Images courtesy of: Asociación Panamericana de Mercadeo Social; Population Services Pilipinas, Inc.; Unjani Clinics

CLINICAL SOCIAL FRANCHISING COMPENDIUM An annual survey of programs: findings from 2013

June 2014

CLINICAL SOCIAL FRANCHISING COMPENDIUM An annual survey of programs: findings from 2013

June 2014 Copyright © 2014 The Global Health Group

The Global Health Group Global Health Sciences University of California, San Francisco 50 Beale Street, Suite 1200 San Francisco, CA 94105, USA Email: [email protected] Website: globalhealthsciences.ucsf.edu/global-health-group

Ordering information Electronic download: This publication is available for electronic download at sf4health.org Print copies: Limited print copies are available from the Global Health Group. To request a copy, please send an email to [email protected]. Information will be updated over time and published online at sf4health.org

Recommended citation Viswanathan, R., Schatzkin, E., and Sprockett, A. (2014). Clinical Social Franchising Compendium: An annual survey of programs: findings from 2013. San Francisco: The Global Health Group, Global Health Sciences, University of California, San Francisco.

Produced in the United States of America.

First Edition, June 2014

This is an open-access document distributed under the terms of the Creative Commons Attribution-Noncommercial License, which permits any noncommercial use, distribution and reproduction in any medium, provided the original author and source are credited.

This document is a product of the Global Health Group at the University of California, San Francisco. The information contained herein was provided by individual franchise programs and was not independently verified. This document is intended to serve as a guide, and the interpretation and use of the information is the responsibility of the reader. Country designations do not express any judgment by the Global Health Group concerning the legal status of any country or territory. References to companies or products do not reflect endorsement or preference by the Global Health Group.

Graphic designer: Kerstin Svendsen Copy editor: Will Hector Cover photos: Courtesy of Asociación Panamericana de Mercadeo Social, Population Services Pilipinas, Inc.and Unjani Clinics

Acknowledgments The editors gratefully acknowledge the franchise program managers and personnel from around the world that responded to the call for data, though they are too numerous to name here. Thanks to Brendan Hayes and Julie McBride for encouraging programs to submit data. Thanks to the Metrics Working Group for providing input on the concepts used in the survey and the themes featured in the report. Thanks to the entire Private Sector Healthcare Initiative for providing critical feedback. A clinical social franchise is a network of private sector financial and social incentives to join. These incentives may healthcare providers that are connected through formal include the creation of a brand identity, mass marketing agreements to provide health services under a common campaigns for that brand or on behalf of members, access franchise name. Clinical social franchising engages the to medical commodities at cost or below market rates, and vast and diverse private health sector to provide clinical technical and business management trainings. In return, and non-clinical health services and commodities that are a member agrees to comply with standards set by the important for population health. franchise program, to report on performance across certain parameters, and to pay fees to maintain membership. Population health initiatives may use clinical social franchis- ing to standardize the quality and range of health services offered by the private health sector, to increase the number of points of service delivery for a particular set of health Why is social franchising important? services, or to otherwise address issues that are challenging Privately delivered care makes up a large portion for the public health system to meet by itself. of health services in many countries. Social franchising presents one practical approach that The graphic below offers a conceptual snapshot of how a can be incorporated within strategies for private social franchise program is typically organized. sector engagement to advance progress toward the Millennium Development Goals. In this model, a third-party franchisor catalyzes the growth of a network of franchisees by offering members a range of

The Clinical Social Franchise Model

√ training √ √

Private sector healthcare The Franchisor (an independent As Franchisees, private sector providers may offer a range agency or program) recruits private healthcare providers now offer of health services, with little sector health providers and offers franchised health services and or no quality oversight from them: commodities that are linked to an independent body. • a shared brand identity and protocols and standards. marketing support • access to health commodities, often subsidized • trainings in better clinical and business management practices • standards for quality oversight and commodities and services

CONTENTS

Introduction...... 1 Methods...... 2 Acronyms...... 3 Global Overview and Data Highlights...... 4 A Call to Social Franchise Programs to Use...... 11 Standardized and Consistent Metrics Pilot Data: Health impact...... 13 Profiles...... 15 ...... 16 ...... 17 Burundi...... 18 ...... 19 ...... 20 Democratic Republic of the Congo...... 21 Dominican Republic...... 22 El Salvador...... 23 ...... 24 ...... 25 Guatemala...... 26 Haiti...... 27 ...... 28 ...... 34 Lao People’s Democratic Republic...... 38 ...... 39 ...... 41 ...... 43 ...... 45 ...... 46 Nicaragua...... 48 ...... 49 ...... 51 Papua New Guinea...... 54 Peru...... 55 ...... 56 Senegal...... 58 ...... 59 Somaliland...... 60 ...... 61 Tanzania...... 62 ...... 63 ...... 64 ...... 67 Yemen...... 71 ...... 72 ...... 74

