Clinical Social Franchising Compendium, 2010

Transcription

CliniCal SoCial FranChiSing Compendium
an annual Survey of programs, 2010
The Global Health Group
University of California, San Francisco
May 2010
Copyright © 2010 The Global Health Group
The global health group
Global Health Sciences
University of California, San Francisco
50 Beale Street, Suite 1200
San Francisco, CA 94105, USA
Email: [email protected]
Website: globalhealthsciences.ucsf.edu/ghg
ordering information
Electronic download: This publication is available for electronic download at
globalhealthsciences.ucsf.edu/ghg.
Print copies: Limited print copies are available from the Global Health Group.
To request a copy, please send an email to [email protected].
Information will be updated over time and published online at
recommended citation
Schlein, K., Kinlaw, H. and Montagu, D. (2010). Clinical Social Franchising Compendium: An
Annual Survey of Programs, 2010. San Francisco: The Global Health Group, Global Health
Sciences, University of California, San Francisco.
Produced in the United States of America
First Edition, May 2010
This is an open-access document distributed under the terms of the Creative Commons Attribution-Noncommercial License, which permits any noncommercial use, distribution and reproduction in any medium, provided the original author and source are credited.
This document is a product of the Global Health Group at the University of California, San Francisco. The information contained herein was provided by individual franchise programs and was
not independently verified. This document is intended to serve as a guide, and the interpretation and use of the information is the responsibility of the reader. Country designations do not
express any judgment by the Global Health Group concerning the legal status of any country or
territory. References to companies or products do not reflect endorsement or preference by the
Global Health Group.
Cover image
Photo © Rodrique Wanjala, Courtesy of Population Services International, Kenya
2
Clinical Social Franchising, 2010
Table of Contents
introduction
5
program services table
7
Social franchise profiles by country
8
Bangladesh ..................................................................................................... 8
Blue Star
8
Smiling Sun
10
Benin............................................................................................................. 12
ProFam
12
Cambodia ..................................................................................................... 14
Sun Quality Health
14
Cameroon ..................................................................................................... 16
ProFam
16
democratic republic of Congo ..................................................................... 18
Reseau Confiance
18
el Salvador .................................................................................................... 20
Vision Spring
20
ethiopia ........................................................................................................ 22
BlueStar
22
ghana ........................................................................................................... 24
BlueStar
24
MicroClinic International
26
india .............................................................................................................. 28
Drishtee Health Franchise
28
MerryGold
30
Saadhan
32
SkyHealth Rural Clinics
34
Surya
36
Kenya ............................................................................................................ 38
AMUA
38
Gold Star Network
40
Tunza Family Health Network
42
madagascar ................................................................................................. 44
BlueStar
44
ProFemina
46
Top Réseau
48
malawi .......................................................................................................... 50
BlueStar
50
mali ............................................................................................................... 52
ProFam
52
myanmar ....................................................................................................... 54
Sun Quality Health
54
3
nepal ............................................................................................................ 56
Sangini Social Franchising
56
nigeria .......................................................................................................... 58
Society for Family Health
58
Hygeia
60
pakistan ........................................................................................................ 62
Greenstar
62
Sehat First
64
Suraj
66
peru .............................................................................................................. 68
RedPlan Salud
68
philippines .................................................................................................... 70
BlueStar
70
Sierra leone.................................................................................................. 72
BlueStar
72
South africa .................................................................................................. 74
BroadReach Healthcare
74
Togo.............................................................................................................. 76
POMEFA
76
uganda ......................................................................................................... 78
Living Goods
78
ProFam
80
Vietnam ........................................................................................................ 82
BlueStar
82
Tinh chi em
84
Zimbabwe ..................................................................................................... 86
New Start
86
appendices
88
appendix a: acronyms ................................................................................. 88
appendix B: map of social franchises ........................................................... 89
appendix C: program summary graphs ........................................................ 90
Timeline
91
Franchises by region
91
Services offered
91
Couple years of protection (CYP)
92
CYP conversion factors
93
Number of clients served
94
Program expenditure
95
Expenditure per client
95
appendix d: demand-side financing ............................................................ 96
appendix e: donors contributing to franchising programs in 2009.............. 98
appendix F: umbrella organizations............................................................. 99
4
introduction
This second annual compendium of clinical social franchise programs is a testament to
the rapidly growing and changing field of social franchising in developing countries.
Forty franchises are profiled herein, ten of which are new additions to the compendium. The data included was provided by the franchises in the first quarter of 2010 and
subsequent edits were made by the Global Health Group.
The profiles that follow describe new innovations in financing, healthcare delivery,
technology and involvement of community health workers. Each profile contains information relevant to the social franchising community as a whole. The successes and
challenges of each franchise are highlighted, providing lessons and a basis for further
communication among implementers and stakeholders of social franchising programs
worldwide.
Some of the novel initiatives profiled this year include the following:
• Video consultation with qualified physicians to support the local staff at Sehat First
clinics in Pakistan
• AMUA’s establishment of a public-private partnership with the MOH in Kenya
• Use of field workers to distribute vouchers as part of the Suraj program in Pakistan
• A toll-free hotline that offers anonymous information on HIV and family planning as
well as referrals to ProFam clinics in Benin
• Planning for a program where hairdressers, dressmakers and female students working as community health workers will refer clients to BlueStar clinics in Ghana
• Cross subsidies among a diverse product mix for Living Goods’ entrepreneurs in
Uganda
• An SMS-based reporting system for family planning sales being used by Tunza in
Kenya
What is a social franchise?
A social franchise encompasses a network of private health practitioners linked
through contracts to provide socially beneficial services under a common brand. To be
considered a social franchise for inclusion in this compendium, a network of providers
had to have the following characteristics:
•
•
•
•
1
2
3
5
Outlets are operator-owned
Payments to outlets are based on services provided1
Services are standardized2
Clinical services are offered, with or without franchise-branded commodities3
The mechanism of payment may vary and may include client out-of-pocket, voucher, third party
insurance or other systems.
Additional, non-franchised products and services may also be offered.
Clinical services are defined as any healthcare practice that would, in an OECD country, require service by a nurse
or other higher-level provider. Under this definition, for example, injections are considered clinical, even if
franchise-supported community health workers or pharmacists provide them.
goals
A social franchise has four primary goals:
• Access — Increase the number of service delivery points (providers) and healthcare
services offered
• Cost-effectiveness — Provide a service at an equal or lower cost to other service
delivery options, inclusive of all subsidy or system costs
• Quality — Provide services that adhere to quality standards and improve the preexisting level of quality
• Equity — Serve all population groups, emphasizing those most in need
Franchises by the numbers
The table below provides a snapshot of social franchising in 2009 and the subsequent
section summarizes the services provided by each franchise. For additional summary
tables, graphs and a map of franchises around the world, please see the appendices.
6
Total number of social franchises in the compendium
40
Social franchises that are new to the 2010 compendium
10
Franchises that do not have brick-and-mortar outlets
2
Franchises that post job aids / training materials on the internet
3
Computer-based inventory management systems in use by franchises
10
Median annual franchise membership fee (in USD)
21
Franchises using or planning to use SMS for client reporting/follow up
9
Programs that accept payment by vouchers or insurance
16
Franchises that target men as clients
15
Franchises offering access to loans as a benefit of membership
7
Programs that integrate community health workers in some way
30
Franchise programs with pharmacy affiliates
11
number of services provided by franchise and health area in 2009*
Family
planning
other
Sexual rh
hiV/aidS
mCh
malaria
TB
other
Number of Programs
Providing Each Service
36
19
9
12
11
6
11
Blue Star, Bangladesh
6,387,172
2,964
241,109,310
Smiling Sun, Bangladesh
33,250,113
68,387
6,233
2,243,616
ProFam, Benin
11,769
3,136
Sun Quality Health, Cambodia
27,643
437
ProFam, Cameroon
22,707,163
Reseau Confiance, DRC
546,541
25,023
2,100
8,529,323
268
43,371
87,130
2,806
1,542
1,045
●
VisionSpring, India/Ghana
211,000
BlueStar, Ethiopia
112,363
6,335
BlueStar, Ghana
129,632
2,052
MicroClinic, Ghana/Uganda
1,567
893
33,940
Drishtee, India
MerryGold, India
345,000
149,530
33,060
SkyHealth, India
809,635
3,130
Surya, India
28,993,884
115,142
AMUA, Kenya
1,004,932
43,648
Gold Star, Kenya
72,455
119,170
Tunza, Kenya
17,863
Top Réseau, Madagascar
59,059
23,244
BlueStar, Madagascar
1,823
41
ProFemina, Madagascar
15,200
BlueStar, Malawi
16,895
ProFam, Mali
5,237
Sun Quality Health, Myanmar
1,527,953
Sangini, Nepal
16,914,071
13,000
2,700
10,803
143,248
●
321
65,265
100
682,598
105,077
17,710
Society for Family Health,
Nigeria
37,444
Suraj, Pakistan
158,464
Greenstar, Pakistan
99,010,825
Sehat First, Pakistan
30
RedPlan Salud, Peru
176,093
BlueStar, Philippines
112,432
3,158
BlueStar, Sierra Leone
10,509
1,125
156
15,242
3,029,075
●
12,236
44,277
1,540
194
441,259
439
4,808
87,130
BroadReach, South Africa
1,500**
44,165
●
●
ProFam, Uganda
13,686
BlueStar, Vietnam
76,093
14,651
Tinh chi em, Vietnam
32,149
17,316
New Start, Zimbabwe
29,859
123,000
Hygeia, Nigeria
Living Goods, Uganda
103
3,500
Saadhan, India
POMEFA, Togo
48,938
●
●
361,355
●
●
●
* The numbers presented in this table represent either the number of commodities provided or the number of clients served. In cases where the numbers
differ, the higher of the two is presented. The dots indicate that services are provided, but the quantity provided was not reported.
** Includes all patients initiated on treatment to date.
7
Bangladesh
Social marketing Company (SmC)
Blue Star Bangladesh
At a glance
Franchise details
Timeline
Services
Launched in 1998
Family planning
●
USAID calculation
435,441 CYP
MSI/DKT calculation 451,442 CYP
Location
64 out of 64 districts
Other sexual and reproductive health
Business model
Fractional franchise
HIV/AIDS
Target clientele
Men, women, children
Maternal and child health
Average staffing
1 doctor and 1 non-graduate medical practitioner per outlet
Malaria
Outlet types
3,600 clinics
Tuberculosis
●
Diarrheal disease treatment,
vitamins
●
Number of clients served in 2009
●
Average clients/outlet
8
Payment sources
100% out-of-pocket payment (OOP)
(The contraceptive injectable “SOMA-JECT” is
donated by USAID to SMC and sold at a subsidized price to Blue Star providers.)
2009 program expenditure (USD)
$244,126
Donor support
USAID
Contact information
Dr. Salah Uddin Ahmed, Manager
www.smc-bd.org
Bangladesh
Social marketing Company (SmC)
Blue Star Bangladesh
Description
Background
Social Marketing Company (SMC) started Blue Star as a
pilot project with a goal to increase informed demand for
high priority public health services through partnerships
with private health providers. A private health practitioner
becomes a Blue Star provider after meeting the selection criteria, signing a partnership agreement that states
they will deliver a defined package of services, attending
a training course, keeping records and sending reports to
SMC. SMC provides training, quality assurance visits, onsite technical assistance, behavior change communication
support, supplies commodities and promotes the social
franchise brand through local and mass media.
Service details
Oral contraceptives, condoms, injectables, Copper T,
emergency contraceptive pills, clean delivery kits, TB referrals, diarrheal disease treatment, vitamins
licensing
Directorate General of Family Planning of Government of
Bangladesh
Job aids
• FP counseling flip chart
• Screening checklist
• Voluntary family planning (FP) charts (also known as "Tiahrt Charts") to ensure informed and voluntary decision
making by clients
inventory management
Blue Star delivers products based on provider requests and
requirements via pre-established service delivery points.
Injectable contraceptives are distributed based on stock
sheets maintained at the outlet level. From the central
warehouse the products are distributed to 12 area offices,
and from there the products go to wholesalers, retailers and
Blue Star outlets.
9
Health practitioners outside of Blue Star Bangladesh clinic
Technology
SMS reporting
Successes
• Strong brand image
• Reputation for quality providers
• Providers are available from morning until night
Future plans
Integrated management of childhood illness (IMCI), reproductive tract infection (RTI)/STI, maternal neonatal health
innovations
• Documentation (record keeping and reporting)
• Introduction of membership fees
• Adding more public health priority services through Blue
Star
Bangladesh
Chemonics international
Smiling Sun
At a glance
Franchise details
Timeline
Services
Launched in 2008
Family planning
●
USAID calculation
1,424,344 CYP
MSI/DKT calculation 1,534,971 CYP
Location
Business model
Full franchise
HIV
Target clientele
Low income, migrants/refugees, women, youth
●
Average staffing
"Vital" clinics have an average of 12 staff
"Ultra" clinics have an average of 30 staff
Malaria
●
Outlet types
320 clinics, 8,500 satellite sites
Tuberculosis
●
23,000,000
Diarrheal disease treatment, lab
services, vitamins, pneumonia testing/treatment
●
2,608
Payment sources
60% OOP, 1% vouchers, 29% free, 5% third
party payers
2009 Program expenditure (USD)
Around $10 million
Donor support
USAID funds around 65% of the network's
operational expenses
Contact information
Juan Carlos Negrette, Chief of Party
www.smilingsunhealth.com
10
●
Bangladesh
Chemonics international
Smiling Sun
Description
Background
Smiling Sun is a USAID-supported network of 28 NGOs
that own 320 clinics, 8,500 satellite sites and an “army” of
6,000 community service providers (volunteer women who
provide health products, basic services and referrals to
clinics in their communities) that operates in 61 (out of 64)
districts of Bangladesh. This full-franchise serves more than
20 million customers every year, and is the largest private
healthcare network in the country.
