1. PILOTING THE EQUITY ASSESSMENT OF SOCIAL FRANCHISES Presented at 2 nd Global Symposium on Health Systems Research 1 November 2012 Nirali Shah, Ph.D. Kenzo Fry May Sudhinaraset, Ph.D.

2.  2 possible metrics –Wealth Index –Progress out of Poverty Index (PPI)  Piloting process  Results from pilots  Lessons learned from pilot  Reflections on the 2 metrics  Next steps Outline

3.  Why? –One of the ‘pillars’ of social franchising –To understand what market segment franchises serve  What? –Providing services in relation to economic need –Not other aspects of societal equity, such as age or gender  How? –Wealth index based on Demographic & Health Surveys(DHS) –PPI –Using client exit interviews Equity

4.  Working group teleconferences  Small group meeting in March 2011  Feasibility study of wealth index method  Proposal of PPI  Agreement to test 2 methods where possible  Small group meetings and teleconferences in future Process of choosing a metric

5.  Initially used within DHS surveys  Ranks households in a nationally representative sample according to observable indicators of wealth  Ranks clients within the national distribution of wealth  Assigns clients to a wealth quintile, based on cut-offs within the national distribution  Proportion of clients in each wealth quintile  Initially used within DHS surveys  Ranks households in a nationally representative sample according to observable indicators of wealth  Ranks clients within the national distribution of wealth  Assigns clients to a wealth quintile, based on cut-offs within the national distribution  Proportion of clients in each wealth quintile Wealth Index Our Application End result

6.  Developed by Grameen Foundation for service delivery organizations (i.e microfinance)  Correlates Income or Expenditure to 10 observable indicators from a national survey such as LSMS  Assigns weights to relevant values of the indicator  Likelihood that a client falls below established poverty line (national; $1/day; $2/day)  Proportion of clients below poverty line Progress out of Poverty Index (PPI) End result

7. PPI scorecard example

8.  3 organizations: World Health Partners, MSI, PSI  Included wealth index and/or PPI questions into previously scheduled client exit interviews  Data analysis conducted by study presenters  Pilot objectives: –Assess each metric individually for ease of implementation –Compare metrics with regard to data obtained and ease of implementation –Propose an aligned metric –Gather information to write a manual for implementation and analysis, that all franchises can use Piloting process

9. OrganizationCountryMetric World Health PartnersIndiaWealth index MSIMadagascarWealth index* PSIBeninWealth index; PPI PSIDRCWealth index* PSIMaliWealth index Piloting process (continued) * PPI not available

10. QuintileIndiaMada.BeninDRCMali n=797n=853n=535n=242n=293 1 (Poorest)27.92.13.400 222.59.32.400 321.725.44.300.3 415.338.613.19.113.9 5 (Richest)12.724.676.890.985.7 Wealth Index Results Proportion of clients in each quintile, by country

11. PPI Results Franchise ClientsPopulation* $1.25/day$2.50/day$1.25/day$2.50/day Benin19%61%47%75% Pakistan17%72%21%60% Philippines17%51%18%42% Vietnam8%51%17%43% * Most recent data available from World Bank

12.  Alignment –Lack of alignment meant that 2 metrics were tested –Only 1 country program able to test both to date –Theoretical difference: absolute or relative equity  Feasibility –In county implementation simple; no comments received on survey length –HQ researcher required for analysis; approx. 8 hrs per survey –DHS dataset or factor weights have to be requested –PPI only possible if questionnaire, weights, scoring table made available by Grameen Foundation Lessons learned

13. Wealth Index  Measures relative wealth - in comparison to national distribution  Available in approx 89 countries, incl 43 African  Feasible with range of items  Comparable with other outcomes found in DHS PPI  Measures absolute wealth – in comparison to a poverty line  Available in approx 46 countries, incl 14 African  All 10 questions must be asked  Analysis is simple

14.  Alignment!  Agreement upon one measure  Dissemination of methodology and resources to calculate equity  Agreement upon the “metric”: Proportion of clients in the bottom 2 quintiles may not be informative for urban franchises Next Steps

15. Questions? PSI