Building Public/Private Partnership for Health System Strengthening Social Franchising Dominic Montagu Bali Hyatt Hotel, Sanur, Bali June 2010

Context

Source of Healthcare Public Private PublicPrivate PublicPrivate PublicPrivate PublicPrivate

Place of Delivery By Wealth Quintile - South Asia 7.4%12.9% 22.1%29.2%27.6% poorest richest Other Person’s Home Home Religious Hospital Private 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 Data is Population-Weighted. Countries included: Bangladesh, India, Nepal, Pakistan

Place of Delivery By Wealth Quintile - Southeast Asia 7.0%12.8% 20.0%24.1% 22.2% poorest richest Other Person’s Home Home Religious Hospital Private 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 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

clinic pharmacy Franchise Programs Franchise Organization (Franchisor) Directly managed clinic Product testing, gold standard Franchise clients Specialist (X-RAY, Lab Tech) Results Franchise fee adherence 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 three social franchises are in Asia

24.5M

who are they

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

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