Service details
implants, emergency contraceptive pills, STI treatment,
cervical screening, post-abortion care, antenatal care
(ANC), labor and delivery, emergency obstetric care, postnatal care, vaccinations, pediatric consultations, malaria
treatment, tuberculosis (TB) case management, diarrheal
disease treatment, lab services, vitamins, pneumonia testing/treatment
Community health workers
Community Service Providers are volunteer women who
provide contraceptives, acute respiratory infection
prevention and diarrhea prevention to members of the
community.
Job aids
A range of job aids and other resources can be found at
the Smiling Sun website, www.smilingsunhealth.com (access restricted to members).
11
Smiling Sun patients
• Stock reports by outlet
• Stock register book
• Inventory management training
• Physical stock counts
• Refrigerators
• Locked/secured storage rooms
Technology
• Web-based reporting
• Piloting SMS-based reporting for satellite clinics
• Working with a general practitioner (GP) to develop a
hotline/SMS dialog with youth
Benin
population Services international
protection de la Famille (proFam)
At a glance
Franchise details
Timeline
Services
Launched in 2004
Family planning
●
USAID calculation
10,779 CYP
Location
5 out of 12 departments
●
Business model
Full franchise; annual franchise fee of $42 USD
HIV/AIDS
●
Target clientele
Low income, youth, men, women
●
Average staffing
4 staff per clinic
Malaria
●
Outlet types
50 clinics
Tuberculosis
2,153
43
Payment sources
OOP, vouchers
Donor support
USAID
The Dutch Government
Contact information
Lisa Moorhouse, HIV/FP Technical Advisor
www.psi.org
12
Benin
protection de la Famille (proFam)
Description
Background
Protection de la Famille (ProFam) clinics aim to improve the
quality and accessibility of FP services in the private sector
and increase the demand for FP services.
Service details
implants, natural FP, STI testing and treatment, prevention
of mother-to-child transmission (PMTCT), HIV counseling
and testing (HCT), ANC, labor and delivery, emergency obstetric care, post-natal care, malaria testing and treatment,
insecticide-treated nets
licensing
Accreditation of midwives by the government through the
Division of Family Health
CHWs provide home visits and conduct education sessions. They are not paid a fee for each referral.
Job aids
Checklists designed by Family Health International
Stock reports by outlet
Technology
Telephone hotline/counseling
13
ProFam education session
Successes
Benin’s Ligne Verte (toll-free hotline) was created to offer
an anonymous way for callers to receive information on HIV,
FP and referrals to ProFam clinics. In 2009, the Ligne Verte
received 78,773 calls.
Challenges
• Implementing and enforcing quality assurance
• Desire of providers to be paid more
Cambodia
Sun Quality health network
At a glance
Franchise details
Services
2002: condom, pill, and injectables
2005: intrauterine device (IUD)
2008: implants
Family planning
Location
13 out of 24 provinces
Business model
HIV
Target clientele
Low income
●
Average staffing
1–2 doctors and 1–2 midwives per clinic
Malaria
●
Outlet types
83 clinics, 6 mobile clinics
Tuberculosis
31,312
Diarrheal disease treatment
352
Payment sources
OOP
Timeline
●
USAID calculation
42,616 CYP
●
●
Donor support
KfW (German development bank)
USAID
Anonymous donor
Contact information
Leng Vanna, Franchise Manager
www.psi.org
14
Cambodia
Sun Quality health network
Description
Background
Population Services International (PSI) Cambodia manages a fractional franchise of 83 private health providers in
support of reproductive health services. Sun Quality Health
(SQH) providers are provided with a wide range of monitoring, support and training tools to improve their clinics.
Service details
Oral contraceptives, condoms, injectables, Copper T, implants, STI treatment, ANC, labor and delivery, emergency
obstetric care, post-natal care, vaccinations, malaria testing/treatment, diarrheal disease treatment
licensing
Certificate of medical doctor, medical doctor assistant or
secondary midwife
PSI Cambodia sub-contracts to a network of local NGOs
which are given the skills and tools to support local volunteers to conduct mobilization and outreach in the communities surrounding the SQH clinics. Local NGOs implement
interactive group sessions, individual outreach and special
events to encourage women of reproductive age to access
services at Sun Quality clinics. These volunteers are paid a
nominal monthly stipend for their work.
Job aids
• Standard Operating Procedures
• Long-term methods services checklists
• Counseling checklists
• Counseling flipcharts
15
• A quarterly health magazine
• Client record forms
• Product display boxes and other point-of-sale materials
Technology
Successes
In an effort to expand access and choice to long-term
methods, PSI hosts ‘Special Training Event Days’ to give
providers the opportunity to refine their practical and
counseling skills in IUD and implant insertions and counseling. Additionally, by linking mobile event days to an SQH
provider and to public health centers, PSI Cambodia can
ensure that complications and method removal, if necessary, are addressed by a trained and qualified provider.
Challenges
• Providers need consistent practice to maintain confidence and competence in providing long-term methods.
• Cost barriers remain an issue.
Future plans
• Linkage of select services to health insurance, vouchers,
and equity funds to increase access to and choice of
reproductive health services
• TB diagnosis, pneumonia and high blood pressure
treatment are also being considered as health areas to
integrate into the franchise.
Cameroon
proFam Cameroon
At a glance
Franchise details
Timeline
Services
Launched in 2003
Family planning
●
USAID calculation
197,721 CYP
Location
Yaoundé City
Business model
HIV/AIDS
Target clientele
Low income, sex workers and clients, men,
youth, women, children under 5
Average staffing
4 staff (nurses, medical assistants, chemical sellers, midwives, doctors, surgeons) per clinic
Malaria
Outlet types
24 clinics, 1 mobile clinic
Tuberculosis
12,347
Pediatric care
494
Payment sources
OOP, vouchers
$497,671
Donor support (USD)
PSI with Core Funds through Dutch government
Strategic Alliance with International NGOs
(SALIN): $1,259,870
Contact information
Monda Léa, ProFam Coordinator
www.psi.org
16
●
Cameroon
proFam Cameroon
Description
Background
ProFam started in 2003 with 25 private health centers in
Yaoundé City. The objectives are to provide FP and pediatric care by offering IMCI according to the Health Ministry
standards.
Service details
Contraceptives, condoms, female condoms, injectables,
Copper T, implants, natural FP, lactational amenorrhea
method, pediatric care
licensing
The Ministry of Health
Community mobilizers are identified and are trained by the
reproductive health staff.
• Computer-based inventory management system
Successes
• Health talks organized with women's associations surrounding health centers
• Subsidized voucher system
• Referral system for adverse events and emergencies
Challenges
• Convincing clients to use IUDs
• Increasing demand for FP services among youth
Future plans
• Organizing "ProFam days" in the suburbs where franchise clinics do not exist
• Recruiting new clinics
ProFam Cameroon community mobilizer training session
17
Democratic Republic of Congo
association de Santé Familiale (aSF) (affiliate of pSi in drC)
reseau Confiance (Confiance network)
At a glance
Franchise details
Timeline
Services
Launched in 2003
Family planning
●
USAID calculation
78,347 CYP
Location
Business model
HIV/AIDS
Target clientele
Low income, women
Average staffing
1 doctor, 4–6 nurses and 1 lab technician per
health center
Malaria
Outlet types
93 health centers, 329 pharmacies
Tuberculosis
Payment sources
OOP
Donor support (USD)
USAID: $1.1 million
Dutch government (SALIN): $400,000 (used
to pay for ASF/PSI’s FP program, of which the
network is the main activity)
Contact information
Jamaica Corker, FP Technical Advisor
www.psi.org
18
Democratic Republic of Congo
association de Santé Familiale (aSF) (affiliate of pSi in drC)
reseau Confiance (Confiance network)
Description
Service details
Oral contraceptives, injectables, Copper T, natural FP
licensing
Medical staff (doctors, nurses) are accredited through the
government.
CHWs carry out interpersonal and mass media communications, as well as referrals to network clinics and pharmacies.
The network currently has 103 CHWs. They do not receive
any fee for referrals but are paid monthly stipends.
Job aids
• Client registration books
• Consultation sheets, stock sheets
• Follow-up reminder cards
• Monthly reporting sheets
• Eligibility criteria folders
• Flipcharts
• Family Planning: A global handbook for providers (in
French)—available at http://info.k4health.org/globalhandbook/
• Arrangement of stock by First In/First Out (FIFO)/First
Expiry/First Out (FEFO)
Technology
Successes
• Signing of a collaboration agreement to ensure that
roles and responsibilities are being fulfilled; this can also
be referred to if under-performing partners are asked to
leave the network
19
Reseau Confiance pharmacy
• Meetings at the provincial level with all network members provide a forum to share information
• Teams of mobile educators in each province diffuse information on FP and refer potential clients to Confiance
network clinics/pharmacies.
Challenges
• Insufficient product quantities (particularly as demand
continues to grow)
• Mobility of clinicians and pharmacists—many leave their
posts within one or two years
• Difficulties collaborating with local government to ensure
supervision of clinics and pharmacies
Future plans
• Introducing the implant Jadelle into the network in 2010
• Expansion of the network (within current sites and into
more cities in DRC) pending additional funds
El Salvador and India
VisionSpring
At a glance
Franchise details
Services
Timeline
Launched in 2003
Family planning
Location
2 out of 14 departments in El Salvador, 6 out of
28 states in India
Business model
15% full franchise/85% fractional franchise
HIV/AIDS
Target clientele
Age 35+ who have difficulties with up-close
vision
Average staffing
5,000 entrepreneurs
Malaria
Outlet types
Physical outlets not utilized
Tuberculosis
201,000 through partners; 25,000 through direct
channels
Eye screening and glasses provision
●
Payment sources
OOP
$171,000
Donor support
(USD)
BlackRock: $25,000
Allergan Foundation.: $2,500
Johnson & Johnson: $50,000
The International Foundation.: $15,000
Contact information
Sean Mayberry, Chief Operating Officer
www.visionspring.org
20
El Salvador and India
VisionSpring
Description
Background
VisionSpring trains local entrepreneurs in developing markets to screen individuals and distribute reading glasses
and sunglasses through their Business in a Bag. VisionSpring addresses the market failure that leaves 500 million
people in the world without access to affordable glasses.
Service details
Eye screening and glasses provision
VisionSpring employs Vision Entrepreneurs, and they receive approximately $1 on a $5 pair of eyeglasses.
• Stock reports
• Stock cards
Technology
Web-based reporting
Successes
• With the Business in a Bag model, the entrepreneur has
everything s/he needs to run a successful business.
• Since presbyopia is something that affects a high
percentage of those over 35 throughout the world, this
franchise model can be easily replicated and brought to
different developing markets.
Challenges
• Providing a sustainable business opportunity for Vision
Entrepreneurs with few products in their basket to sell.
• With a primary focus on a low-turnover product like
eyeglasses, the model runs the risk of market saturation
for the entrepreneur.
21
VisionSpring entrepreneur testing glasses on patient
• Awareness of the need for the product remains low in
most developing countries, requiring greater investment
in field marketing to raise both supply and demand.
Future plans
• Creation of a more efficient partner engagement model
which should facilitate faster and more profitable scaling
• New Products: photochromics (lenses that change shade
depending on amount of sunlight) and eye drops
• Expansion to Indonesia and Brazil
innovations
Testing the viability of having an optometrist available on a
bi-monthly basis at a central location to treat patients who
have vision problems beyond presbyopia.
Ethiopia
marie Stopes international ethiopia
BlueStar healthcare network
At a glance
Franchise details
Services
Pilot in 2007 with FP services. Medical and surgical abortion services started in January 2009.
Will launch HCT/STI management services in
some clinics in April 2010.
Family planning
Location
Amhara, Oromia and SNNP regional states (3
of 8 states)
Business model
Fractional franchise; annual franchise fee of
$3.70–11.10 USD (based on clinic size)
HIV/AIDS
Target clientele
Low-income women, sex workers and clients,
long distance truck drivers, military
Average staffing
The minimum number of professionals in lower
clinics is 2, while it is 3 and 6 for medium and
higher clinics respectively.
Malaria
Outlet types
205 clinics, 2 hospitals
Tuberculosis
118,919
574
Payment sources
OOP, voucher
$490,038
Donor support
Anonymous donor
Contact information
Girma Mintesnot, Social Franchise Manager
www.mariestopes.org
Timeline
22
●
USAID calculation
29,443 CYP
●
Ethiopia
marie Stopes international ethiopia
BlueStar healthcare network
Description
Background
BlueStar Ethiopia provides franchised services including
the provision of long-term FP methods, permanent FP
methods and medical and safe surgical abortion services.
Some of the clinics will soon provide HIV testing and STI
diagnosis services.
