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Social franchising is the application of commercial franchising concepts to achieve socially beneficial ends, rather than profit [1].

Overview

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Social franchising, similar to commercial franchising, is a contractual relationship wherein an independent coordinating organization (usually a non-governmental organization, but occasionally a governmental body or private company[2]) offers individual independent operators the ability join into a franchise network for the provision of selected services over a specified area in accordance with an overall blueprint devised by the franchisor[3]. Once joining the network, operators are given the right to employ previously tested incentives including: professional training, use of brands or brand advertisements, subsidized or proprietary supplies and equipment, support services, and access to professional advice [4]. Members also gain beneficial spin-off effects such as increased consumer volume and improved reputation due to brand affiliation [5]. Franchisees must adhere to a range of requirements including: providing socially beneficial services, meeting quality and pricing standards, undergoing mandatory education on provision of services, subjecting outlets to quality assurance mechanisms, reporting service and sales statistics, and occasionally, paying fixed or profit-share fees [6][7]. Social franchises have been used for primary health services, pharmaceutical sales of essential drugs, HIV testing and counseling, and reproductive health services in the developing world.

Social Franchising for Health Services

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Social franchising for essential health services is an emerging technique used by governments and aid-donors in developing countries where a substantial percentage of health services are provided by private sector (including non-profit NGOs and private for-profit) to improve access, equity, effectiveness, and quality. Clinical franchising often takes the form of a fractional model where franchised services are added to an existing medical practice, but also can exist as a stand alone practice wherein the site exclusively provides franchise supported services or commodities. Social franchising has been used to deliver a wide range of services including DOTS tuberculosis treatment [8], sexual transmitted infection management [9] [10], primary care, and HIV / AIDS treatment [11] [12].

Strengths and Weaknesses of Social Franchising

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Strengths

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By organizing small independent providers into larger units, social franchises can yield returns to scale in investment in physical capital, supply chains, advertising, and worker training and supervision [13]. Additionally, social franchises can offer the ability to: faster scale up programs, decrease transaction costs, provide uniform services to a broad market, collectively negotiate financial reimbursement mechanisms, and replicate best practice services among a large group [14]. Franchisees can also cross-subsidize less profitable services with the more profitable ones supported by the franchisor. The use of brand advertising makes social franchising compatible with social marketing [15] [16]. In addition, social franchising for health services allows an expansion of services because of cross-subsidization, addition of less-profitable services if fractionally franchised, and access to costly medicines if subsidized by the coordinating organization.

Weaknesses

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Several inherent logistical and economic weaknesses are present within the social franchising model. These include the difficulty in standardizing medical care among participants, the need for networks to be sufficiently large to attain an economy of scale, the cost and challenge of regulatory oversight of outlets, and the need to base organizational decisions on the population demand which may not maximize quality or minimize cost [17]. There also exists the possibility of “tragedy of the commons” wherein franchisees provide low quality, low cost due to incomplete monitoring [18]. Social franchising for health services runs the risk of overly procedural, “cookie cutter” medical provision, overtreatment of disease conditions, and the possibility of fraud if oversight is not present.

History of Social Franchise Programs

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The first significant implementation of social franchising was conducted in 1995 by the Greenstar franchise in Pakistan. Since its inception, Greenstar has trained over 24,000 providers, and provides family planning, sexual and reproductive health services, maternal and child health services, and tuberculosis diagnosis and treatment through over 80,000 retail outlets [19]. Since then, over 35 additional social franchise programs have arisen, with much of the increase in the number and size of social franchises occurring in the last four years. Franchises have additionally expanded their services from mostly family planning to testing and treatment of malaria, tuberculosis, and HIV / AIDS [20].

Existing Clinical Social Franchises[21]

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Franchise Name Country Coordinating Organization Date Founded Number of Clinics Family Planning HIV Sexual and Reproductive Health Maternal and Child Health Tuberculosis Malaria Other
AMUA Kenya Marie Stopes International 2004 186 Yes
BlueStar (Bangladesh) Bangladesh Social Marketing Company 1998 3600 Yes
BlueStar (Ethiopia) Ethiopia Marie Stopes International 2007 150 Yes Yes
BlueStar (Ghana) Ghana Marie Stopes International 2008 100 Yes Yes
BlueStar (Malawi) Malawi Marie Stopes International 2008 59 Yes Yes
BlueStar (Philippines) Philippines Marie Stopes International 2007 77 Yes Yes
BlueStar (Sierra Leone) Sierra Leone Marie Stopes International 2008 70 Yes
BlueStar (Vietnam) Vietnam Marie Stopes International 2007 32 Yes Yes
Confiance Congo Population Services International 2004 78 Yes
DiMPA Network India PSP-One 1998 1150 Yes
FriendlyCare (Phillipines) Phillipines FriendlyCare 1999 6 Yes Yes
Greenstar Pakistan Population Services International 1995 8000 Yes Yes Yes Yes
Gold Star Kenya Family Health International 2006 279 Yes Yes Yes Yes
Merrygold Health India Hindustan Latex FP Trust 1995 Yes Yes Yes Yes
Key Clinics India Population Services International 2004 701 Yes Yes
K-Met (Kenya) Kenya K-MET 1995 200 Yes Yes
New Start (South Africa) South Africa Population Services International 2007 11 Yes
New Start (Lesotho) Lesotho Population Services International 2004 6 Yes
New Start (Swaziland) Swaziland Population Services International 2003 16 Yes Yes
New Start (Zambia) Zambia Population Services International 2002 8 Yes
New Start (Zimbabwe) Zimbabwe Population Services International 1999 41 Yes Yes Yes
Operation Light House India Population Services International 2002 12 Yes
ProFam (Benin) Benin Population Services International 2004 30 Yes Yes
ProFam (Cameroon) Cameroon Population Services International 2004 25 Yes Yes
ProFam (Mali) Mali Population Services International 2005 33 Yes
PSI Togo Togo Population Services International 2002 13 Yes
PSI Uganda Uganda Population Services International 2007 2 Yes
RedPlan Salud Peru INPPARES 2003 1087 Yes
Sangini Nepal Nepal CRS Company 1994 2484 Yes
SkyHealth / SkyCare Centres India World Health Partners 2008 Yes
Smiling Sun Bangladesh Chemonics International 2008 Yes Yes Yes
Society for Family Health Nigeria Population Services International 2006 Yes
Sun Quality Health (Myanmar) Myanmar Population Services International 2001 846 Yes Yes Yes Yes Yes Yes
Sun Quality Health (Cambodia) Cambodia Population Services International 2002 159 Yes Yes Yes Yes Yes
Surya Clinic India Janani/DKT International 1998 564 Yes
Top Reseau Madagascar Population Services International 2001 155 Yes Yes Yes
Well-Family Midwife Clinics Philippines Well-Family Midwife Clinic 2008 Yes
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Private Healthcare in the Developing Countries section on Social Franchising

