EQUITY PROFILES OF THREE SOCIAL FRANCHISE NETWORKS IN WEST AFRICA

Nirali Chakraborty, Ph.DResearch Advisor for Reproductive Health

9th World Congress on Health Economics, Sydney, Australia

10 July 2013

Background– Franchising– Study sites

Equity calculation methodology Results

– Benin– Democratic Republic of Congo (DRC)– Mali

Implications

Outline

PAGE 2

24 FRANCHISES IN 23 COUNTRIES

SOCIAL FRANCHISING AT PSI

+10,000 FRANCHISEES 10 MILLION CLIENTS PER YEAR

+ Health Impact

✓ Quality

$ Cost-Effectiveness

Equity

Market Expansion

Improving population health

Ensuring adherence to clinical standards for client care

Providing services at equal or lower cost to alternatives

Enabling the poorest to access services

Delivering services that would not otherwise be provided

Goals of Social Franchising

Pilot equity measurement at franchises Justify use of national or sub-national reference

population, for program decision making

Study objectives

page 5

Client exit interviews Equity benchmarked

to reference population

Franchises primarily urban and peri-urban

Study context

page 6

Benin

page 7

Indicator Total Urban Rural

CPR among married women

6.1 9.0 4.5

Unmet need among married women

27.3 26.3 27.9

Under 5 mortality 136 116 145

Has electricity 27.9 56.6 8.5

Urban residence 41.4

Private Health Expenditure/THE

46.7

Out of Pocket/PHE 91.2

Source: DHS 2006 and WHO Global Health Observatory 2011 data

Offers Family Planning, SRH/HIV and MNCH services

185 clinic outlets ~33% of providers are

MDs ~100,000 clinic visits

recorded in 2012

Benin – ProFam franchise

page 8

Source: 2013 Social Franchising Compendium, www.sf4health.org

Democratic Republic of Congo

page 9

Indicator Total Urban Rural

CPR among married women

5.8 9.5 3.3

Unmet need among married women

26.9 28.1 26.1

Under 5 mortality 155 122 177

Has electricity 15.2 36.6 1.1

Urban residence 45.4

Private Health Expenditure/THE

66.3

Out of Pocket/PHE 65.7

Source: DHS 2007 and WHO Global Health Observatory 2011 data

Offers Family Planning, MNCH and Water Purification services

138 clinic outlets ~15% of providers are

MDs ~192,000 clinic visits

recorded in 2012

DRC – Réseau Confiance

page 10

Source: 2013 Social Franchising Compendium, www.sf4health.org

Mali

page 11

Indicator Total Urban Rural

CPR among married women

6.9 13 4.2

Unmet need among married women

27.6 28.4 27.2

Under 5 mortality 215 158 234

Has electricity 16.6 47.4 3.2

Urban residence 33.7

Private Health Expenditure/THE

54.9

Out of Pocket/PHE 99.6

Source: DHS 2006 and WHO Global Health Observatory 2011 data

Offers Family Planning, SRH/HIV and MNCH services

71 clinic outlets ~42% of providers are

MDs ~43,000 clinic visits

recorded in 2012

Mali – ProFam franchise

page 12

Source: 2013 Social Franchising Compendium, www.sf4health.org

Equity measurement methodology

PAGE 13

Data collection

1. Principal Components Analysis on weighted DHS asset ownership data

2. Capture eigenvector from first principal component for each asset, and quintile cut-points from asset index

3. Standardize Client data to DHS data

4. Multiply each asset by eigenvector

5. Sum (Std value*eigenvector) for each client

6. Place clients within DHS quintiles

Placing clients within reference population

Calculation done twice:National populationUrban only

Let Ai1=Asset score for each household i in DHS

Let =standardized value of each asset for household i in DHS

Let v = Value of eigenvector from first component for variable v

Let Ai2=Asset score for each client i sampled

Mathematically speaking…

page 16

ˆ v i

DHS data Client data

Wealth quintiles of franchising clients, within national reference population

Results: Client wealth profile

page 17

Quintile Benin DRC Mali

n=535 n=242 n=293

1 (Poorest) 3.4 0 0

2 2.4 0 0

3 4.3 0 0.3

4 13.1 9.1 13.9

5 (Richest) 76.8 90.9 85.7

Quintile National Urban

Poorest 3.4 6.7

Quintile 2 2.4 8.8

Quintile 3 4.3 11.4

Quintile 4 13.1 33.3

Richest 76.8 39.8

Poore

st Q2

Q3

Q4

Riches

t0

10

20

30

40

50

60

70

80

90

NationalUrban

Results: Client wealth profiles in context

page 18

Benin – ProFam Franchise

Quintile National Urban

Poorest 0 0

Quintile 2 0 4.6

Quintile 3 0 12.8

Quintile 4 9.1 40.9

Richest 90.9 41.7

Poore

st Q2

Q3

Q4

Riches

t0

102030405060708090

100

NationalUrban

Results: Client wealth profiles in context

page 19

DRC – Réseau Confiance

Quintile National Urban

Poorest 0 0.3

Quintile 2 0 2.1

Quintile 3 0.3 4.1

Quintile 4 14.0 15.0

Richest 85.7 78.5

Poore

st Q2

Q3

Q4

Riches

t0

10

20

30

40

50

60

70

80

90

NationalUrban

Results: Client wealth profiles in context

page 20

Mali – ProFam Franchise

Social Franchise community of practice is recommending client equity to be benchmarked against national reference population

For program decision making, sub-national reference population may be more informative

In these 3 countries, franchises appear to serve a wealthy population segment

Do social franchises serve the poor? Should social franchises aim to serve the poor(est)?

Implications

page 21

Acknowledgements: I gratefully acknowledge the PSI research managers from the three countries where this data was collected: Cyprien Zinsou (Benin), Willy Onema (DRC), and Mamadou Bah (Mali).

page 22

Questions?

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PSI

nchakraborty@psi.org