Service details
Oral contraceptives, condoms, injectables, Copper T, implants, emergency contraceptive pills, sterilization, abortion
(medical and surgical)
licensing
The Drug Administration and Control Authority
Involvement of CHWs is in a pilot phase
Job aids
• BlueStar pictorial teaching aid
• Global Hand Book for Providers (FP)
• Internal audit checklists
Physical stock counts
Technology
Telephone reporting
Successes
• BlueStar Ethiopia is considered the first to offer longterm and permanent FP methods in the private sector.
• The provision of training on medical abortion and safe
surgical abortion services in private clinics.
Family planning client in consultation with BlueStar provider
• The misconceptions about FP, and lack of awareness
about the availability of services in the private sector
• Because long-term FP services are provided for free in
government health facilities, BlueStar reduces the cost of
delivering FP supplies to the franchisees to enable franchisees to provide services at a reduced price to attract
business and make a profit.
Future plans
• The program is planning to integrate HCT/STI testing
and diagnosis services in some of the BlueStar clinics
and in some other private facilities.
• Geographic expansion is planned to the Afar regional
state, Addis Ababa and Dire Dawa.
Challenges
• Because franchisees were not previously offering longterm FP methods, training has taken a long period of time.
23
Ghana
marie Stopes international
BlueStar ghana
At a glance
Franchise details
Timeline
Services
Launched in March 2008
Family planning
●
Location
1 out of 10 regions
Business model
Fractional franchise; annual franchise fees from
$28–69 USD based on outlet type
HIV/AIDS
Target clientele
Low income
Average staffing
1–10 staff per clinic
Malaria
Outlet types
25 clinics, 16 pharmacies, 19 chemical sellers
Tuberculosis
36,451
608
Payment sources
OOP
$278,395
Donor support (USD)
Anonymous donor: $222,966
Contact information
Senanu Arkutu, Social Franchising Manager
www.mariestopes.org
24
●
Ghana
BlueStar ghana
Description
Background
BlueStar is a private provider network made up of maternity homes, pharmacies and chemical shops. The outlets are
trained to deliver FP and sexual and reproductive health
services to their communities.
Service details
Oral contraceptives, condoms, vaginal foaming tablets,
injectables, implants, abortion (medical and surgical)
licensing
Midwives: by Midwives Association (Ghana Health Service)
Pharmacies: by Pharmacy Council
CHW program is currently being developed. Each clinic
outlet aims to have ten CHWs. CHWs will include hairdressers, dressmakers, students, etc. who talk to clients and refer
to designated outlets. CHWs will be paid for each effective
referral.
25
Job aids
• FP flipcharts
• Labels for waste and emergency drugs
Successes
• Demand creation events
• Reaching low-income population through pharmacies and chemical shops (as these are the first point of
contact)
Challenges
• Providers changing their minds about providing abortion
services
• Outlet staff turnover
• Staff leaving after being trained by Marie Stopes
Pharmacist Akua Afi Ampofo greets clients outside BlueStar Ghana
pharmacy
Ghana and Uganda
microClinic international
At a glance
Franchise details
Timeline
Services
Launched in 2009
Family planning
●
USAID calculation
104 CYP
MSI/DKT calculation 112 CYP
Location
Ghana and Uganda
Business model
25% full franchise, 75% fractional franchise; annual franchise fee of $1000 USD
HIV
Target clientele
No target groups
●
Average staffing
3 nurses, 1 medical assistant,1 pharmacist, 1
midwife and 7 other staff per clinic
Malaria
●
Outlet types
4 clinics, 200 hospitals, 10 pharmacies
Tuberculosis
●
3,900 per clinic location
3,900
Diarrheal disease treatment,
vitamins, lab services, pneumonia
testing/treatment
●
Payment sources
30% OOP, 10% insurance, 60% government
reimbursement
●
Donor support
Contact information
26
Kojo Benjamin Taylor, President
www.microclinics.com
Ghana and Uganda
microClinic international
Description
Background
Following a franchise business model that combines ownership with proven operating, marketing and distribution
standards, MicroClinic empowers community health nurses
to own and grow their own MicroClinic.
Service details
Oral contraceptives, STI testing, ANC, labor and delivery, post-natal care, vaccinations, pediatric consultations,
malaria testing/treatment, insecticide-treated nets, TB case
management, diarrheal disease management, lab services,
vitamins, pneumonia testing/treatment
licensing
The government health education system
Job aids
Standard of care disease protocol resource manual
27
• Refrigerators
Technology
Successes
• Enforcement of system standards
• Establishment of a third-party payment system
Challenges
• Traditional franchise business model is new to sub-Saharan Africa, so educating policy makers is a crucial part of
the enterprise.
• Entrepreneurship training and customer service are
not emphasized in the healthcare education system, so
MicroClinic has had to develop more elaborate training
programs than anticipated.
Future plans
Blood chemistry analysis
India
drishtee development & Communication ltd.
drishtee health Franchise
At a glance
Franchise details
Services
Timeline
Launched in 2007
Family planning
Location
2 out of 28 states
Business model
Full franchise; one-time licensing fee
HIV/AIDS
Target clientele
Rural community
Average staffing
1 doctor, 1 midwife, 1 nurse and 1 clinical officer
per kiosk
Malaria
Outlet types
43 kiosks
Tuberculosis
8,000+
General medicine, lab services,
vitamins
186
Payment sources
OOP
$1.8 million on all franchise activities, of which
10% was spent on health franchising
●
●
Donor support
Contact information
28
Dr. Minal Singh, Area Controller-Health
www.drishtee.com
India
drishtee development & Communication ltd.
drishtee health Franchise
Description
Background
Female health franchisees are trained to work as Drishtee
Health Franchisees (DHFs) at each cluster of villages on
defined routes. The DHFs are trained in basic emergency
care, non-invasive diagnostic and path tests and in business skills. DHFs are linked with qualified Bachelor of Medicine and Bachelor of Surgery (MBBS) doctors.
Service details
Pediatric consultations, gynecologist consultations, general
medicine, lab services, vitamins
Computer-based inventory management system
Technology
Telephone/hotline counseling
Drishtee Health Franchisees at a training
29
Successes
• The success of the model is directly related to the ownership of the DHF towards the outlet, quality of health
services provided and the promotion of the services.
• If the location of the health outlet is remote, the utilization of the services is higher.
Challenges
Educating villagers about common diseases and their
proper treatment since villagers trust the quacks/traditional
healers who have been practicing in the villages for years.
Future plans
The Maternal Health Care program has generated demand
for proper and timely maternal care. In the future, this
program will be combined with the provision of maternal
care in the form of check-ups within the villages at Drishtee
Health Kiosks.
India
hindustan latex Family planning promotion Trust (hlFppT)
merrygold
At a glance
Franchise details
Timeline
Services
Launched in 2007
Family planning
●
USAID calculation
24,975 CYP
Location
35 out of 70 districts in Uttar Pradesh
Business model
30% full franchise, 70% fractional franchise;
royalty after first year
HIV
Target clientele
Low income, migrants/refugees, women,
children
Average staffing
10–15 per clinic (doctors, nurses, medical assistants, chemical sellers, midwives)
Malaria
Outlet types
220 clinics, 35 hospitals, 6,000 Merry Tarang
Tuberculosis
417,000
67
Payment sources
OOP, insurance, government reimbursement,
vouchers (services are subsidized for voucher
holders)
$630,000
Donor support
$1.05 million in USAID through SIFPSA (State
for Innovations for Family Planning Services
Agency)
Contact information
Mr. Sharad Agarwal, State Director UP;
Mr. Birender Kumar, Team Leader
www.hlfppt.org
30
●
India
hindustan latex Family planning promotion Trust (hlFppT)
merrygold
Description
Background
Hindustan Latex Family Planning Promotion Trust (HLFPPT)
works with partners pioneering innovations for improving
the health of the poor. The social franchising project in Uttar Pradesh (UP) aims to create a sustainable public-private
partnership in healthcare for the low income, working
class and poor by developing a sustainable network of
franchised hospitals (MerryGold Hospitals) offering quality
reproductive child health services at pre-fixed prices.
Service details
Oral contraceptives, condoms, Copper T, sterilization,
ANC, clean delivery kits, labor and delivery, post-natal care
licensing
The staff members are not accredited individually, but
hospitals and clinics are accredited by the Chief Medical
Officer of the District. The units are accredited by various
government schemes like Rogiswasthya Beema Yojana and
Sobhagyawati Yojana.
CHWs are used and are involved in a referral gift scheme
for motivation
Job aids
• Manuals: obstetric, FP, infection prevention, basic newborn care, emergency newborn care
• Posters on infection control and waste management (in
Hindi)
31
• Refrigerators
Technology
Successes
• Strong brand image associated with quality
• Attitude change in service providers towards safe delivery promotion and preventive health
• Integrated platform for promoting MCH through various
modes, and options like direct paying clients
Challenges
• Identification and selection of franchisees with desired
qualifications
• Maintaining attendance during training sessions, as doctors are reluctant to leave their practice
• Conversion of knowledge into practice, as the staff attrition rate at private hospitals/nursing homes is high
• 80% of beneficiaries are from a rural background—transport in itself is a challenge
Future plans
• Integrating the safe motherhood initiatives with PMTCT
• Upgrading the services to other gynecological treatments like infertility
• Expanding infant care to pediatric care
innovations
Call center for clients, franchisees and other stakeholders
available 24 hours a day
India
Saadhan
At a glance
Franchise details
Timeline
Services
Launched in July 2008
Family planning
●
USAID calculation
437,945 CYP
Location
3 out of 28 states
Business model
HIV/AIDS
Target clientele
Low income, men, women
Average staffing
At least 1 doctor, some clinics also have a nurse
Malaria
Outlet types
1,000 clinics
Tuberculosis
●
Payment sources
OOP, free
Donor support
Contact information
32
Sanjeev Dham, Director of Programs
www.psi.org
India
Saadhan
Description
Background
To improve maternal health, PSI India harnesses private
qualified gynecologists and doctors with gynecology practices through its Saadhan network. The members of the
network are private practitioners providing health services
to urban and peri-urban women.
Service details
Condoms, Copper T, injectables, medical abortion
licensing
Educational degrees and registration numbers (with Medical Council of India) are verified by program staff before
including them in the network. Most of the doctors are also
members of the Federation of Obstetric and Gynecological
Societies of India (FOGSI).
CHWs serve as interpersonal communicators, who make
house-to-house visits in the target area to provide IUD
counseling and referrals to network doctors.
Job aids
• Manuals and handbook containing minimum quality
standards
• Checklist for IUD counseling and insertion/removal
• Checklist for instrument processing
• Posters on IUD insertion steps
• Poster on instrument processing
• Manual on medical abortion
• Poster on medical abortion
• Pictorial client information booklet in prepackaged
medicines kit, called Safe Abort, for medical abortion
33
Stock cards
Technology
Successes
• Working with already existing private providers—the
outlets are perceived as providers of quality services and
the providers are already well trained in IUD and medical
abortion skills.
• The partnership with FOGSI enhances the visibility of the
program, encourages doctors to join the network and
helps to increase standards for quality related to IUD and
medical abortion services.
Challenges
• Changing historically negative perceptions about IUDs
• Lack of spousal support is a barrier to adoption of IUDs
• Discontinuation by IUD users
• Working with private providers who are motivated by
profits
• Educating chemists on medical abortion drugs
Future plans
Expansion of injectables in the network clinics of Delhi and
Uttar Pradesh
innovations
On-site demonstration of infection prevention measures
by program staff. These visits help the network doctors in
supervised practice sessions of IUD insertion on a pelvic
model, using the infection prevention measures.
India
World health partners
Skyhealth rural Clinics
At a glance
Franchise details
Timeline
Services
Launched in 2008
Family planning
●
USAID calculation
84,757 CYP
Location
3 districts in Western Uttar Pradesh and 1 district in Madhya Pradesh
Business model
HIV/AIDS
Target clientele
Low income, women
Average staffing
1–3 doctors, 1–5 nurses per clinic and 1 visiting
midwife, 3 technicians at diagnostic centers
Malaria
Outlet types
16 clinics, 1,400 chemical sellers, 127 telemedicine centers, 1,339 rural referral centers
Tuberculosis
Telemedicine Provision Centers: 12,756 (consultation through Central Medical Facility); franchised clinics: 7,490 ( family planning services)
●
●
Payment sources
OOP, free sterilization services during camps
(Profits from some services to people above
poverty line are used to offset cost of services
to people below poverty line.)
$2,200,000
Donor support (USD)
Anonymous donor: $3 million
Contact information
Gopi Gopalakrishnan, Project Director
www.worldhealthpartners.org
34
India
World health partners
Skyhealth rural Clinics
Description
Background
World Health Partners runs four mutually beneficial
franchisee networks, which are also linked to shops and
medical specialists. Providers earn profits by providing care
or facilitating care at a higher level. The franchisees earn
profits by delivering curative care but also have to deliver
a mandated quantum of preventive services which are not
commercially viable.
Service details
emergency contraceptive pills, sterilization, abortion (medical and surgical), malaria testing
licensing
Three of the medical clinics are government-accredited.
A public sector nurse-midwife visits the village centers to
provide paramedical care in person or in tele-consultation
with a town-based doctor
Job aids
• Medical algorithms
• Instrument sterilization procedures
• Post-abortion care guides
Technology
• Telemedicine
• SMS client follow up
• SMS reporting
35
SkyHealth Rural Clinics clinic
• Telephone hotline/counseling
Successes
• By identifying private providers on the basis of skill levels
and location, and breaking down service provision into
various components, the project delivers some components locally and others through a physical and virtual
referral or consultation process.
