water and sanitation infrastructure. The strength of this approach is that it is built on a robust foundation of mutual support and incentives. The paper describes how franchise partners have been working with schools and municipalities to address operational issues. The Eastern Cape provincial Department of Education now has a proven model which it is rolling out to further school districts, beyond the initial pilot in the Butterworth education district. Municipalities in the area are also employing the franchisee microbusinesses to undertake maintenance services. Further opportunities lie in applying the approach to operation and/or maintenance activities within the water and sanitation services delivery chain, and thereafter extending it to other types of infrastructure (e.g. roads and electricity reticulation).
Article
Full-text available
A business model (BM) can be developed based on a business model framework (BMF) consisting of key components such as value proposition, customers, and resources. To systematically generate and analyze emerging BMs such as healthcare BM, an integration of diverse BMF components is needed. The present study is to establish a comprehensive BMF and evaluate its applicability to healthcare BMs. Based on a review of eight BMF studies, ten BMF components were identified and classified into five major components (value proposition, resources, organizing model, customers, and revenue model) and five minor components (technology, service platform, delivery, competitive strategy, and growth/exit) by analyses of frequency and functional importance. Lastly, the BMs of three emerging healthcare companies (WellDoc, Inc., CFW Shops, and Aravind Eye Care System) were analyzed and compared in terms of the proposed BMF components. The comprehensive BMF components presented in the study can be of help for developing new BMs and analyzing the strengths and weaknesses of BMs.
Article
Despite the rapid growth of social franchising, there is little evidence on its population impact in the health sector. Similar in many ways to private-sector commercial franchising, social franchising can be found in sectors with a social objective, such as health care. This article evaluates the World Health Partners (WHP) Sky program, a large-scale social franchising and telemedicine program in Bihar, India. We studied appropriate treatment for childhood diarrhea and pneumonia and associated health care outcomes. We used multivariate difference-indifferences models to analyze data on 67,950 children ages five and under in 2011 and 2014. We found that the WHP-Sky program did not improve rates of appropriate treatment or disease prevalence. Both provider participation and service use among target populations were low. Our results do not imply that social franchising cannot succeed; instead, they underscore the importance of understanding factors that explain variation in the performance of social franchises. Our findings also highlight, for donors and governments in particular, the importance of conducting rigorous impact evaluations of new and potentially innovative health care delivery programs before investing in scaling them up.
Article
This is one of the first studies to explore customer retention in reference to the franchisee–customer relationship. A subsequent objective was to examine localization and standardization from a franchise unit and system-level perspective. Data was collected using a self-administered survey based on customers of pet grooming services in Australia. Findings suggest that the addition of a customer retention perspective reveals a greater depth to the franchisee–customer relationship. Importantly, this implies that there are additional factors likely to influence franchisee–customer retention within franchise outlets. We suggest that individual franchise units, in cooperation with local customers, should co-create local marketing initiatives.
Chapter
Full-text available
The Act-Belong-Commit campaign is an evidence-based social marketing program making extensive use of social franchising to promote the mental health and wellbeing of individuals and communities. The campaign targets individuals with respect to engaging in activities that strengthen and maintain good mental health. At the same time, the campaign targets organisations that offer mentally healthy activities to act as social franchises for the campaign, promoting the messages internally to their staff and/or externally to their clients or local communities. Act-Belong-Commit’s overarching framework allows for implementation at the population level, as well as in specific settings and for targeted groups. The campaign has a mass and targeted media presence and is implemented through partnerships with local governments, schools, workplaces, health services, state government departments, community organizations, and local sporting and recreational clubs. This chapter describes the campaign, how it operates in the community, how it is evolving from a largely population wide (universal) approach to include targeted (selective) approaches, its geographic diffusion, and evaluation.
Article
Full-text available
Family planning programs are increasingly making quality of care the highest priority. With improvement in quality of care, contraceptive use is safer and more effective, information and services are more accessible, clients make informed choices and are more satisfied. In addition, family planning providers find their work more rewarding and the general public has a positive view of health care and its providers. Applying the lessons of the quality movement of health care and family planning, programs and providers are finding more creative approaches that suit reproductive health care in developing countries. In addition to adopting a client-centered approach, these efforts suggest that the three sides of the quality triangle are equally essential: quality design, quality control, and quality improvement.
