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The Private Sector Healthcare Initiative Clinical Social Franchising Compendium Results Rekha Viswanathan, Eric Schatzkin, Andrea Sprockett & Dominic Montagu September 2014 1

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What is Social Franchising? 2

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SOCIAL FRANCHISING Problem: Many private clinics in LMICs, but each has a limited range of services and uncertain quality

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SOCIAL FRANCHISING Solution: Grouped into branded franchise. Still independent, but common standards and new services.

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SOCIAL FRANCHISING Solution: Grouped into branded franchise. Still independent, but common standards and new services.

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SOCIAL FRANCHISING - GOALS + Health Impact Quality $ Cost-Effectiveness Equity Market Expansion

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SOCIAL FRANCHISING - GOALS + Health Impact A summary of health benefits resulting from avoiding a disease or unintended pregnancy.

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SOCIAL FRANCHISING - GOALS Quality The ability to treat or refer clients with complications, and adherence to overall program protocols

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$ Cost-Effectiveness SOCIAL FRANCHISING - GOALS Able to deliver a service to a target population at a lower cost than alternative delivery options.

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Equity SOCIAL FRANCHISING - GOALS The percentage of patients receiving franchised services that are within the lowest two national wealth quintiles.

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Market Expansion SOCIAL FRANCHISING - GOALS Provide services to patients in need who would otherwise receive lower quality care, delay seeking care, or go without care.

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Provides a range of services Some existing services are improved Most existing services remain unchanged Typical private clinic Private Clinic Services Aches, pains, headaches Cuts, abrasions Stomach problems Eye, nose, throat Fevers and coughs Diarrheal diseases Infections Chronic illnesses FRACTIONAL FRANCHISING

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Typical franchise clinic New services are added Some existing services are improved Most existing services remain unchanged services Aches, pains, headaches Cuts, abrasions Stomach problems Eye, nose, throat Fevers and coughs Diarrheal diseases Infections Chronic illnesses Family planning TB diagnosis and Care Franchise Clinic FRACTIONAL FRANCHISING

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Typical franchise clinic New services are added Some existing services are improved Most existing services remain unchanged services Aches, pains, headaches Cuts, abrasions Stomach problems Eye, nose, throat Fevers and coughs Diarrheal diseases Infections Chronic illnesses Family planning TB diagnosis and Care Franchise Clinic FRACTIONAL FRANCHISING

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Typical franchise clinic New services are added Some existing services are improved Most existing services remain unchanged services Aches, pains, headaches Cuts, abrasions Stomach problems Eye, nose, throat Fevers and coughs Diarrheal diseases Infections Chronic illnesses Family planning TB diagnosis and Care Franchise Clinic FRACTIONAL FRANCHISING

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Outlets are owner-operated Payment is for services delivered Services are standardized Clinical services are provided DEFINITION

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In 2009, PSHi launched a global survey to understand the scale, quality, impact, implementation models, and financing models of clinical social franchising programs. The results were reported in the First Compendium of Clinical Social Franchising. In June 2014, the sixth annual edition was released. It is available at http://www.sf4health.org/ Profiles about each of the programs are also available at http://healthmarketinnovations.org Global survey of clinical SF programs

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Growth Worldwide

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19 Countries with programs, 2009

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20 Expansion of programs, 2013

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Franchise Funding

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Use of Demand-side Financing

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Health Impact DALYs averted by service area Over seven million DALYs, or healthy years of life lost, were averted in 2013 by the 50 programs that reported service provision numbers. The greatest contribution came from the provision of family planning services.

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Disaggregation of MNCH service provision data shows: 30+ programs offer safe abortion or post- abortion care services 19 programs offer safe motherhood services, many of which include cervical cancer screenings and/or treatment A look at MNCH services

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Health Impact DALYs averted due to FP Long-term family planning methods accounted for over 80% of the health impact attributable to family planning services.

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Trend in CYPs

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The model of health service delivery through social franchising continues to grow, with over 90 programs worldwide. The principal attractions are: 1.Leverage of existing infrastructure 2.Scalability 3.Quality assurance As the reach of social franchises for health continues to grow, there is a need to focus on: 1.Improved data collection and reporting, through the use of consistent metrics 2.Sustainability, cost-effectiveness, and market expansion 3.Defined role in an evolving health system Conclusion

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Visit SF4Health.org to download Clinical Social Franchising Compendium: An annual survey of programs findings from 2013. For more information