• Using disparate elements of the public sector ensures
a continuum of care and generates an immediate client
response.
• Informal providers are easier to franchise because they
are more open to following standards than doctors are.
Challenges
Lack of facilities makes training difficult.
India
dKT international/Janani
Surya
At a glance
Franchise details
Timeline
Services
Launched in 1995
Family planning
●
USAID calculation
905,820 CYP
Location
2 out of 28 states—Bihar & Jharkhand
Business model
HIV
Target clientele
Low income, youth, sex workers and clients,
truck drivers, migrants/refugees, military, men,
women
Average staffing
10 per clinic (doctors, nurses, medical assistants, lab techs, counselors, etc)
Malaria
Outlet types
Chemists/pharmacists: 50,000 in Bihar and
8,000 in Jharkhand
Clinics: 36 own clinics and 60 franchisee clinics
Tuberculosis
●
Payment sources
OOP, government reimbursement, free
$456,990
Donor support
Contact information
36
S.P. Bose, Program Director
www.janani.org
India
dKT international/Janani
Surya
Description
Background
Janani’s operational framework includes 1) its own clinics
which provide clinical FP services, and 2) franchisee clinics,
chemists/pharmacists and rural providers who create access
to products and services for village communities.
Service details
Oral contraceptives, condoms, injectables, Copper T, emergency contraceptive pills, sterilization, abortion (medical
and surgical)
licensing
Accredited under the District Health Society under the
Public Private Partnership of the National Rural Health
Mission (NRHM)
The Surya Health Promoters work as the first point of contact for the community. They advise and counsel the clients
on the range and usefulness of available contraceptives.
Job aids
• Contraception Technology
• Handbook on Family Planning
• Call Admission Control (CAC) Protocol
• Government Guideline for Male and Female Sterilization
• NSV (no-scalpel vasectomy) for Male Sterilization
• Minilaprotomy for Female Sterilization Guideline
• Medical Termination of Pregnancy Act—2009
37
• Stock cards at franchisee outlets
• Refrigerators
Successes
• Providing high-quality FP services
• Providing services free of cost, making them more widely
accessible
• Stationing the Surya Health Promoters at the village
level, making it convenient for the clients to access information about the services being provided
Challenges
• Identification of requisite number of health providers
• Accreditation under the NRHM for the franchisee clinics
• Behavioral change of the community towards contraception
Kenya
amua
At a glance
Franchise details
Timeline
Services
Launched in 2004
Family planning
●
USAID calculation
116,597 CYP
Location
3 out of 7 provinces (Nyanza, Rift valley, Western)
Business model
Full franchise; annual franchise fee of $35 USD
HIV
●
Target clientele
Low income, men, women, youth
●
Average staffing
2 medical assistants and 1 clinical officer per
clinic
Malaria
Outlet types
186 clinics
Tuberculosis
157,103
845
Payment sources
100% OOP
Donor support
KfW
Venture Strategies
UNFPA
Contact information
Walter Odhiambo, Deputy Country Director
www.mariestopes.org
38
Kenya
amua
Description
Background
AMUA is a fractional social franchise currently made up of
186 privately owned and operated clinics. AMUA is implemented on behalf of the Government of Kenya by Marie
Stopes Kenya with funds from the German Development
Corporation (KfW). AMUA franchisees operate in periurban and rural areas of five strategically selected zones
where Kenya DHS data indicate higher fertility and unmet
need for FP. The majority of franchisees comprise small,
stand-alone medical clinics that are owned and operated by
a licensed nurse and staffed by a few other health workers.
Service details
implants, sterilization, HCT, labor and delivery, emergency
obstetric care
AMUA currently works with 350 CHWs. The CHW model is:
• 2 individuals assigned per franchisee
• CHWs receive branded materials, pictorial aids, bicycles
• For other FP services, incentives are negotiated and paid
individually by franchisees.
Technology
SMS reporting (planned)
Successes
• Improving private-public partnership with the Ministry
of Health. AMUA franchisees are now recognized by
the government and are able to source FP commodities
from the Ministry stores.
• Use of already recognized CHWs
• Demand generation activities
39
AMUA clinic
Challenges
• The inability to recruit medical doctors due to low interest in FP
• AMUA staff reported having to provide significant support in order to bring franchisees up to quality standards.
• Client inability to pay private sector fees
• Government facilities offer a comparable range of services at no cost to the user.
• Healthcare market saturated with private sector providers, including providers at other social franchises
• High staff turnover at larger facilities such as hospitals
and maternity homes
• Regulating service fees actually charged by the providers
Kenya
Family health international
gold Star network
At a glance
Franchise details
Timeline
Services
Launched in 2006
Family planning
●
USAID calculation
8,850 CYP
Location
Business model
Fractional franchise; annual fee of $47
HIV
Target clientele
Employed persons and business people who
can pay for part of their healthcare costs
Average staffing
5 staff per outlet (doctors, nurses, medical assistants, pharmacists, clinical officers)
Malaria
Outlet types
393 clinics, 57 hospitals, 13 pharmacies, 17 labs,
9 nursing homes
Tuberculosis
109,567
232
Payment sources
50% OOP, 20% insurance, 30% free antiretroviral
therapy (ART)
$180,118 (program activities only)
Donor support
USAID: $513,520
Contact information
Dr. Margaret Kaseje, Director, Program Support
www.goldstar-network.org
40
●
Kenya
Family health international
gold Star network
Description
Background
The Gold Star Network (GSN) is a private-sector HIV care
and treatment program executed in collaboration with the
Ministry of Health, Kenya Medical Association, Kenya Clinical Officers Association and Pharm Access Africa Limited.
This project is a private healthcare and financing model
that involves training accredited doctors in private clinics,
nursing homes, mission and for-profit hospitals and workplace health centers to provide safe and affordable ART.
While the network was originally established to provide
HIV care and treatment, family planning services have been
added.
Service details
Oral contraceptives, condoms (male and female), injectables, Copper T, implants, natural family planning, sterilization, PMTCT, HCT, ART, opportunistic infection management
licensing
The providers are accredited and given a certificate with
NASCOP (National AIDS and STI Control Programme)
serialization.
Job aids
• Guidelines to ARV Therapy in Kenya
• National Home-Based Care Programme and Service
Guidelines (summary)
• National Condom Policy and Strategy
• National Guidelines for Voluntary Counseling and Testing
• National Guidelines for PMTCT
• Guidelines for HIV Testing in Clinical Settings
• Handbook on Pediatric AIDS in Africa
• Kenyan National Clinical Manual for ARV providers, a
concise and practical guide to ARV provision
41
Technology
• Telemedicine
• SMS reporting
• Emails
Successes
• Strong brand presence and unique brand positioning—its
positioning has allowed GSN to tap into a niche (private
sector patients who can pay some or part of the cost)
• Workplace program—GSN carries out numerous workplace sensitization and HCT activities. From these activities, clients are referred to GSN sites or alternatively,
GSN trains workplace and clinic healthcare providers
Challenges
• Marketing/brand promotion has never been a forte for
NGOs such as GSN. At the funding level it is difficult to
justify this cost center.
• Geographical challenges—GSN facilities are scattered.
To collect lab samples and deliver them in good time/
condition to labs is often a challenge. By partnering with
strategic partners e.g. the AIDS, Population and Health
Integrated Assistance II, GSN has been able to access
motorcycle courier facilities to ease the problem. However, the coverage is still low and occasionally samples/
drugs are delivered late.
Future plans
Expansion of services to cover: TB, FP/RH, MCH and
malaria treatment
innovations
Partnerships with insurance companies—GSN is working
on strategies to partner with insurance companies in the
provision of HIV treatment services. Being a registered nonprofit organization, GSN is unable to accept monies from
companies and individuals. To remedy that issue, GSN will
become an incorporated company.
Kenya
Tunza Family health network
At a glance
Franchise details
Timeline
Services
Launched in December 2008
Family planning
●
USAID calculation
62,521CYP
Location
Business model
Fractional franchise; annual franchise fee of $13
USD
HIV
Target clientele
Low income, men, women
Average staffing
2 staff per clinic (majority of clinics in network
are owned by nurses and operated by one
nurse or nurse-midwife)
Malaria
Outlet types
184 clinics
Tuberculosis
16,227 IUDs and 1,636 implants
97
Payment sources
OOP, vouchers
$1,400,000
Donor support (USD)
Anonymous donor (approximately $340,000)
Contact information
Joyce Wanderi, Deputy Director, RH Marketing
www.psi.org
42
Kenya
Tunza Family health network
Description
Background
The Tunza Family Health Network is a fractional franchise
that is made up largely of nurses and a few clinical officers.
PSI Kenya provides standards, service delivery protocols,
provider training and supportive supervision for long-term
FP methods. Tunza is a Kiswahili word meaning "to nurture
or care for."
Service details
Copper T, implants
licensing
Nurses are accredited by the Nursing Council of Kenya.
Clinical officers are certified by the Clinical Officers Council.
For both cadres, the license to operate a private clinic is
from the Medical Practitioners and Dentists Board.
• Each clinic has one–two community mobilizers who mobilize women in their communities to attend FP educational sessions conducted by PSI/Kenya.
• CHWs refer women to franchise clinics using a referral
card and hold educational sessions.
• CHWs are paid for organizing and conducting the sessions and for any successful referrals for IUDs.
Job aids
A variety of job aids including the Quick FP Methods Reference Guide (a small booklet used by mobilizers in case
they forget a point while mobilizing)
Technology
SMS reporting
Successes
• Strong private sector in Kenya makes recruitment of
qualified providers relatively easy
43
Registration of patients at a Tunza clinic
• Support from the MOH
• Community mobilization and education through small
groups of women
Challenges
• The deeply entrenched myths and misconceptions about
long-term FP methods
• The adjustment to a newly introduced SMS-based
reporting system that is expected to replace paper
reporting
Future plans
Integration of other services into the network: PMTCT of
HIV, HCT, voluntary medical male circumcision, diarrhea
prevention, early diagnosis and treatment of pneumonia
innovations
SMS-based reporting system that ensures real-time reporting on service uptake of IUDs, complications/adverse
events related to IUDs and implants, implant removals and
reasons for removal
Madagascar
BlueStar madagascar
At a glance
Franchise details
Services
Network was fully operational in December
2009; official launch in February 2010
Family planning
Location
6 out of 22 regions
Business model
USD
HIV/AIDS
Target clientele
Low income, women
Average staffing
1 doctor per clinic
Malaria
Outlet types
71 clinics
Tuberculosis
1,765
25
Payment sources
90% OOP, 10% token free week
$300,000
Donor support
MSI
Contact information
Ranja Chrys Rakotomahanina, Social Franchising Director
www.mariestopes.org
Timeline
44
●
USAID calculation
899 CYP
●
Madagascar
BlueStar madagascar
Description
Background
BlueStar is a fractional franchise comprised of doctors who
are already practicing. Marie Stopes Madagascar builds
their capacity to deliver high-quality sexual and reproductive health services, focused on long-term FP methods.
Fanchisees are located in peri-urban and rural areas.
Service details
Oral contraceptives, condoms, injectables, Copper T, implants, post-abortion care
CHWs develop informed demand within the community
by doing interpersonal communication through household
visits and small-group sensitization. They are incentivized
by client referrals and service uptake.
BlueStar Madagascar launch
• Arrangement of stock by FIFO/FEFO
Challenges
• Finding private doctors in rural and peri-urban zones, as
there are fewer than 700 accredited doctors nationwide
• To achieve national impact, a wide geographic area is
covered, which is difficult for the monitoring and evaluation team.
• The 2009 political crisis made the implementation phase
longer than expected due to administrative red tape and
changes in key government decision makers.
Technology
In mid-2010 an SMS client follow-up and reporting system,
coupled with a hotline and web-based reporting will be
implemented.
Future plans
Expansion to 14 regions and to 200 members by the end
of 2010. By 2011, the majority of members will offer the full
range of sexual and reproductive health services.
Job aids
• Operation manual
• Training manual
Successes
• Co-branding with local MSI chapter
• Focus on long-term contraceptive methods
• Strong public and private partnership (Ministry of Health,
National Board of Doctors)
45
Madagascar
proFemina
At a glance
Franchise details
Timeline
Services
Launched in 2009
Family planning
●
USAID calculation
53,200 CYP*
MSI/DKT calculation 81,718 CYP*
Location
Business model
HIV/AIDS
Target clientele
Low income, women
Average staffing
1.3 staff per clinic (doctors, nurses, midwives)
Malaria
Outlet types
68 clinics
Tuberculosis
15,206 clients served with long-term methods
(LTMs)
224
Payment sources
40% OOP, 60% vouchers, free services at public
sector franchised clinics
●
Donor support
Anonymous donor, in cost share with USAID
Contact information
Brian McKenna, Country Representative
www.psi.org
* Excludes services not tracked at the
franchise level
46
Madagascar
proFemina
Description
Background
ProFemina serves all women of reproductive age, in urban
and rural areas. The network consists of public, liberal sector centers (independent doctors) and NGO partners. The
main mission of this program is to create demand for FP
while also serving the RH needs of target populations.