References

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  1. ^ Montagu, D. (2002). "Franchising of Health Services in Developing Countries" (PDF). Health Policy and Planning. 17 (2): 121–130. Retrieved 2008-03-06.
  2. ^ Bishai, D. (2008). "Social Franchising to Improve Quality and Access in Private Health Care in Developing Countries" (PDF). Harvard Health Policy Review. 9 (1): 184–197. Retrieved 2008-03-06.
  3. ^ Stanworth, J. (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. {{cite journal}}: Unknown parameter |co-authors= ignored (help)
  4. ^ Koehlmoos, T. (2008). "The effect of social franchising on access to and quality of health services in low- and middle-income countries" (PDF). DOI: 10.1002/14651858.CD007136.pub2. CD007136. (1). {{cite journal}}: Unknown parameter |co-author= ignored (help); line feed character in |title= at position 59 (help)
  5. ^ Montagu, D. (2002). "Franchising of Health Services in Developing Countries" (PDF). Health Policy and Planning. 17 (2): 121–130. Retrieved 2008-03-06.
  6. ^ Montagu, D. (2002). "Franchising of Health Services in Developing Countries" (PDF). Health Policy and Planning. 17 (2): 121–130. Retrieved 2008-03-06.
  7. ^ Prata, N. (2005). "Private Sector, Human Resources and Health Franchising in Africa". Bulletin of the World Health Organization. 83: 274–279.
  8. ^ Lonnroth, K. (2007). "Social franchising of TB care through private GPs in Myanmar: an assessment of treatment results, access, equity and financial protection". Health Policy and Planning. 22: 156–166. Retrieved 2008-03-06. {{cite journal}}: Unknown parameter |co-authors= ignored (help)
  9. ^ Peters, D. (2004). "Strategies for engaging the private sector in sexual and reproductive health: how effective are they?". Health Policy and Planning. 19 (Supplement 1): i5–i21. Retrieved 2008-03-06. {{cite journal}}: Unknown parameter |co-authors= ignored (help)
  10. ^ World Health Organization and USAID. (2007). "Public policy and franchising reproductive health: current evidence and future directions. Guidance from a technical consultation meeting". {{cite journal}}: Cite journal requires |journal= (help); Unknown parameter |co-authors= ignored (help)
  11. ^ Perrot, J. (2006). "Different approaches to contracting in health systems". Bulletin of the World Health Organization. 84 (11): 859–866. Retrieved 2008-03-06. {{cite journal}}: Unknown parameter |co-authors= ignored (help)
  12. ^ Montagu, D. (2003). "Innovations in access to TB and HIV/AIDS care in sub-Saharan Africa: dynamic engagement of the private sector" (PDF). Applied Health Economics and Health Policy. 2: 175–180. Retrieved 2008-03-06. {{cite journal}}: Unknown parameter |co-author= ignored (help)
  13. ^ Bishai, D. (2008). "Social Franchising to Improve Quality and Access in Private Health Care in Developing Countries" (PDF). Harvard Health Policy Review. 9 (1): 184–197. Retrieved 2008-03-06.
  14. ^ World Health Organization and USAID. (2007). "Public policy and franchising reproductive health: current evidence and future directions. Guidance from a technical consultation meeting". {{cite journal}}: Cite journal requires |journal= (help); Unknown parameter |co-authors= ignored (help)
  15. ^ Montagu, D. (2002). "Franchising of Health Services in Developing Countries" (PDF). Health Policy and Planning. 17 (2): 121–130. Retrieved 2008-03-06.
  16. ^ Private Healthcare in Developing Countries
  17. ^ Private Healthcare in Developing Countries
  18. ^ Montagu, D. (2002). "Franchising of Health Services in Developing Countries" (PDF). Health Policy and Planning. 17 (2): 121–130. Retrieved 2008-03-06.
  19. ^ "Greenstar Social Marketing: Social Franchising Private Health Services". 2009-01-25. Retrieved 2009-03-29.
  20. ^ Montagu, D., and the Global Health Group (2009). "Clinical Social Franchising 2009: Annual description of country programs worldwide". {{cite journal}}: Cite journal requires |journal= (help)CS1 maint: multiple names: authors list (link)
  21. ^ Montagu, D., and the Global Health Group (2009). "Clinical Social Franchising 2009: Annual description of country programs worldwide". {{cite journal}}: Cite journal requires |journal= (help)CS1 maint: multiple names: authors list (link)
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