Article
Full-text available
The behavior of private sector health care providers will depend critically on the environment within which they operate. A bewildering array of possible regulatory and incentive setting structures exist. Most developing countries have the basic legislation for regulation, but there are frequently difficulties in enforcing such controls. While process aspects of quality of care regulation are often the responsibility of professional organizations, these organizations may have limited incentives to be active in ensuring high quality medical car.e There has been less experience with the use of incentives to encourage appropriate behavior amongst private providers: this appears a promising area for further work. Above all, adequate information is essential both for the enforcement of regulations and the application of incentive mechanisms.
Article
Full-text available
Better health care quality is a universal goal, yet measuring quality has proven to be difficult and problematic. A central problem has been isolating physician practices from other effects of the health care system. To validate clinical vignettes as a method for measuring the competence of physicians and the quality of their actual practice. Prospective trial conducted in 1997 comparing 3 methods for measuring the quality of care for 4 common outpatient conditions: (1) structured reports by standardized patients (SPs), trained actors who presented unannounced to physicians' clinics (the gold standard); (2) abstraction of medical records for those same visits; and (3) physicians' responses to clinical vignettes that exactly corresponded to the SPs' presentations. Setting Outpatient primary care clinics at 2 Veterans Affairs medical centers. Ninety-eight (97%) of 101 general internal medicine staff physicians, faculty, and second- and third-year residents consented to be randomized for the study. From this group, 10 physicians at each site were randomly selected for inclusion. A total of 160 quality scores (8 cases x 20 physicians) were generated for each method using identical explicit criteria based on national guidelines and local expert panels. Scores were defined as the percentage of process criteria correctly met and were compared among the 3 methods. The quality of care, as measured by all 3 methods, ranged from 76.2% (SPs) to 71.0% (vignettes) to 65.6% (chart abstraction). Measuring quality using vignettes consistently produced scores closer to the gold standard of SP scores than using chart abstraction. This pattern was robust when the scores were disaggregated by the 4 conditions (P<.001 to <.05), by case complexity (P<.001), by site (P<.001), and by level of physician training (P values from <.001 to <.05). The pattern persisted, although less dominantly, when we assessed the component domains of the clinical encounter--history, physical examination, diagnosis, and treatment. Vignettes were responsive to expected directions of variation in quality between sites and levels of training. The vignette responses did not appear to be sensitive to physicians' having seen an SP presenting with the same case. Our data indicate that quality of health care can be measured in an outpatient setting by using clinical vignettes. Vignettes appear to be a valid and comprehensive method that directly focuses on the process of care provided in actual clinical practice. Vignettes show promise as an inexpensive case-mix adjusted method for measuring the quality of care provided by a group of physicians.
Article
bers were salaried personnel. In addition, MEXFAM's clinics were in locations where they were increasingly competing with government-run family planning centers. Consequently, the association decided to close most of the less effective clinics and begin a search for a new service model that would contribute to the expansion of family planning activities. Initially, MEXFAM attempted to transfer clinic doctors to underserved communities, opening part-time family planning offices-sometimes in the homes of community residents-where the physician would see patients for a few hours on certain days of the week. Thus, most doctors served more than one area. The experiment proved to be short-lived. When the project's poor performance was analyzed, however, two elements emerged as being directly related to success: the community and the support it provides the doctor, and the doctor's personal character. With this information in hand, the MEXFAM staff again assessed family planning service delivery in Mexico. The foundation, as with any health care organization in Mexico, was well aware of the sizable reservoir of unemployed Mexican
Article
Access to family planning, quality of care and medical barriers to services are key factors in the adoption of contraceptive use. Access helps determine whether the individual makes contact with the family planning provider, while quality of care greatly affects the client's decision to accept a method and the motivation to continue using it. Medical barriers are scientifically unjustifiable policies or practices, based at least in part on a medical rationale, that inappropriately prevent clients from receiving the contraceptive method of their choice or impose unnecessary process barriers to access to family planning services. In the past, international family planning efforts have been criticized as placing too much emphasis on issues of access and the quantity of contraceptives distributed. The climate now exists for pursuing improvements in quality and access simultaneously and for exploring through research the linkages between access, quality and medical barriers.
