1. November 20, 2008Global Health Group University of California, San Francisco Franchise Evaluation Study priorities

2. Health Franchise Programs Current None Unknown status

3. Determining what we want to know Operations, finance, and economics –Cost-effectiveness? –Difference in incentive/financing models? –What structures work best? Quality, equity, and access –Increasing access to underserved populations? –Improved quality and service delivery?

4. Study methods Case studies Cross-sectional surveys Case-control –Randomized, non-randomized –By clinic, district Before/after studies –Data collected prior to launching of new franchise or service Prospective/retrospective longitudinal analysis

5. Qualitative methods Focus groups In-depth interviews Observation Ethnographic research

6. Existing tools StarScan (MSI): Adherence to franchisee agreement Monthly franchisee reports (PSI) Rapid Assessment Audit Tool (PSI) Clinic records (financial, services, clientele)

7. Tools: Monitoring quality Mystery client Exit interviews Quality Technical Assistance review (MSI) Surprise inspections (PSI) Facility assessment (Clincscan/MSI) Observation

8. Program outcomes CYP –1.4M CYP (GreenStar Pakistan) Cost per CYP –$8 (GreenStar) DALYs –72,009 DALYs (New Start South Africa) Sustainability

9. Defining key terms What do we mean by… –a clinical franchise? –Increased access? –Improved quality?

10. Indicators Clients served and demographics Products and services sold Quality of care (client satisfaction, compliance with standards) CYP DALY Cost recovery, cost effectiveness

11. Small group discussion What are the priority issues for further research? What do we want to learn? What are possible study designs? What are the key indicators?