• Stock cards at franchises
Service details
Oral contraceptives, condoms (male and female), injectables, Copper T, implants, natural FP, STI treatment
Successes
• The “canalization”strategy provides a safe, sustainable
and cost efficient approach (with a first-tier franchised
fixed site provider offering RH services on a regular rotating basis at second-tier remote non-franchised sites).
• Using private sector providers (mostly in urban areas)
and public sector providers where the private sector is
not developed enough, allows for a more sustainable
intervention strategy while maximizing reach.
licensing
All outlets are authorized to practice under local law,
and are certified through PSI and its partner organization
Jhpiego.
• CHWs educate community members, hold community
events, offer referrals to the franchised clinics and support follow-up care in collaboration with the provider.
• They receive a fixed salary in urban areas, and fixed inkind compensation in rural areas. Up to 11% of their pay
can include performance-based compensation, based
on both qualitative and quantitative criteria.
Job aids
• Infection prevention, counseling, LTM insertions
• Service provision reference guides
• Complication management job aids developed for the
franchise network
• Client screening checklist
• WHO eligibility wheel
• Anatomical models
• Information Education and Communication (IEC) materials
47
Challenges
• Conforming to quality assurance standards by private
sector providers
• Maintaining providers’ motivation over time requires that
their expectations be regularly monitored and adjustments be made to fulfill them. PSI is currently conducting a provider survey on the determinants of productivity
for LTM service provision specifically.
Future plans
• Expansion of the franchise to other sites
• Expansion of the “canalization” strategy
• MCH services
• Other RH services being considered: cervical cancer
detection and prevention, emergency contraception
Madagascar
Top réseau
At a glance
Franchise details
Timeline
Services
Launched in 2001
Family planning
●
USAID calculation
15,156 CYP
Location
●
Business model
USD
HIV/AIDS
●
Target clientele
Low income, sex workers and clients, youth,
truck drivers, military personnel, men who have
sex with men
Average staffing
1 doctor per clinic
Malaria
Outlet types
135 clinics
Tuberculosis
140,140
1,038
Payment sources
75% OOP, 25% vouchers
Donor support (USD)
$625,000
Contact information
Brian McKenna, Country Representative
www.psi.org
48
Madagascar
Top réseau
Description
Background
Top Réseau aims to improve access to reproductive health
services among vulnerable groups, particularly youth.
Locations are selected based on 1) epidemiological and
behavioral data on reproductive health, 2) the number and
interest of private sector providers who could become potential franchise members and 3) a strategic location with
large at-risk populations.
Service details
Oral contraceptives, condoms, injectable, STI treatment,
HCT
licensing
Accredited through the government
Peer educators sensitize target groups and make referrals
to franchised clinics.
Job aids
• Flipchart to guide syndromic management of STIs and
FP counseling
• Algorithm on HIV test
• STI prevention kits
• Partner referral cards
49
Technology
Web-based reporting for VCT services
Successes
• Top Réseau network was integrated into existing health
facilities which offer the normal range of primary care
• Integration of HIV and FP services
• Integrated communication campaign (mass media, mobile video unit and interpersonal communication)
Challenges
Implementation of quality assurance plan in the private/
liberal sector
Future plans
Expansion of HCT services to other sites
Malawi
Banja la mtsogolo/marie Stopes international
BlueStar malawi
At a glance
Franchise details
Timeline
Services
Launched in 2008
Family planning
●
USAID calculation
7,873 CYP
Location
Business model
USD
HIV/AIDS
Target clientele
Low income, women
Average staffing
1 nurse, 1 clinical officer and 2 other staff per
clinic
Malaria
Outlet types
60 clinics
Tuberculosis
17,748
296
Payment sources
OOP
Donor support
MSI
Contact information
Linda Edwards, Country Director
www.banja.org.mw
50
Malawi
Banja la mtsogolo/marie Stopes international
BlueStar malawi
Description
Background
Fractional franchise of FP services in private clinics
Service details
Oral contraceptives, injectables, Copper T, sterilization
• Diversification of service provision at general medicine
practices by including family planning methods
• Referral system established to refer tubal ligation clients
to Banja La Mtsogolo centres
Stock cards
Challenges
• Very few providers with skills to provide tubal ligations in
the current network
• Persisting misconceptions surrounding IUDs in most
communities
Successes
• Introduction and improvement of quality standards in
most clinics
Future plans
• Scaling up in the central and northern regions of Malawi
• Training more BlueStar community mobilizers
CHWs are utilized and paid a fee per client referred.
BlueStar Malawi clinic
51
Mali
proFam
At a glance
Franchise details
Timeline
Services
Launched in 2005
Family planning
●
USAID calculation
2,776 CYP
Location
Bamako only
Business model
90% full franchise, 10% fractional franchise
HIV/AIDS
Target clientele
Women
Average staffing
1 doctor, 2 nurses and 3 medical assistants per
clinic
Malaria
Outlet types
53 clinics
Tuberculosis
5,598
106
Payment sources
OOP
●
Donor support
USAID
Contact information
Boureima Maiga, Presponsable PF/Diarrhée
www.psi.org
52
Mali
proFam
Description
Background
ProFam is a social franchise network with 53 private clinics
which offer FP services in the district of Bamako.
Service details
Oral contraceptives, condoms, vaginal foaming tablets,
injectables, Copper T, implants, natural FP, HCT
Successes
Promotion of ProFam during vaccination meetings in
private clinics
licensing
MOH, Order Des Medecins
53
Myanmar
Sun Quality health
At a glance
Franchise details
Services
Launched in 2001, RH: 2001, Malaria: 2003, STI:
2003; TB: 2004, Pneumonia: 2007, Diarrhea:
2009
Family planning
Location
15 out of 17 states
●
Business model
HIV/AIDS
●
Target clientele
Low income, sex workers and clients
Average staffing
1 doctor and 2 medical assistants per clinic
Malaria
●
Outlet types
1,186 clinics
Tuberculosis
●
1,389,212
Diarrheal disease treatment, pneumonia testing treatment
●
1,171
Payment sources
88% OOP, 10% free (TB and VCT), 2% vouchers (vouchers mainly used for long-term FP
methods)
$6,700,000
Donor support (USD)
UNFPA
Bill and Melinda Gates Foundation
William and Flora Hewlett Foundation
Packard Foundation
USAID
Anonymous donor
Total contributed: $5,200,000
Contact information
Dr. Nyo Nyo Minn, Franchising Director
www.psi.org
Timeline
54
●
USAID calculation
255,754 CYP
Myanmar
Sun Quality health
Description
Background
PSI Myanmar provides reproductive health products and
services to low-income communities through the Sun network. The network consists of a first tier of private licensed
general practitioners called Sun Quality Health (SQH). SQH
clinics offer services in the following areas: reproductive
health; TB; pneumonia; diarrhea; malaria and HIV including
STIs. In July 2008, a Sun Primary Health (SPH) channel was
launched to reach poor and vulnerable rural communities
within a three-hour radius of an SQH clinic. SPH workers are
a second tier of the Sun network and are trained on a range
of health areas for which they sell subsidized products.
Service details
Oral contraceptives, condoms, female condoms, injectables, Copper T, implants, emergency contraceptive pills,
STI treatment, ART, opportunistic infection management,
malaria testing/treatment, insecticide-treated nets, KO
tabs, TB case management, diarrheal disease treatment,
pneumonia testing/treatment
licensing
License to practice issued by the Government of Myanmar
SPH workers refer clients to the SQH clinic for TB and IUD
services. SPH workers keep the sales margin on the products and are also paid up to $25 USD per month if they
reach set criteria within the health areas.
Jobs aids/training
• Counseling flipcharts
• Infection prevention step by step poster
• IUD insertion and removal posters
Patient consultation at Sun Quality Health clinic
Successes
• Effective strategies for how to remove non-performers
from the network (dissociation)
• Strong links with the government that is generally supportive of engagement with the private sector and plays
an instrumental role in addressing policy issues around
de-medicalizing procedures
Challenges
• Lack of documentation of the FP policy of Myanmar
results in different and confusing instructions at the local
level.
Future plans
• Postpartum hemhorrage prevention through use of
Misoprostol distributed through SPH workers
• Screening for cervical cancer
55
Nepal
nepal CrS Company
At a glance
Franchise details
Timeline
Services
Launched in 1994
Family planning
●
USAID calculation
372,642 CYP
Location
Business model
HIV
●
Target clientele
Truck drivers, military, women, low income, men
●
Average staffing
2-3 staff per outlet
Malaria
Outlet types
4,679 pharmacies, 2,684 tier-one outlets, 100
tier-two outlets
Tuberculosis
121,838
Diarrheal disease treatment, water
purification
44
●
Payment sources
Donor support
USAID
KfW
Contact information
Mr. Krishna Bahadur Rayamajhi, Managing
Director
www.crs.org.np/sangini
56
Nepal
nepal CrS Company
Description
Background
In 1994, with USAID support, Nepal CRS Company introduced social franchising of injectable contraceptives in
Kathmandu Valley, through a network of pharmacies, under
a local brand name called “Sangini-Tin Mahine Sui.” In the
first year, Sangini was introduced through 50 trained and
certified service providers (paramedics) in selected medical shops of Kathmandu Valley. The social franchising of
Sangini has now been expanded to 69 of 75 districts, and
the total number of franchising outlets has reached 2,684,
while sales went beyond 460,000 vials in the year 2009.
Service details
implants, emergency contraceptive pills, clean delivery
kits, labor and delivery, emergency obstetric care, diarrheal
disease treatment, water purification
licensing
In the private sector, paramedics are accredited by a local
NGO called Nepal Fertility Care Centre.
Job aids
• Informed choice poster
• Clients' rights poster
• Puncture-proof container
• Screening checklist
• Participants manual
• Log book (clients’ record book)
• ID cards
57
Nepal CRS medical shop
Successes
Strong expansion geographically and also strong expansion of the number of outlets
Challenges
• Expanding Sangini services to the remaining six districts
which encompass hard-to-reach areas
• Conducting monitoring of hilly, hard-to-reach outlets
Future plans
Expand Misoprostol distribution to five additional districts
in hilly, hard-to-reach regions in the coming fiscal year
Nigeria
Society for Family health (affiliate of pSi in nigeria)
(Franchise name TBd)
At a glance
Franchise details
Timeline
Services
Launching in second quarter of 2010
Family planning
●
USAID calculation
131,054 CYP
Location
20 out of 36 states
Business model
Fractional franchise; franchisees will pay annual
fee
HIV
Target clientele
Low income, men, women, youth
Average staffing
5–6 per outlet (doctors, nurses, midwives, medical assistants)
Malaria
Outlet types
60 clinics
Tuberculosis
37,444
624
Payment sources
100% OOP
Donor support
Anonymous donor
Contact information
www.sfhnigeria.org
58
Nigeria
Society for Family health (affiliate of pSi in nigeria)
(Franchise name TBd)
Description
Background
The proposed franchise will include only private sector
facilities which means that there will be a brand name
(TBD). Providers will be certified and facilities will have
standardized quality indicators. FP services will be offered.
Sites will be evaluated based on the infrastructure in place,
provider's attitude toward RH/FP services and willingness
to ensure services are provided according to the recommended practices.
Service details
Copper T, implants
licensing
The government accredits doctors, nurses and community
health officers.
Traditional birth attendants and CHWs will be used.
Job aids
• PSI quality service delivery protocols
• Jhpiego, Family Health International and Federal Ministry of Health protocols
• Self designed protocols
• Refrigerators
Successes
• Having referrals in place for specialized care
• FP is not an integral part of services in the private sector,
so adding this to the core service areas contributed to
the providers' motivation
59
Society for Family Health provider
Challenges
• Getting private sector providers to provide affordable
services and spend time on counseling
• Managing services which do not pay much compared
to the more lucrative ones like ANC, immunization and
malaria treatment
Future plans
• Advertising of branded facilities and developing more
effective referral linkages for networking
Nigeria
hygeia nigeria limited
hygeia
At a glance
Franchise details
Services
Timeline
Hygeia launched in 1986, franchise launched
in 2006
Family planning
Location
36 out of 36 states
Business model
HIV/AIDS
●
Target clientele
Low income, general population
●
Average staffing
Outlets are staffed with a small number of
employees.
Malaria
●
Outlet types
Pharmacies within 79 clinics and 1,676 hospitals
Tuberculosis
●
229,577
131
Payment sources
Insurance, free
Donor support
Dutch Health Insurance Fund
World Bank
Contact information
Mrs. Fola Laoye, Group Managing Director
www.hygeiagroup.com
60
Nigeria
hygeia nigeria limited
hygeia
Description
Background
Hygeia is a healthcare services group which offers fully
integrated healthcare services. It incorporates both private
and public sector initiatives through various subsidiaries
that work with operator-owned and contracted hospitals.
Low-income communities access care through a subsidized
health insurance scheme. Hygeia is also involved in the
implementation of a free ART program.
Service details
HCT, ART, opportunistic infection management, ANC,
clean delivery kits, vaccination, malaria case management,
TB case management
licensing
• Doctors: Medical and Dental Council of Nigeria
• Nurses: National Nurse and Midwife Council
• Pharmacists: Pharmacists Council of Nigeria
• Laboratory technicians: Medical Laboratory Science
Council of Nigeria
• Facilities: National Health Insurance Scheme
Hygeia utilizes community members under the auspices
of community health associations to mobilize enrollment
into the scheme and motivate the utilization of providers.