Article
We reconcile seemingly conflicting hypotheses and evidence that surface in the principal-agent literature. Specifically, we examine the literature that deals with the effect of costly monitoring on retail-organizational form. Our principal-agent model of the optimal relationship between up and downstream firms allows the principal to garner two types of imperfect signals of agent effort: sales data and behavior data. The model yields predictions that we confront with the econometric evidence, which comes from both franchising and sales-force-compensation literatures. We find that, when variation in the informativeness and in the cost of increasing the informativeness of both signals is considered, the evidence is consistent with the theory.
Article
This paper argues that the positive impact of public accountability on public service performance and governance in general can be augmented by moving away from an exclusive reliance on control mechanisms such as hierarchical monitoring and use of organizational incentives to a system that uses “exit” or “voice” mechanisms in conjunction with control. Whether the public will resort to exit or voice will depend on the relative costs associated with these options and the expected value to them of the performance improvement resulting from their use in a specific context. Public services can be categorized in terms of the exit and voice potential they afford the public by reference to certain barriers and characteristics. The paper provides a framework for the analysis of the features and barriers of public services and of the publics involved that can be used to predict the potential for the use of exit and voice in specific service contexts. A menu of options for improving public accountability through the use of exit and voice mechanisms and their policy implications are also presented.
Article
This article provides an empirical assessment of various agency-theoretic explanations for franchising, including risk sharing, one-sided moral hazard, and two-sided moral hazard. The empirical models use proxies for factors such as risk, moral hazard, and franchisors' need for capital to explain both franchisors' decisions about the terms of their contracts (royalty rates and up-front franchise fees) and the extent to which they use franchising. In this article, I exploit several new sources of data on franchising to construct a cross section of 548 franchisors involved in various business activities in the United States in 1986. The data are most consistent with a model based on two-sided moral hazard. The empirical models are also more successful at explaining the extent to which franchisors choose to franchise stores than at explaining the terms of franchise contracts. Finally, contrary to the predictions of several theoretical models, I find that royalty rates and franchise fees are not negatively related.
Article
Argues that decisions regarding the intended and achievable levels of care - as with issues regarding access or coverage - must be defined within the context of an individual program by persons responsible for that program. This judgement is based on both an understanding of the scientific complexities involved and a conviction that without the ingenuity and support of program managers, any international rhetoric about improving the quality of services would be but empty words. -from Authors
Article
This article argues for attention to a neglected dimension of family planning services--their quality. A framework for assessing quality from the client's perspective is offered, consisting of six parts (choice of methods, information given to clients, technical competence, interpersonal relations, follow-up and continuity mechanisms, and the appropriate constellation of services). The literature is reviewed regarding evidence that improvements in these various dimensions of care result in gains at the individual level; an even scarcer body of literature is reviewed for evidence of gains at the level of program efficiency and impact. A concluding section discusses how to make practical use of the framework and distinguishes three vantage points from which to view quality: the structure of the program, the service-giving process itself, and the outcome of care, particularly with respect to individual knowledge, behavior, and satisfaction with services.
Article
The meaning of quality of care for the women who receive reproductive health services at a family planning and maternal and infant care clinic in Santiago, Chile, was examined to describe the clinic's service from the women's point of view. A participatory research project with the staff of the clinic was conducted. The central part of that study, reported here, consisted of interviews with 60 of the 330 women who came to the clinic during two weeks in June 1991. The women defined high quality of care as "being treated like a human being." Among specific elements of care they identified were cleanliness, promptness and availability of service, time made available for consultation, learning opportunities for themselves and their partners, and cordial treatment. Clients' view of quality of care must be supplemented by professional judgments about how well services meet clients' needs. But the client's view is determinant if improvements are to result in greater acceptance and sustained use of the services offered. The issues identified by the clients involve only minor costs for the clinic.
