1. PRIMARY HEALTH CARE CLINIC SOCIAL FRANCHISE PROJECT 2014 Global Conference on Social Franchising for Health Mactan Island, Philippines 22-24 October 2014 Dr Andrew K L Robinson, Anita du Toit, Dr Uma Nagpal

2. PROBLEM STATEMENT While certain clinics run excellent services, there is no uniformity of standards across all clinics, nor are there effective mechanisms to do so. The well-run clinics are primarily a result of the initiatives, inspiration, motivation and dedication of the facility manager and not as a result of business models, support structures or training.

3. CurrentMove towards 1 Poor image of PHC clinics, by-passing of PHC services resulting in hospital congestion with inappropriate levels of care patients High acceptability by service users 2 Headed up by a facility manager, usually a good nurse, with no training on facility management Health professional with ‘equity stake’, performance driven 3 Run according to:  Core Standards, Clinic supervision manual, Various operational SOP’s and stock management systems and Limited HR plans  All vary between facility and district Clearly defined operations manual with training manual with specific emphasis on:  Business management administration, processes and procedures, Clearly defined support and training, Efficient stock management and procurement (Pharmaceuticals), HR management systems, Time management and allocations, Asset management 4 Variable PHC package of services, of variable quality -only provided if resources exist Standardised, quality full PHC package of care provided at each PHC facility 5Poor data collection and managementData driven management with clear outcomes 6Limited opportunities for job creation Numerous opportunities for job creation at a local or rural level Paradigm shift from status quo to social franchise business model

4. PROPOSED SOLUTION An innovative and dynamic approach will be necessary to shift the “current” situation to the “future” required standards expected from our clinics within the NHI. 28 March 2012 meeting with the South African Franchise Association - a social franchise solution was deemed possible and warmly supported. Franchising consultants were approached assist to develop this innovative solution using business principles within the social franchising concept and business models.

5. HOW TO DEVELOP A PHC CLINIC TO MEET NHI REQUIREMENTS…

6. CONSISTENT HIGH QUALITY HEALTH SERVICES THAT CAN BE REPLICATED SOCIAL FRANCHISING AS A MECHANISM? 1.Standardised consistent service 2.Brand 3.Replicable 4.Sense of ownership 5.Systems and Controls 6.Support Develop Model Clinic Pilot ClinicLearningsReplicate Ongoing Monitoring and Support PROJECT PROCESS We are here

8. Opportunities for job creation in rural areas Within this model, a number of micro enterprises and business opportunities could be created, particularly in rural areas, which would have the potential to create jobs and enhance the sense of ownership of facilities (not privatisation). These enterprises could comprise:  Cleaning services  Garden services, vegetable and traditional medicine production  Maintenance  Security  Water management, waste management and recycling  Laundry  Transport

9. PROGRESS / CONCLUSION  The procurement process is the rate limiting factor.  The business plan is developed, the operations and training manuals are almost complete.  Clinic decorating and renovations are commencing.  Once implemented, this model will be replicated to one clinic in the NHI pilot district to prove concept, before being rolled-out province wide.

10. Thank you!