People living with HIV and AIDS (PLWHA) are also utilized
to mobilize their peers to visit the clinics/hospitals to receive ART care.
Job aids
Guidelines on management of malaria, hypertension,
diabetes mellitus, ANC, labor and post-natal care, enrollee
identification and benefit administration, ART, PMTCT and
Cotrim administration, laboratory activities, pharmacy stock
activities
• Locked/secure storage rooms
61
Women waiting to see a physician at a franchised clinic
Technology
Telemedicine
Successes
• Focus on healthcare quality management
• Effective partnership with providers
• Demand-driven funding of franchises
Challenges
Human resource challenges, particularly in sites outside of
the major cities. Hygeia is working to improve this through
a continuing medical education framework.
Future plans
Expansion of franchisees and training activities
innovations
• Data management system that allows monitoring of
provider utilization activities
• Provider continuing healthcare worker educational
system
• Provider quality management framework to evaluate
provider performance against identified clinical and nonclinical metrics
Pakistan
greenstar
At a glance
Franchise details
Timeline
Services
Launched in 1995
Family planning
●
USAID calculation
2,104,333 CYP
Location
Business model
HIV
Target clientele
Low income, women
Average staffing
2 staff per outlet
Malaria
Outlet types
6,500 clinics, 1,000 hospitals, 20,000 pharmacies, 80,000 retail outlets
Tuberculosis
2,100,000
20
Payment sources
90% OOP, 5% government reimbursement, 5%
vouchers
$9.83 million
Donor support
USAID
KfW
Anonymous donor
Contact information
Dr. Aminah Khan, DM - Central
www.greenstar.org.pk
62
Pakistan
greenstar
Description
Background
The Greenstar franchise accepts private sector healthcare
providers that have the facilities to insert an IUD, have a
good reputation in the community and have taken Greenstar’s classroom and clinical skills training in FP and RH
service provision. Providers include doctors (MBBS), Lady
Health Visitors, Family Welfare Workers and midwives (in
rural areas).
Service details
Oral contraceptives, condoms, IUD, injectables, sterilization
licensing
MBBS doctors are registered with the Pakistan Medical and
Dental Councils and Lady Health Visitors with their concerned institute.
Greenstar has an Interpersonal Communications (IPC)
department which supports newly trained providers by
working in the catchment area of the provider for two
weeks. During this time an IPC team sensitizes clients,
motivates them, gives them tokens and invites them to the
trained provider's outlet on two assigned event days known
as “Clinic Sahoolat.” Products and services are sold to the
clients at subsidized prices on these days.
63
Job aids
• IEC Material
• IUD insertion guide and checklists
• Infection prevention checklists and brochures
Successes
• Introduction of innovative private sector approaches
for reducing maternal and newborn mortality, including
public-private partnerships
• Large-scale provision of services: Greenstar is Pakistan's
second largest FP provider, after the government.
Challenges
• Maintain quality standards
• High volume of clients results in reduced counseling
time per client
• Initiating FP perinatal period
• Record keeping
Future plans
Planning to reach underserved areas (rural focus) using 13
mobile service units equipped with resources required to
insert IUDs
Pakistan
Sehat First
At a glance
Franchise details
Services
Timeline
Launched in 2008
Family planning
●
Location
●
Business model
Full franchise
HIV
●
Target clientele
Low income, women, men, children
●
Average staffing
5 staff per clinic (Lady Health Visitors, Dispensers, Store Keepers)
Malaria
●
Outlet types
3 clinics that each have a pharmacy, as well as a
general store and a multi-purpose telecenter
Tuberculosis
5,944
Diarrheal disease treatment, lab
services, vitamins, general medicine
1,981
Payment sources
100% OOP (health services subsidized through
the revenues generated at the general store)
$100,000 (approximately)
Donor support
None
Contact information
Shahida Saleem, Chairperson
www.sehatfirst.com
64
●
Pakistan
Sehat First
Description
Background
Sehat First is a social enterprise that provides access to basic healthcare and pharmaceutical services across Pakistan
through self-sustainable franchised telehealth centers. A
central component of the Sehat First model is the telehealth consulting service, which supports the local clinic
staff with Intranet-protocol-based video phone consultations with a qualified physician.
Service details
Oral contraceptives, condoms, injectables, STI treatment,
ANC, post-natal care, vaccinations, pediatric consultations,
malaria treatment, diarrheal disease treatment, general
medicine, lab services, vitamins
licensing
• Lady Health Visitors certified by the Public Health School
• Dispensers certified by provincial pharmacy councils
The health staff at the centers create linkages with the existing CHWs who are working in their respective catchment
areas. The CHWs are employed by the government.
Job aids
Some job aids were developed internally and some were
provided by other local and international institutions.
• Pakistan Pharma Guide
• Family Guide for Paramedics (by Greenstar)
• Reference Manual for Antenatal and Post-natal Care (by
Greenstar)
• Reference Manual for Neonatal Health
• The Essentials of Contraceptive Technology
• Integrated Management of Neonatal and Childhood
Illnesses—Identify Treatment
• Illustrated manual for maternal, newborn and child
health and RH/FP Services (by Women Empowerment
Group)
65
• Use of a discrepancy report form
Technology
• Telemedicine
• Mobile and RFID (radio frequency identification)-based
patient tracking system for Pneumonia patients, with the
aim to replicate the same for tracking the patients
• Implementing an e-Referral Network supported by a
Clinical Decision Support System and Electronic Medical
Records System
• Implementing low-cost remote medical diagnostics
Successes
• Using a proven business model (franchise model)
which takes advantage of expertise from a variety of
knowledge areas (i.e. health, business and information
technology)
• Video consultation service maximizes the use of available scarce human, financial and technical resources
• The telehealth service and other non-traditional revenue
streams enable subsidization of services
Challenges
• Availability of trained and qualified human resources
• Developing practical processes to be implemented by
the available human resources
• Unavailability of required infrastructure (e.g. electricity
and internet connectivity)
• The design of the ideal telehealth solution
• Identifying technical assistance to develop comprehensive franchise marketing plan
Future plans
• Remote medical diagnostic services and e-Referral Network services
• Distance learning programs using the same technology
infrastructure
Pakistan
marie Stopes Society
Suraj
At a glance
Franchise details
Timeline
Services
Launched in 2008
Family planning
●
USAID calculation
156,545 CYP
Location
Business model
$1.75 USD
HIV/AIDS
Target clientele
Low income, women, rural population
Average staffing
1 staff per outlet (doctor, nurse, midwife or Lady
Health Visitor
Malaria
Outlet types
100 clinics
Tuberculosis
77,736
777
Payment sources
61% OOP, 39% vouchers
$560,611
Donor support
Anonymous donor
Contact information
Dr. Mohsina Bilgrami, Managing Director
www.mariestopespk.org
66
Pakistan
marie Stopes Society
Suraj
Description
Background
“Suraj” (sun) is a branded network of private providers in
rural areas in the Punjab and Sindh provinces. The providers provide FP methods and make referrals to Marie Stopes
Society health centers for permanent FP methods.
Service details
Oral contraceptives, condoms, injectables, IUDs, emergency contraceptive pills
A full-time Field Worker of Marketing at each clinic is
responsible for marketing, generating referrals, distributing
vouchers and following up with clients.
Job aids
Handouts on infection prevention, FP and counseling
• Stock cards
Technology
Telephone/hotline counseling
Field Worker of Marketing making door-to-door visits to market
products and services available at Suraj clinics
Challenges
Ensuring quality of services, especially infection prevention
standards
Future plans
• Post-abortion services in 2010
• Scale-up of Suraj network in all four provinces of Pakistan
by 2012
Successes
• Output-based aid (OBA) voucher scheme
• Training of private providers on basic business management
• The Field Worker of Marketing is one of the most important factors contributing to the success of the model
through generating client load and distributing the OBA
vouchers.
67
Peru
instituto peruano de paternidad responsible (inppareS)
redplan Salud
At a glance
Franchise details
Timeline
Services
Launched in 2003
Family planning
●
USAID calculation
24,659 CYP
Location
9 out of 25 regions
Business model
20% fractional franchise, 80% full franchise
HIV/AIDS
Target clientele
Low income, women, youth
Average staffing
1 doctor, 2 medical assistants, 1 midwife and 1
clinical officer per clinic (most clinics managed
by a midwife)
Malaria
Outlet types
1,784 clinics
Tuberculosis
574,542
322
Payment sources
OOP
$561,400
Donor support
Contact information
68
Daniel Aspilcueta, Executive Director
www.inppares.org
Peru
instituto peruano de paternidad responsible (inppareS)
redplan Salud
Description
Background
RedPlan Salud is a network of affiliated health professionals who provide reproductive healthcare in private offices
under the support of INPPARES.
Service details
Oral contraceptives, condoms, injectables, Copper T, implants, emergency contraceptive pills
licensing
Peru Midwives Association or Peru Medical Association
Successes
• Receiving visitors and offering a wide range of products
• Access to credit
• Access to free training
• Suppliers of products participate in promotional activities
Challenges
• Collecting information and statistics
• Increasing product distribution capability in remote and
poor areas
69
RedPlan Salud training
• The product portfolio is broad and demand has grown
more than planned
• Developing and implementing more effective strategies for social marketing, as there are other competitors
where none existed before
Future plans
• Continue to expand the network to other regions of the
country
• Develop branded pharmaceutical products
Philippines
population Services pilipinas, incorporated (pSpi)
BlueStar pilipinas
At a glance
Franchise details
Timeline
Services
Launched in 2008
Family planning
●
USAID calculation
75,008 CYP
Location
34 out of 80 provinces (including 10 cities in
Metro Manila)
Business model
USD
HIV/AIDS
Target clientele
Low income, women
Average staffing per outlet
1 midwife per clinic
Malaria
Outlet types
200 clinics
Tuberculosis
75,622
378
Payment sources
OOP
$1,238,460
Donor support
MSI
Contact information
Franklin John T. Francisco, Portfolio Projects
Officer
www.mariestopes.org
70
●
Philippines
population Services pilipinas, incorporated (pSpi)
BlueStar pilipinas
Description
Background
BlueStar Pilipinas is an FP franchise run by licensed midwives. PSPI started BlueStar Pilipinas in 2008 to increase
availability of accessible and affordable quality FP services.
Services details
Oral contraceptives, condoms, injectables, Copper T, cervical screening, RTI management
licensing
Philippine Regulatory Commission for private practice
Job aids
• Provision of FP services manual
• Facility management manual
• Flipchart and models as counseling guides
Technology
• SMS reporting
Successes
• Use of SMS messages collected by computer software
makes the Field Training Managers more effective at
providing supportive supervision
• Reducing the cost of the franchised services has
increased the volume of clients.
Challenges
• Franchise cannot support the current level of activity and
expenditure on demand generation
71
A BlueStar midwife-franchisee explains the benefits of the IUD during a marketing and promotional event.
• Franchisor has thus far been skewed towards lengthening the membership roster which has resulted in some
clinics with little business
• Due to the low member-acceptance rate, the franchisor
has been compelled to explore nearly all geographic
regions of the country. Expanded geographical reach
creates difficulties related to monitoring and support.
• Provision of supplies ‘at cost’ and on credit will not be
possible in the future. Cost mark-ups and cash-ordersonly shall have to be imposed to finance franchisor
operations.
Future plans
• PSPI is considering raising the qualifications of the
franchisees so they are eligible to accept PhilHealth, the
national health insurance that serves the poor.
• PSPI will implement a demand-side financing initiative,
financed through the Global Partnership on OutputBased Aid.
Sierra Leone
BlueStar healthcare network Sierra leone
ÊÊ
At a glance
Franchise details
Timeline
Services
Launched in 2008
Family planning
●
USAID calculation
15,060 CYP
Location
4 out of 4 regions
Business model
USD for clinic and $8 USD for pharmacy
HIV/AIDS
Target clientele
Low income, sex workers and clients, youth,
military, women
Average staffing
3 per clinic, 2 per pharmacy
Malaria
Outlet types
61 clinics, 48 pharmacies
Tuberculosis
13,000+
119
Payment sources
30% OOP, 70% free
$271,960
Donor support (USD)
CARE from KfW: $81,960
MSI: $190,000
Contact information
Manty Tarawalli, Private Sector Partnerships
Director
www.mariestopes.org
72
●
●
Sierra Leone
BlueStar healthcare network Sierra leone
Description
Background
BlueStar Healthcare Network Sierra Leone delivers sexual
and reproductive health services though a single-tier
model. BlueStar aims to engage women new to long-term
FP methods, and in a restricted environment, make safe
surgical abortion services available to the underserved.
Service details
Implants, sterilization, surgical abortion, malaria testing and
treatment, Insecticide treated nets
licensing
All clinicians must be accredited by the Sierra Leone Medical & Dental Council.
CHWs are involved and non-financial incentives are provided.