Article
Within the past five years, accreditation has been adopted in a number of countries. Accreditation, originally perceived as a vehicle to enable organisational development, is found to be increasingly of interest to wider publics including governments in regulating and promoting quality. The newer systems are based upon the experience of the mature accreditation systems of the Joint Commission in the USA, the Canadian Council on Health Facilities Accreditation and the Australian Council on Health Care Standards. The mature accreditation systems have demonstrated their responsiveness to the changing needs of the health care systems in which they operate. In the past decade, these accreditation systems have responded to the decline in the role of the hospital in health care delivery; the demands of governments and the public for greater information about quality of health care. They have also responded to pressure for greater knowledge of clinical effectiveness by introducing indicators of clinical performance and are looking to outcome measures.
Article
This study examines the relationship between common objective measures of quality and perceptions of the quality of family planning facilities. Results of prior research indicate that such perceptions are an important determinant of contraceptive use in rural Tanzania. The data for this study are drawn from two surveys conducted in rural Tanzania. Three models are tested separately for women and for men. The important determinants of perceptions of quality among women and men are: perceived travel time to the facility, availability of immunizations, and availability of maternal and child health services. Additionally, the ratio of the number of staff to outpatients is important to men. The data explain a moderate amount of the variance in the quality measures, indicating that perceived quality is not fully predicted by common objective measures of quality. Future surveys of facility quality should develop objective measures to better predict the perceived quality, with the underlying goal of increasing contraceptive use.
Article
The experience of low- and middle-income countries (LMC) with respect to regulation and legislation in the health sector is in marked contrast to that of Canada and Europe. It is suggested that the degree to which regulatory mechanisms can influence private sector activity in LMC is quite low. However, there has been little work done on exploring just how, and to what extent, these regulations fail. Through the use of stakeholder interviews, this study explored the effectiveness of regulations directed at the private-for-profit sector (general practitioners, private clinics and hospitals) in Zimbabwe. The study found that there was limited and asymmetric knowledge of basic regulations among government bodies and private providers. However, there was a clear feeling that regulations are not being implemented and enforced effectively. A variety of opportunistic practices have been observed among private providers, including: practices of self-referral, where patients are sent to other services the provider has a financial interest in; over-servicing; doctor-patient collusion to collect health insurance payments; and the use of unlicensed staff in private facilities. Key factors limiting effectiveness of regulation in the health sector include the over-centralization and lack of independence of the regulatory body, the absence of legal mechanisms to control the price of care, and the lack of knowledge by patients of their rights. The study also identified a number of potential strategies for improving the current regulatory environment. For example, in order to improve monitoring, 'informal' arrangements between the centralized regulatory body and local authorities developed. There is a need to develop ways to formalize the role of these authorities. In addition, professional associations of private providers are also identified as key players through which to improve the impact of regulation among private providers. Increasing consumer access to information and knowledge is another potential way to improve information within the regulatory process as well as implementation.
Will successful systems ultimately become wholly-owned chains?
  • Ar Oxenfelt
  • Kelly
Oxenfelt AR, Kelly AO. 1969. Will successful systems ultimately become wholly-owned chains? Journal of Retailing 44: 69–83
Not-for-profit franchising?
  • M Amies
Amies M. 2000. Not-for-profit franchising? Franchising World 32: 38–39
Franchise prototypes: why it’s so important to get the first unit right
  • K Farrell
Farrell K. 1984. Franchise prototypes: why it’s so important to get the first unit right. Venture 6: 38–41
Carrot and stick: state mechanisms to influence private provider behaviour Franchising of health services 129 rBertrand Access, quality of care and medical barriers in family planning pro-grams
  • S Bennett
  • G Dakpallah
  • Garner
Bennett S, Dakpallah G, Garner P et al. 1994. Carrot and stick: state mechanisms to influence private provider behaviour. Health Policy and Planning 9: 1–13. Franchising of health services 129 rBertrand JT, Hardee K, Magnani RJ, Angle MA. 1995. Access, quality of care and medical barriers in family planning pro-grams. International Family Planning Perspectives 21: 64–69, 74
Introduction Franchising: contemporary issues and research
  • Rp Dant
  • Pj Kauffman
Dant RP, Kauffman PJ. 1995. Introduction. In: Kauffman PJ, Dant RP (eds). Franchising: contemporary issues and research. New York: Hawthorne Press.
