Building Public/Private Partnership for Health System Strengthening

Social FranchisingDominic Montagu

Bali Hyatt Hotel, Sanur, Bali21-25 June 2010

Context

Source of Healthcare

Public Private

Public Private

Public Private

Public Private

Public Private

Place of DeliveryBy Wealth Quintile - South Asia

7.4% 12.9% 22.1% 29.2% 27.6%

poorest richest

Other Person’s Home

Home

Religious HospitalPrivate Hospital/Clinic

Public Facility

10.4%

10.6%

9.7%

7.0%3.5%

78.1% 69.0% 56.3% 40.0%

17.8%

0.1%0.2%

0.4%

0.8%

49.1%

3.9% 7.3% 11.4% 22.8%

1.7%

N = 72,333 women reporting births in DHS Surveys in South Asia since 2000. Data is Population-Weighted. Countries included: Bangladesh, India, Nepal, Pakistan

Place of DeliveryBy Wealth Quintile - Southeast Asia

7.0% 12.8% 20.0% 24.1% 22.2%

poorest richest

Other Person’s Home

Home

Religious HospitalPrivate Hospital/Clinic

Public Facility

6.1%4.7%

3.2%2.2% 1.3%

82.8% 70.0% 54.3%37.0%

18.9%

2.9%

8.5%

13.7%

19.2%

35.9%

1.2% 4.1% 8.8% 17.5%

21.5%

N = 11,654 women reporting births in DHS Surveys in Southeast Asia since 2000. Data is Population-Weighted. Countries included: Cambodia, Indonesia, Philippines (note: Vietnam data is not available with wealth quintiles) * ‘East Asia and the Pacific’

One response: organize the private

sector

• “…is an attempt to use franchising methods to achieve social rather than financial goals, influencing the service delivery systems of the private sector similarly to the way in which social marketing has adapted traditional outlets for commodity sales.”

Social Franchising

clinicclinic pharmacy

Franchise ProgramsFranchise

Organization(Franchisor)

Directlymanaged clinic

Product testing,

gold standard

FranchiseFranchise Franchise

clients

Specialist (X-RAY, Lab Tech)

Results

Franchise feeadherence to standards

•Brand Equity•Advertising•Training•Standards•Commodities

Service Provided

More Clients

Private providers value training

Client choice of provider

• Outlets are owner-operated

• Payment is for services delivered»vouchers»out-of-pocket» insurance / 3rd party payer

• Services are standardized

What makes a franchise

Services and Clients Served

One in threesocial franchisesare in Asia

24.5M

who are they

why this structure works

why this structure works•incentives are well aligned

•need for oversight is limited

•most healthcare services are low-volume, so a distributed high-number of SDPs is key

•there are economies of scale

•adding structure to the private healthcare market reduces transaction costs and benefits both patients and providers

•use of intermediary institutions

What Can Governments Do?

•Determine when a social franchise is an appropriate response

•Invite, subsidize, or create a supportive environment

•Monitor, evaluate, contract

Learn Morewww.sf4health.org