Job aids
Bespoke job aid on FP counseling
inventory management system
Successes
• The quality of the private sector at an affordable price
• Building on the reputation of the private sector by improving on quality while also expanding knowledge and
striving to address gaps in the supply chain
73
BlueStar Sierra Leone clinician
Challenges
• External factors due to the structure of the country’s
health system
• Managing the supply chain
• Balancing the base cost of products
• Sierra Leoneans’ ability to pay for services
Future plans
Introduce a more robust referral system in which drug
stores would be franchised as referral agents and would
receive a small payment for referrals for long-term FP services to any of the clinical franchisees
South Africa
Broadreach healthcare
At a glance
Franchise details
Services
Timeline
Launched in 2005
Family planning
Location
North West Province (1 out of 9 provinces)
Business model
Public-private partnership — treatment model
HIV
Target clientele
PLWHA
Average staffing
Varies by clinic
Malaria
Outlet types
60 contracted GPs supporting the clinics
Tuberculosis
1,500 (includes all patients initiated on treatment to date)
25
Payment sources
The President’s Emergency Plan for AIDS Relief
(PEPFAR)
●
Donor support
PEPFAR
Contact information
Niles Friedman, Director
www.broadreachhealthcare.com
74
South Africa
Broadreach healthcare
Description
Background
The program is a network of private sector GPs trained in
HIV treatment. The program creates a parallel system of
care that is closely tied to the public sector program, and
operates in compliance with the South African Department
of Health guidelines. The goal of the program is to alleviate some of the burden on the public sector by leveraging
existing capacity within the private sector.
Service details
ART
licensing
Regional continuing medical education program with accredited training program for healthcare providers
Provincial hospital complex pharmacy procures and distributes all patient medications to GP offices for patient
collection
Technology
Disease management and monitoring system
75
Zanele Mphikwa delivers training on ARV adherence
Successes
• Demonstrated an ability to increase capacity of the public sector health system in order to meet the demand for
HIV care and treatment
• Over 1,500 patients on ARV treatment across the pilot
program
• Viral load supression rates exceed 90% after 36 months.
• Patient retention rates exceed 80% after 24 months.
• 100+ physicians trained
Togo
pomeFa (“pour une meilleure Famille”)
At a glance
Franchise details
Timeline
Services
Launched in 2009
Family planning
●
USAID calculation
34,774 CYP
Location
Business model
HIV/AIDS
Target clientele
Low income, women, men, youth
Average staffing
Each clinic is staffed differently, and staff move
depending on the need.
Malaria
Outlet types
57 clinics, 24 hospitals
Tuberculosis
16,777
207
Payment sources
OOP (free LTMs on special event days)
$905,403
Donor support (USD)
About $1.8 million from the Dutch government
(SALIN)
USAID (commodity support)
Contact information
Awa Tchedre, Project Coordinator
www.psi.org
76
Togo
pomeFa (“pour une meilleure Famille”)
Description
Background
POMEFA is a network that consists of 81 public and private
sector clinics that offer quality FP services.
Successes
The linkage between IEC social mobilization, clinical services and the mobile outreach strategy
Service details
Oral contraceptives, injectables, Copper T, implants
Challenges
• Gathering accurate monthly reports from all 81 centers
• The mobility of service providers within the medical
system—many providers move on quickly
• Service providers who have not been trained by PSI are
reluctant to participate in network reporting activities.
licensing
Staff members accredited through the government
CHWs educate people on FP and refer them to network
centers for further counseling and services.
Job aids
• Flip chart to help with informing and counseling clients
• A general reproductive health pamphlet
• Stock cards
• Each center responsible for buying/maintaining stock
• Stock management monitored by PSI employees during
bi-monthly visits
77
Future plans
• Train pharmacists and counter agents who are often the
first contact for FP information, especially in cities
• Add an IEC focus that specifically targets men and addresses their role in reproductive decision making
• Integrate HCT into existing FP services
• Train service providers in the screening and treatment of
pre-cancerous cervical lesions
Uganda
living goods
LivingGoods
At a glance
Franchise details
Services
Timeline
Launched in 2007
Family planning
●
Location
●
Business model
Full franchise
HIV
Target clientele
Low income, women, children under 5
●
Average staffing
All Living Goods Community Health Promoters
(CHPs) are independent agents. One branch
office supports approximately 25–35 CHPs.
Malaria
●
Outlet types
540 Community Health Promoters who are supported by 28 branch offices
Tuberculosis
460,000 estimated
Fortified foods, water treatment,
ORS, de-worming
900
Payment sources
100% OOP
$1.6 million
Donor support (USD)
$1.6 million
Contact information
Charles Slaughter, President and Founder
www.livinggoods.org
78
●
Uganda
living goods
Description
Background
Living Goods (LG) operates networks of ‘Avon-like’ women
health entrepreneurs, called “Community Health Promoters.” (CHPs). The model synthesizes the best practices from
microfinance, franchising, and public health in an effort to
achieve a 100% sustainable system for defeating diseases
of poverty. CHPs deliver health education and earn a modest income going door-to-door selling high-impact health
products like ACT, ORS, mosquito nets, fortified foods,
condoms and water treatment. LG also provides its agents
a broad basket of items that help them increase sales and,
thereby, bolster their financial sustainability. CHPs also
track and support pregnancies, make prompt referrals for
secondary care, and record all treatments. LG employs all
the key characteristics of successful franchises: methodically screened agents, strict quality monitoring and followup training, uniform branding and product mix, effective
promotions, low cost of goods achieved through scale, and
stiff penalties for violating the rules.
• Monthly physical stock counts
• Stock reports by branch
Service details
Key Products: ACT, ORS, bed nets, fortified foods, condoms, water treatment, de-worming, solar lights, high
efficiency stoves. Services: home delivery, family planning,
pregnancy care, referrals
Successes
• Strong sales of high impact health items: ACT, ORS,
fortified foods, de-worming
• Steady increases in sales per agent
• Achieving 95%+ in-stock rates
LG franchisees are essentially sustainable CHWs
Challenges
• Hiring experienced, capable East Africa-based management
• Driving behavior change on preventative health behaviors
• Price fluctuations of consumer products, especially imports
Job aids
• Visual Health education flip book on 17 key health behaviors—Simple Habits for Healthy Living
• Visual Dosage Guide, Visual Referral Guide, script forms
• Backpack, uniform, locking storage, business record
keeping tools
• Dozens of micro warehouses sited within 7 km of every
agent
79
LG Community Health Promoter talking to client
Future plans
• Expanding geographically in Uganda
• Launching divisions in Kenya and/or Rwanda
• Testing new products, promotions and incentives
• Testing hub and spoke clinics
Uganda
paCe* (affiliate of pSi in uganda)
proFam
At a glance
Franchise details
Timeline
Services
Launched in 2008
Family planning
●
USAID calculation
47,901 CYP
Location
Business model
USD
HIV
Target clientele
Low income, women
Average staffing
4 staff per clinic (nurses, midwives, clinical officers)
Malaria
Outlet types
100 clinics
Tuberculosis
13,686
137
Payment sources
100% OOP
Donor support
Anonymous donor (approximately $244,853 USD)
Contact information
Dr. Susan Mpanga-Mukasa, Executive Director
www.pace.org.ug
*PACE: Program for Accessible Health, Communication and Education
80
Uganda
paCe (affiliate of pSi in uganda)
proFam
Description
Background
Through mapping and facility audit, PACE identified 100 facilities meeting defined quality criteria and recruited them
into the ProFam network. At least two providers from each
facility were trained in FP methods, and the clinics were
fully equipped for LTM service delivery.
Services
Copper T, implants
licensing
Registration with respective bodies, such as Uganda Medical and Dental Practitioners Council, Nurses and Midwifery
Council and Uganda Allied Medical Practitioners Council
Each ProFam facility has five CHWs referred to as village
health teams (VHTs) who implement demand creation activities and follow up with new accepters. The VHTs are given
a monthly performance-related stipend that ranges from
$7.5 to $10 USD. The stipend is not tied to the number of
women referred, but to the level of effort of the VHT.
Job aids
• WHO medical eligibility criteria
• IUD and implant insertions check list
• Ministry of Health FP counseling guide
• Infection control protocol and complication management plan
• Referral directory
81
ProFam training
Successes
• The facility/ProFam-led client mobilization strategy working with the VHTs
• The VHT strategy: an effective way of not only mobilizing
clients but also following up to address any side effects
• Satisfied user strategy: satisfied users go out to the
community and mobilize new users (a less expensive, but
effective way of mobilizing communities)
Challenges
• Data capture at facility level
• Equipment and instruments required for adequate insertion and infection control are not always not available.
Future plans
Introduction of diagnosis and management of childhood
illness
Vietnam
BlueStar Vietnam
At a glance
Franchise details
Timeline
Services
Launched in April 2008
Family planning
●
USAID calculation
6,257 CYP
Location
Business model
$120–150 USD (poor/small clinics pay less)
HIV
Target clientele
Low income, women, migrants/refugees, youth
Average staffing
1 doctor, 1 nurse, 1 midwife and 1 clinical officer
per clinic
Malaria
Outlet types
95 clinics
Tuberculosis
191,087
2,011
Payment sources
OOP, vouchers, free
(With an IUD voucher, a free IUD insertion is
combined with a paid cervical cancer screening
as a form of cross-subsidization.)
$295,903
Donor support
Marie Stopes International, UK
Contact information
Le Thi Kim Yen, Social Franchise Manager
www.mariestopes.org
82
●
Vietnam
BlueStar Vietnam
Description
Background
BlueStar Vietnam operates in seven provinces in all three
geographical areas of Vietnam: Northern, Central and
Southern. Duration of establishment and support of the
network is four years, from 2007 to 2011 (2008 launch).
Services include modern FP methods and safe surgical
abortion services.
Service details
Oral contraceptives, condoms, Copper T, emergency contraceptive pills, injectables, abortion (medical and surgical)
licensing
Accredited by the government and by licensing bodies
• CHWs disseminate information about the location and
services provided by clinics
• They promote an IUD insertion plus cervical cancer
screening package
• For distributing an IUD insertion/cervical screening
voucher, they are paid a small fee for pre-service counseling of women on a per-case basis
Job aids
BlueStar brand management guide for clinic staff for reference and observation of the brand standards
Successes
• The first intervention targeting the private healthcare
sector to promote FP and safe surgical abortion services
to date in Vietnam
• Building organizational capacity for MSI Vietnam and its
local partners in new approaches to FP/RH care
• Building rapport and trust with BlueStar service providers
• Building database to create evidence for decision making and advocacy
Challenges
• Lack of support for a social franchise, as this is a new
model in Vietnam
• Difficulty obtaining government approvals for project
implementation
• Low level of interest among private providers to provide
at-cost FP methods, without financial support
• Cost-cutting measures (taken by some providers) that
compromise patient care
Future plans
• Pilot of vouchers for IUDs and medical abortion services
• Adding other long-term FP method such as new IUD
(GyneFix) and implant
• Expansion of the network by 160 clinics
• Consideration of pharmacies as referral sites to clinics
• Monitoring checklists for quality control
Technology
• SMS reporting
• MSI Vietnam launched a One Call Center in April 2009
to support and encourage MSI Vietnam and franchise
clients to access information and services, especially appointment bookings and post-treatment support.
83
Vietnam
Tinh chi em (“Sisterhood”)
At a glance
Franchise details
Timeline
Services
Launched in July 2007
Family planning
●
USAID calculation
4,884 CYP
Location
Business model
Fractional government franchise
HIV/AIDS
Target clientele
Low income, migrants/refugees, youth, men,
women
Average staffing
6 staff per health station
Malaria
Outlet types
56 commune health stations
Tuberculosis
63,337
1,131
Payment sources
10% OOP, 50% insurance, 40% government
reimbursement
$290,000
Donor support
The Atlantic Philanthropies
Contact information
Nguyen Thi Bich Hang, Country Representative
www.tinhchiem.vn
●
*Note that this program does not currently include all of the characteristics of a social franchise as defined for this compendium.
84
Vietnam
Tinh chi em (“Sisterhood”)
Description
Background
“Tinh chi em” is the first government-run social franchise
model in Vietnam. With technical assistance from MSI
Vietnam, the provincial Department of Health (franchisor)
forms and operates the model at commune health stations
(franchisee).
Service details
Oral contraceptives, condoms, injectables, Copper T, emergency contraceptive pills, counseling on FP, STI treatment,
surgical abortion, normal birth delivery, counseling on RH
licensing
Through the government
• Brand ambassadors are selected from the community.
They receive training on basic RH/FP, brand management, communication skills, etc. in order to mobilize
clients.
• They receive a monthly allowance to compensate for the
time and transportation costs used for referrals (about $5
USD per month).
85
Job aids
• Franchise manual
• Operational guide in Vietnamese (www.tinhchiem.vn)
• Refrigerators
Successes
• Strong partnership with local authorities
• Training on service quality, infection prevention, demand
generation
Challenges
Lack of fee collection from patients at the commune health
stations
Future plans
Expansion into three new provinces, with a target of establishing over 70 franchise units
Zimbabwe
new Start
At a glance
Franchise details
Services
Timeline
Launched in 1999
Family planning
Location
Business model
20% full franchise, 80% fractional franchise
HIV
Target clientele
Truck drivers, military, women, low income,
men, sex workers and clients, youth, migrants/
refugees
Average staffing
8 per site (nurses, pharmacists, clinical officers,
social workers)
Malaria
Outlet types
17 statics sites, 23 outreach teams
Tuberculosis
361,355
9,034
Payment sources
100% OOP
●
●
●
Donor support
DFID
USAID
Contact information
Dr. Karin Hatzold, HIV Services Director
www.psi.org
86
Zimbabwe
new Start
Description
Background
New Start is an HIV testing and counseling franchise
started in Zimbabwe in 1999 in support of the Ministry of
Health and Child Welfare Testing and Counseling Program.