Private practitioners in the slums of Karachi: professional development and innovative approaches for improving practice Private health providers in developing countries: serving the public interest? London: Zed Books. US Department of Commerce Franchising in the economy
  • Ih Thaver
  • T Harpham
Thaver IH, Harpham T. 1997. Private practitioners in the slums of Karachi: professional development and innovative approaches for improving practice. In: Bennett S, McPake B, Mills A (eds). 1997. Private health providers in developing countries: serving the public interest? London: Zed Books. US Department of Commerce. 1988. Franchising in the economy 1986–1988. Washington DC: US Government Printing Office.
The power of pharmacy franchising: independents say insurance is the main benefit of affiliation
  • D Hedgpeth
Hedgpeth D. 2000. The power of pharmacy franchising: independents say insurance is the main benefit of affiliation. Washington Post, January 10, 2000; p. F05.
A project to develop a blueprint for franchising family planning and other reproductive health services
  • E Smith
Smith E. 1996. A project to develop a blueprint for franchising family planning and other reproductive health services; Vol. II. London: Marie Stopes International.
Proposal for franchising of health services in Latin America
  • G Mortimore
Mortimore G. 2001. Proposal for franchising of health services in Latin America. Unpublished.
Advertising frees in the franchised channel Franchising: contemporary issues and research
  • Kc Sen
Sen KC. 1995. Advertising frees in the franchised channel. In: Kauffman PJ, Dant RP (eds). Franchising: contemporary issues and research. New York: Hawthorne Press.
Franchising family planning services in western Kenya
  • D Montagu
Montagu D. 2001. Franchising family planning services in western Kenya. Unpublished.
Evaluation of the Green Star Pilot Project
  • S Agha
  • C Squire
  • R Ahmed
Agha S, Squire C, Ahmed R. 1997. Evaluation of the Green Star Pilot Project. Washington DC: Population Services International.
Arisingh director of the Janani Program
  • Dutt
Dutt, Arisingh director of the Janani Program, Bihar, India. Personal communication.
Master franchising and system growth rates Franchising: contemporary issues and research
  • Pj Kauffman
  • Sh Kim
Kauffman PJ, Kim SH. 1995. Master franchising and system growth rates. In: Kauffman PJ, Dant RP (eds). 1995. Franchising: contemporary issues and research. New York: Hawthorne Press.
Franchise organizations
  • Jl Bradach
Bradach JL. 1998. Franchise organizations. Boston, MA: Harvard Business School Press.
Grilling the suspect in food-related illness
  • R Kent
Kent R. 1993. Grilling the suspect in food-related illness. Research Reporter 23, vol. 3, University of Georgia. [http://www.ovpr. uga.edu/rcd/researchreporter/93f/food.html] accessed November 2001.
Social franchising for EU member states; experts meeting on HIV
  • E Smith
Smith E. 1997. Social franchising for EU member states; experts meeting on HIV/AIDS. London: Options.
  • R Justis
  • R Judd
Justis R, Judd R. 1989. Franchising. Cincinnati, OH: South-Western Publishing Co.
Franchising as a source of technology transfer to developing economies. Special Studies Series
  • J Stanworth
  • S Price
  • C Porter
  • T Swabe
  • M Gold
Stanworth J, Price S, Porter C, Swabe T, Gold M. 1995. Franchising as a source of technology transfer to developing economies. Special Studies Series, No 7, ed. I.F.R. Center. Vol. 7. Westminster: University of Westminster Press.
Trade-off between rural expansion and financial self-sufficiency in the delivery of family planning services: the case of Honduras. Washington DC: The Futures Group
  • T Dmytraczenko
Dmytraczenko T. 1997. Trade-off between rural expansion and financial self-sufficiency in the delivery of family planning services: the case of Honduras. Washington DC: The Futures Group. [http: //www.tfgi.com/hond%5fpub.asp]
Let every child be wanted: how social marketing is revolutionizing contraceptive use around the world
  • Pd Harvey
Harvey PD. 1999. Let every child be wanted: how social marketing is revolutionizing contraceptive use around the world. Westport, CT: Auburn House.