The impact of social franchising on the use of reproductive health and family planning services at public commune health stations in Vietnam

Abstract

BackgroundService franchising is a business model that involves building a network of outlets (franchisees) that are locally owned, but act in coordinated manner with the guidance of a central headquarters (franchisor). The franchisor maintains quality standards, provides managerial training, conducts centralized purchasing and promotes a common brand. Research indicates that franchising private reproductive health and family planning (RHFP) services in developing countries improves quality and utilization. However, there is very little evidence that franchising improves RHFP services delivered through community-based public health clinics. This study evaluates behavioral outcomes associated with a new approach - the Government Social Franchise (GSF) model - developed to improve RHFP service quality and capacity in Vietnam's commune health stations (CHSs).MethodsThe project involved networking and branding 36 commune health station (CHS) clinics in two central provinces of Da Nang and Khanh Hoa, Vietnam. A quasi-experimental design with 36 control CHSs assessed GSF model effects on client use as measured by: 1) clinic-reported client volume; 2) the proportion of self-reported RHFP service users at participating CHS clinics over the total sample of respondents; and 3) self-reported RHFP service use frequency. Monthly clinic records were analyzed. In addition, household surveys of 1,181 CHS users and potential users were conducted prior to launch and then 6 and 12 months after implementing the GSF network. Regression analyses controlled for baseline differences between intervention and control groups.ResultsCHS franchise membership was significantly associated with a 40% plus increase in clinic-reported client volumes for both reproductive and general health services. A 45% increase in clinic-reported family planning service clients related to GSF membership was marginally significant (p = 0.05). Self-reported frequency of RHFP service use increased by 20% from the baseline survey to the 12 month post-launch survey (p < 0.05). However, changes in self-reported usage rate were not significantly associated with franchise membership (p = 0.15).ConclusionsThis study provides preliminary evidence regarding the ability of the Government Social Franchise model to increase use of reproductive health and family planning service in smaller public sector clinics. Further investigations, including assessment of health outcomes associated with increased use of GSF services and cost-effectiveness of the model, are required to better delineate the effectiveness and limitations of franchising RHFP services in the public health system in Vietnam and other developing countries.

Program Impact Pathway Analysis of a Social Franchise Model Shows Potential to Improve Infant and Young Child Feeding Practices in Vietnam

“…Although social franchising has been linked with increased community-level utilization of child health (12,33) and tuberculosis services (34), the findings are mixed for reproductive health services. In Vietnam, franchising was shown to increase client volume and use of reproductive health services, but these increases were attributed to increased frequency of use rather than higher utilization rates in the community (4). Similarly, studies in Nepal reported no change in the utilization of reproductive health services in franchise or control districts; however, the rate of return visits increased among franchise but not control clients (35,36).…”

“…3 Comparison between baseline 2010 and process evaluation 2013. 4 Prelacteal feeding is defined as the administration of any foods or liquids other than breast milk to an infant during the first 3 d after birth. 5 Minimum is defined as 2 times for breast-fed infants aged 6-8 mo, 3 times for breast-fed children aged 9-23.9 mo, and 4 times for non-breast-fed children aged 6-23.9 mo.…”

“…This approach has been used to improve services in the areas of reproductive health, tuberculosis, malaria, pneumonia, HIV/AIDS, and child health (3). In Vietnam, 2 reproductive health and family planning franchises have been launched by Marie Stopes International: Tinh chi em in the public sector (4) and BlueStar in the private sector (3). Alive & Thrive (A&T) 9 , an initiative to reduce undernutrition through improved breastfeeding and complementary feeding (CF) practices, is the first program to apply a social franchising approach to improving access to good-quality nutrition counseling services in Vietnam and worldwide (5).…”

Quality of reproductive health services at commune health stations in Viet Nam: implications for national reproductive health care strategy

“…Experiments with the government social franchise business model, 30 which increases service utilisation and patient perceptions of quality through branding and social marketing programmes, quality improvement, formalisation of user fees and staff incentive schemes have been successful in some CHS system trials in Viet Nam. 31,32 Revenues generated by user fees can be used to improve and sustain service quality. Both the poor who need subsidies and those who are better off will benefit from higher quality services offered at their local CHS as a result of such initiatives.…”

Success Factors and Benefits of Social Franchising as a Form of Entrepreneurship

“…There is a need for a better understanding of the various forms of the phenomenon and clarification of its fundamental meaning. The prior research work that took into consideration social franchising within the healthcare and educational context in the developing world mostly focused on health aspects (Alur, 2011;Bishai et al, 2008Bishai et al, , 2012Ngo et al, 2010). Tracey and Jarvis (2007) were the first to attempt to analyse social franchising.…”