The franchise is managed by professional counselors who
have another professional background such as nursing,
teaching or social sciences. To improve access to care,
treatment and support for people living with HIV, PSI has
introduced TB screening using a standard questionnaire
and FP counseling.
Service details
ART, HCT, TB screening, FP counseling
licensing
Accredited through the professional bodies they belong to
e.g., nursing, teaching, social sciences
Job aids
Site staff are provided with counseling guides and operating procedure manuals designed by PSI Zimbabwe.
Technology
Web-based reporting
Successes
• Guidance on operation of the sites
• Instilling a sense of program ownership into partner
• Ability to reach remote rural areas
Challenges
• Unstable political and economic environment—few
clients visit sites during periods of political unrest
• Aging vehicle fleet (requesting more vehicles in proposals)
• Poor road networks and accessibility
87
New Start training session
Future plans
• Reaching out to poor rural communities by intensifying
outreach activities
• Incorporation of CD testing, TB screening and investigations
• FP distribution through New Start centers to promote
dual protection and prevent unwanted pregnancies
• ARV therapy supply through private partnership
innovations
• Expansion of outreach activities to displaced populations and returned migrants
• Setting up an HCT site for returned migrants at the
border
• Capacity building for partners with weaknesses in management of testing and counseling programs
• Incorporation of new innovations in the HCT program—
TB smear microscopy, FP counseling, CD4 cell count
testing
• Setting up strong referral and referral tracking systems
with all referral partners in each area of operation
appendix a: acronyms
ANC
ART
ARV
CYP
FIFO
FEFO
FP
GP
HCT
IEC
IMCI
IUD
LTM
MBBS
MCH
MSI
OBA
OOP
ORS
PEPFAR
PLWHA
PMTCT
PSI
RH
SALIN
RTI
SMS
STI
TB
VCT
88
Antenatal care
Antiretroviral therapy
Antiretroviral drugs
Couple years of protection
First in, first out
First expiry, first out
Family planning
General Practitioner
HIV Counseling and Testing
Information, Education and Communication
Integrated management of childhood illness
Intrauterine device
Long-term method
Bachelor of Medicine and Bachelor of Surgery
Marie Stopes International
Output-based aid
Out-of-pocket payment
Oral rehydration salts
The US President’s Emergency Plan for AIDS Relief
People living with HIV and AIDS
Prevention of mother-to-child transmission
Population Services International
Reproductive health
Strategic Alliance with International NGOs
Reproductive tract infection
Short messaging service
Sexually transmitted infection
Tuberculosis
Voluntary counseling and testing for HIV/AIDS
89
Social franchises in 2009
appendix B: map of social franchises
appendix C: program summary graphs
Timeline
The number of franchises has doubled every four years since 1994.
45
40
35
number of franchises
30
25
20
15
10
5
0
1994
90
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Franchises by region
86% percent of social franchising clients are from South asia.*
5%
2% 1%
South Asia
6%
South East Asia
East & Southern Africa
Latin America
West Africa
*23 million clients are from
Smiling Sun, Bangladesh
86%
Services offered
Since 2008, more franchises are offering services in family planning, Srh, malaria, hiV/aidS, TB and other areas.
40
35
number of franchises
30
25
20
15
10
5
0
FP
Other SRH
MCH
Malaria
HIV/AIDS
TB
Other
Services
2 008
91
2009
MSI/DKT calculation
USAID calculation
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ta
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ua
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o
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f
n
n
ty
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ie
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c
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100
1,000
10,000
100,000
1,000,000
10,000,000
CYp calculations used by uSaid and mSi/dKT are closely correlated.
Couple years of protection (CYp)
log scale
92
CYp conversion factors
uSaid (last updated: June 2009)
mSi/dKT (last updated: February 2010)
method
units needed to provide 1 CYp
units needed to provide 1 CYp
Oral contraceptive pill (1 cycle, paid*)
15
14
Oral contraceptive pill (1 cycle, free)
15
70
Male condom (1 piece, paid)
120
100
Male condom (1 piece, free)
N/A
500
Female condom (1 piece, paid)
120
20
Female condom (1 piece, free)
N/A
100
1-month injectable
13
12
2-month injectable
6
6
3-month injectable
4
4
Foam tablet (paid)
120
150
Foam tablet (free)
N/A
750
IUD
0.29
0.182
Sterilization (male or female)—Asia
0.1
0.08
Sterilization (male or female)—Latin
America
0.1
0.08
Sterilization (male or female)—Africa
0.125
0.08
Implant (5 years)
0.29
0.286
Implant (3 years)
0.5
0.286
Emergency contraception
20
9
Surgical abortion
N/A
0.5
Medical abortion
N/A
0.5
*This report assumes that all reported services were paid for.
93
94
P
TO
percent increase 2008–2009
Sm
ng
ili
an
Su
,
ar
t
ns
e
re
G
gl
h
es
ad
Pa
S
t
ha
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an
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ki
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*Recently launched franchises not included
s
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ea
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n,
ar
sc
ga
a
ad
0%
20%
40%
60%
80%
100%
120%
140%
160%
180%
200%
e
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l
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am
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bw
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The median number of clients served by franchises increased 32% between 2008 and 2009.*
number of clients served
i
G
d
ol
in
en
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am
oF
Pr
al
St
M
e
ol
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rry
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ny
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t
ie
ity
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ar
ua
Q
t
eS
d
In
d,
,
a
Ug
nd
a
program expenditure
The majority of franchises had < $1 million uSd in program expenditure in 2009.*
3 programs
10 programs
4 programs
< $400,000 USD
$4,000,000 – $1,000,000 USD
$1,000,000 – $5,000,000 USD
> $5,000,000 USD
7 programs
*24 of 40 programs reported on
program expenditure.
expenditure per client
as the number of clients treated increases, the expenditure per client decreases.
100,000,000
$1,000.00
10,000,000
$100.00
100,000
10,000
$10.00
1,000
100
$1.00
10
$0.10
1
Clients served in 2009
Expenditure per client treated (USD)
95
log scale
log scale
1,000,000
appendix d: demand-side financing
Social franchising offers a way to improve the accessibility and quality of a wide range
of health services using existing private providers. Nearly two decades of evidence
exists to demonstrate the effectiveness of social franchising as a platform for service
delivery in developing countries. However, the social franchising model alone, as
financed through supply-side mechanisms such as donor funding of inputs (i.e.
physical infrastructure, salaries and commodities), does not ensure that services reach
all the patients who need them, particularly poor and vulnerable populations.
The limitations of supply-side financing impact both the receipt and delivery of services by patients and providers, respectively. When subsidies target solely the supply
side, there is no mechanism in place to ensure that poor patients can afford the services and there is no guarantee that patients have a choice of provider. For the providers, there is no incentive to spend the subsidy efficiently with a goal of providing the
best care for the most patients. Furthermore, there is no linkage between the payment
and performance once the subsidies are delivered, regardless of the services provided.
One way to overcome these constraints is through a demand-side financing mechanism—a third-party-payer linked to patient use—which involves channeling the subsidy
for health services directly to patients and allowing them to purchase health services
themselves. This process incentivizes providers to deliver high quality services and to
reach a larger population because they are reimbursed based on performance. For
patients, they now have the ability to choose which provider to visit and can access
services that otherwise might have been unaffordable. Demand-side financing
mechanisms are also attractive to donors who often prefer to purchase outputs (i.e.
consultations provided) as opposed to the inputs.
In the context of social franchises, demand-side financing can take the form of a
voucher program, an insurance program or other systems of output-based service
reimbursement provided to franchisees. Of the 40 social franchising programs identified in this compendium, 16 have implemented demand-side financing initiatives. The
table below provides a brief summary of these franchises and their programs. A Working Group on Social Franchising and Demand-Side Financing is actively engaged in
documenting best practices and sharing experiences and tools in this area. For more
information, visit SF4Health.org.
96
umbrella
organization
Franchise name,
Country
demand-side
Financing
mechanism
description of mechanism
Family Health International
Gold Star, Kenya
Insurance
Gold Star is working on strategies to partner with insurance
companies in the provision of HIV treatment services.
Hindustan Latex Family
Planning Promotion Trust
MerryGold, India
Voucher, Insurance
MerryGold facilities are accredited as part of a larger voucher
program, meaning clients can redeem vouchers at MerryGold in
addition to other facilities. In addition, MerryGold is linked to an
insurance scheme.
Hygeia Nigeria Ltd.
Hygeia, Nigeria
Insurance
Demand driven financing initiative that has enrolled 119,382
clients since inception in 2007. To enroll, the client pays $2 per
annum in Kwara and $8 per annum in Lagos.
BlueStar, Sierra Leone
Voucher
6,000 Healthy Life vouchers for LT family planning and 1000
Healthy Baby vouchers for maternal health will be distributed
over 12 months. The client pays 50 cents for the Healthy Life
voucher and 75 cents for the Healthy Baby Voucher.
BlueStar, Vietnam
Voucher
In October, 2009, a pilot voucher scheme was launched. 9000
vouchers for IUD and other medical abortion services have been
disbursed. The voucher is free to the client.
Population Services
International
Sun Quality Health,
Myanmar
Voucher
Vouchers are mainly used for long term FP methods and reach
30,000 patients per annum. PSI Myanmar first piloted the use
of vouchers in 2005 and since then has launched 11 such OBA
schemes for FP/RH services as well as TB screening and treatment.
Suraj, Pakistan
Voucher
Voucher scheme was launched in 2008 and to date, 21,112
vouchers have been redeemed. The voucher is free to the client.
MicroClinic, Ghana/Uganda
Insurance
Clients can access services through the National Insurance Plan
that is run by the private sector.
Population Services
International
Greenstar, Pakistan
Voucher
Voucher booklets are sold to clients identified through the Pakistan Poverty Scorecard (developed by World Bank) for delivery
and ANC/PNC visits. Vouchers pay for 98% of total cost and
available to poor women with no history of clinic based deliveries, implemented in three districts of Pakistan. The client pays
$1.25 for voucher booklet.
Population Services
International
ProFam, Benin
Voucher
The voucher scheme offers subsidized FP services and was
introduced in April 2009. Vouchers are given out during event
days. To date, 16,502 vouchers have been distributed and 4162
vouchers have been disbursed. The voucher is free to the client.
Population Services
International
ProFam, Cameroon
Voucher
The vouchers are used to redeem FP services at 25 clinics.
Population Services
International
ProFemina, Madagascar
Voucher
The voucher scheme targets low income women and subsidizes
long term FP methods. The scheme was launched in 2008 and
to date,13,136 vouchers have been disbursed. The voucher is
free to the client.
Population Services
International
Sun Quality Health, Cambodia
Voucher
The voucher scheme offers subsidized IUD services at franchised
private sector clinics. The program was introduced February
2010 and to date, 277 vouchers have been disbursed. The client
pays $1.25 at the point of service.
Population Services
International
Top Réseau, Madagascar
Voucher
The voucher scheme targets youth and high risk groups and
subsidizes FP/RH counseling and STI treatment. The scheme
was launched in 2005, and to date, 282,552 vouchers have been
disbursed. The voucher is free to the client.
Population Services
International
Tunza, Kenya
Voucher
Referral vouchers are distributed to women of reproductive
age via community mobilizers and PSI communications staff
following behavior change communication sessions on family
planning. The referral vouchers are redeemed at 172 Tunza
clinics and entitle women to FP counseling and subsidized FP
services, with a focus on IUDs. To date, 7763 vouchers have
been disbursed. The client pays $2.66 for the voucher.
97
appendix e: donors contributing to franchising
programs in 2009
The Allergan Foundation
An anonymous foundation
The Atlantic Philanthropies
The Bill & Melinda Gates Foundation
BlackRock
The David & Lucile Packard Foundation
Dutch Health Insurance Fund
The International Foundation
Johnson & Johnson Corporate
KfW
PEPFAR
Strategic Alliances with International NGOs (SALIN) of the Dutch Government
UNFPA
USAID
Venture Strategies
The William and Flora Hewlett Foundation
World Bank
98
appendix F: umbrella organizations
The 40 programs profiled in this compendium are implemented by the following
agencies.
Banja La Mtsogolo
BroadReach Healthcare
Chemonics
DKT
Drishtee
Family Health International (FHI)
Greenstar Social Marketing
Hygeia Nigeria Limited
INPPARES
Living Goods
Marie Stopes International (MSI)
Marie Stopes Society (MSS)
Hindustan Latex Family Planning Promotion Trust
Nepal CRS Company
Program for Accessible health,
Communication and Education (PACE)
Population Services International (PSI)
Sehat First
Social Marketing Company (SMC)
Society for Family Health (SFH)
VisionSpring
World Health Partners
99
banja.org.mw
broadreachhealthcare.com
chemonics.com
dktinternational.org
drishtee.com
fhi.org
greenstar.org.pk
hygeiagroup.com
inppares.org
livinggoods.org
mariestopes.org
mariestopespk.org
hlfppt.org
microclinics.com
crs.org.np
pace.org.ug
psi.org
sehatfirst.com
smc-bd.org
sfhnigeria.org
visionspring.org
worldhealthpartners.org
Visit the Global Health Group at
Find this document and other franchising
information at SF4Health.org.

Clinical Social Franchising Compendium, 2010

Transcription

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