HOWFARCANASOCIALFRANCHISECOVERITSCOSTS?

ANECONOMICANALYSISOFTHEPROFAMMATERNALHEALTHFRANCHISEINUGANDA

MANONHAEMMERLI,ANDREIASANTOS,FREDMATOVU,

CATHERINEGOODMAN

EVIDENCEONSOCIALFRANCHISING•  Socialfranchisesusefranchisingmethodstoachievesocialratherthanfinancialgoals

bylinkingpre-exis;ngprivatehealthprac;;onersinanetworktoprovidesociallybeneficialservicesunderacommonbrand(Montagu,2002)

•  Socialfranchisingprogrammesareafastgrowingmethodtoengagewiththeprivate

sectorinLMICs•  Keyconcernswithsocialfranchisingincludethedifficultytocontrolclinicalqualityof

careandequityimpact(MontaguandGoodman,2016)•  Limitedevidenceontheimpactonclientsvolumesformaternalhealthservicesand

financialimplica;onswhenjoiningasocialfranchisenetwork(Beyeleretal,2013)•  Donorinterestinknowingtowhatdegreesocialfranchiseprogrammeshave

capacitytoachievefinancialsustainability,ie,towhatextenttheSFprogrammescanbefundedbyfranchiseefees

PROFAMNETWORKINUGANDA Networkofprivateproviderscreatedin

2008byPACE.MUMprogrammeformaternalhealthstartedin2012Opera;ngin43districtsandofferingfranchisedmaternalhealthservicesthroughmorethan134healthfacili;esFranchiseesreceivetechnicalandbusinesstraining,subsidisedproductsandequipment,monitoringandsupervisionfromPACECommunityoutreachthroughMamaAmbassadors(CHW):createsdemandandpromotesthebrandasofferinghighquality,affordableservices.Thefranchiseecommitstomee;ngPACEqualitystandardsandtopayayearlymembership(≈7.5$)

OBJECTIVESOFTHECOSTINGSTUDY

Objec;ve:Toes;matetheeffectofbeingamemberoftheprogrammeonafacility’soverallprofit,fromtheprovider’sperspec;ve

•  Ques;on1:Whatarethestart-upcostsassociatedwithjoiningtheMUMprogram?

•  Ques;on2:Whatistheincrementalprofitgeneratedbypar;cipa;ngintheMUMprogramme?

SAMPLEOFFACILITIES

15facili;esrandomlyselectedintheProFam

network

8Privateforprofitfacili;es(PFP)

7Privatenotforprofitfacili;es

(PNFP)

METHODS

Incrementalprofitgeneratedbyjoiningtheprogramme

Differenceinpa;entvolumesbefore/agertheprogramme

Differencebetweenthe

providercostanduserfeesperclient

RevenuegeneratedwiththesellofClean

birthkits

Pa;entloadcapturedoneyearbeforetheprogram(2012-2013)andthemostrecentyear(2014-2015)Source:HMISbooks

•  Providercostspercase:recurrentcostsofmedicalsuppliesandstaff;me•  RevenuegeneratedpercasewithuserfeesSources:Providersurveyandobserva;ons

NumberofkitssoldinayearSource:Providersurvey

Start-upcostswereanalysedseparately

RESULTS:START-UPCOSTS•  Outof14respondingfacili;es,onlyonefacilitystaffreportedrepairs($57)andonereportedminormodifica;onofthewardwithsomepain;ng($489)

•  NoneofthesefigurescouldbeverifiedanditwasnotclearwhetherthesechangesoccurredasaresultofjoiningMUM

•  Overall,therewasnostandardchangeinfacilityinfrastructureatthestartofjoiningMUM

•  ThePACEfranchisefeewas$7.50peryear,althoughthequalita;veinterviewswithprovidershighlightedthatthiswasnotalwayspaidrou;nely

RESULTS:CHANGEINPATIENTLOADFacility AbsolutedifferenceinnumberofANC

visits(rela>vedifference)Absolutedifferenceinnumberofdeliveries(rela>vedifference)

