Public sector social franchising: the key to contraceptive choice for women? Boubacar Cissé – Social Franchise Director MSI Mali Anne Coolen – Country Director Marie Stopes International Mali Brendan Hayes – Head of Social Franchise MSI

Contraceptive Choice in Mali

Challenges for family planning West Africa There is a high unmet need for FP in the region Source: most recent DHS

Set up Social Franchise for FP and HIV VCT in Mali

Why Social Franchises in the Public Sector in Mali? Increase long-term impact of Mobile Outreach Potential to offer a whole range of FP services daily Community Health Centre is the entry point for the health system 2010 – 2011 political situation favorable with political engagement to Franchise Public Sector

Social Franchising in Mali Contractual arrangements ASACO Capacity building through: – Training of providers on FP counselling and service provision – Supportive supervision Quality assurance - Facility audits Contraceptives supply chain support Branding Standardized pricing Demand generation

RESULTS

Results of the different channels Number of CYPs per channel,

Results Feb Jun 2014 Number Number of Franchisees140 Number of total FP clients Clients that use a FP method for the first time Number of Implants Number of IUDs3 196 Clients that have benefited from HIV counselling Number of clients tested for HIV Number of clients tested positive230 Total CYPs

Results External Evaluation  Utilization of Family Planning: quadrupled the contraceptive prevalence rate in BlueStar zones  Geographic Accessibility  Financial accessibility by 77% of the women interviewed  Quality of service and the level of client satisfaction of 80%  Behavior change activities: 51% of the people interviewed had been involved in the activities

BlueStar vs non-BlueStar

Programme implications Increased acceptors of family planning and long-acting family planning methods in particular. Public sector franchising may be a cost-effective alternative to family planning outreach Pre-conditions for an intervention like public-sector franchising: – Government appropriation – Management arrangement of facility staff – Strong support: supervision and on the job training – Demand creation

Potential for Sustainability Appropriation of Social Franchise by the Government Increasing contribution from ASACO (investments in material, equipment etc) Capacity building: – Trained staff - all FP methods, Management of Emergencies, Clinical Quality – Most importantly, change provider behavior Increased acceptability - Reaching a threshold of awareness on importance of FP and continuous demand in the area

CONCLUSION Social Franchise has proved an interesting approach for Mali Great successes with the BlueStar network Potential is great with over a 1000 community health centres However, BlueStar has not (yet) reached sustainability Efforts needed to continue to reduce subsidies and improve contribution of the franchisees

QUESTIONS?