PFP1 +177(+285%) +39(+70%)

PFP2 +43(73%) +14(+23%)

PFP3 -14(-3.4%) +31(+43%)

PFP4 +50(+79%) -5(-31%)

PFP5 -51(-44%) +5(+22%)

PFP6 -207(-28%) -100(-26%)

PFP7 Notavailable Notavailable

PFP8 +187(+25%) -22(-6.7%)

PNFP1 -878(-40%) -43(-13%)

PNFP2 -75(-2.3%) -257(-13%)

PNFP3 -152(-6.5%) +16(+4.5%)

PNFP4 Notavailable Notavailable

PNFP5 Notavailable +41(+4.6%)

PNFP6 -49(-29%) +4(+200%)

PNFP7 +18(+1.4%) +75(+12%)

RESULTS:MEANPROVIDERSCOSTSANDUSERFEESACROSSTHESAMPLE(INUSDOLLARS)

0

2

4

6

8

10

12

14

AnyANC ANC1 ANC4 Delivery

USdo

llars

Medianprovidercostpervisit

Medianuserfeepervisit

RESULTS:COMPARISONOFUSERFEESINPFPANDPNFPFACILITIES

0

2

4

6

8

10

12

14

16

MedianuserfeechargedforANC

Medianuserfeechargedfornormaldelivery

USDo

llars

Privatefor-profitfacili>es

Privatenot-for-profitfacili>es

INCREMENTALPROFITGENERATEDFacility Incremental

pro0itfromANCservices

Incrementalpro0itfromdeliveryservices

Pro0itfromsaleofMamaKits

Totalincrementalpro0itin2015

PFP1 755$ 1618$ 720$ 3093$

PFP2 36$ 360$ 47$ 443$

PFP3 -3$ 225$ 327$ 549$

PFP4 347$ 338$* 81$ 767$

PFP5 -71$ 24$ 360$ 313$

PFP6 32$* -770$ 900$ 162$

PFP8 301$ -242$ 630$ 698$

PNFP1 412$* 176$* 0 587$

PNFP2 -100$ -1207$ 0 -1307$

PNFP3 -346$ -11$* 630$ 273$

PNFP6 16$* 18$ 32$ 66$

PNFP7 -202$* 127$ 189$ 114$

MedianincrementalprofitforPFPfacili>es:496$MedianincrementalprofitforPNFPfacili>es:193$

IMPLICATIONS•  Difficultytocollectu;liza;onandcostdataintheprivatesector

wasamajordifficultytoconductsuchstudy•  Medianprofitinthisstudywas293$peryear:amidwife’ssalaryis

roughly1420$peryear.Thisreflectsthelimitedimpactonfinancialgrowthforproviders

•  U;liza;onandfinancialdataraiseques;onsontheaimofthe

socialfranchiseandthedifficultyforclinicmanagerstoachievefinancialsustainabilitybyprovidingaffordableserviceswhilemaintainingqualityofcare

•  Datasuggesttheimportanceofhavingaincomegenera;ngac;vity

suchasthesellingoffranchisedproducts(MamaKits)

ACKNOWLEDGMENTS•  METteam,LondonSchoolofHygieneandTropicalMedicine•  FredMatovuandAlexAligaa,PolicyAnalysisandDevelopment

ResearchIns;tute(PADRI)•  ProFamproviderswhopar;cipatedinthisstudyTheresearchinthispresenta-onwassupportedbyfundingfromMSD,throughitsMSDforMothersprogram.MSDhadnoroleinthedesign,

collec-on,analysisorinterpreta-onofdata,inwri-ngofthemanuscript,orinthedecisiontosubmitthemanuscriptforpublica-on.Thecontentofthispublica-onissolelytheresponsibilityoftheauthorsanddoesnotrepresenttheofficialviewsofMSD.MSDforMothersisan

ini-a-veofMerck&Co.,Inc.,Kenilworth,N.J.,U.S.A.

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