Appendix: Resources and Publications...... 75

INTRODUCTION

The Private Sector Healthcare Initiative of the needs and to diversify sources of revenue for Global Health Group started releasing global franchisees; they also present a way to test the data on clinical social franchising programs in principles of franchising around services that 2009, in the first compendium on clinical social may require different approaches to measure, franchising (available at sf4health.org). Since monitor, and assure service quality. the release of that report, the publication has evolved into a vehicle for displaying data on Metrics, therefore, are a critical theme within this program performance, in addition to data on report, and will be addressed within a “call to each program’s size, services, geographic range, action” to all social franchise programs to adopt financing, and the composition of its network. robust and consistent metrics to measure perfor- mance not only around quality, but also equity, Tracking of the data over five years reveals a health impact, cost, and expansion of the health remarkable growth in the sheer number and size market to new users. Where available, data on of programs. Beyond growth in numbers, how- each of these areas is presented for each program. ever, it also reveals a changing landscape—one in which maternal, newborn, and child health This report can be a valuable reference for services and the management of sexually trans- social investors, public health officials, donors, mitted infections are taking a more prominent population health programs with an interest in role alongside the provision of family planning private health sector engagement, and clinical services. These health services are being brought social franchise programs. on as a means to respond to population health

Introduction | 1 METHODS

This report attempts to be a comprehensive survey of all Note: All data is self-reported, and reporting and calcula- clinical social franchise programs that operate in low- and tion methods may vary across programs. While the authors middle-income countries. In addition to reaching out to have made every attempt to ensure consistency, plausibility, programs that are already known to the Social Franchising and completeness of data, data could not be verified for for Health (SF4Health) community (including academics, accuracy. donors, and experts in the field), the authors scanned the : Data from the 2013 and 2014 editions are not directly Center for Health Market Innovations website (healthmarke- Note comparable. Lessons learned from the 2013 survey process tinnovations.org) for newer programs; broadcasted a call for franchise programs in public health newsletters and blogs; were applied, and survey questions, terminology, and the and inquired among social franchise programs to learn data quality-check process were altered to ensure data about offshoots. To the best of the authors’ knowledge, quality was improved. there are currently upward of 90 programs, nearly two dozen For further information, or to report additional programs, of which have launched very recently or are in the process of please contact [email protected]. launching. Those programs have little to no data to report for this current edition. Additionally, some programs were non-responsive. This report includes data from 58 programs that were fully operational in 2013. It is important to note that survey data was not gathered from any of the five SF4Health is the social franchising community of social franchise programs that are affiliated with the DKT practice. We are a global group of program International, nor from nine of 11 programs affiliated with managers, advisers, donors, researchers, the International Planned Parenthood Federation. academics, and policymakers with a common interest in developing, improving, and advancing private health sector engagement through the Chart 1. Respondent characteristics social franchising model. For more information, Number of Name of the parent international agency that is visit sf4health.org. The secretariat for SF4Health programs affiliated with the program that responded is the Private Sector Health Initiative, an arm of that the University of California, San Francisco’s Global responded Health Group. SF4Health receives funding from the Center for Health Market Innovations and the 1 FHI 360 Rockefeller Foundation. 1 Futures Group

1 HealthStore Foundation

2 International Planned Parenthood Federation

18 Marie Stopes International

25 Population Services International

2 Other

8 No affiliated parent international agency

Methods | 2 ACRONYMS

ANC antenatal care ARI acute respiratory infection CHW community health worker CYP couple year of protection DALY disability-adjusted life year DOTS directly observed treatment, short-course FoQus Framework for Qualitative Research in FP family planning GHG Global Health Group HAART highly active antiretroviral therapy IMCI integrated management of childhood illnesses IPC interpersonal communication/interpersonal communicator IUD intrauterine device LLIN long-lasting insecticide-treated net MBBS Medicinal Baccalaureus, Baccalaureus Chirurgiae (Bachelor of Medicine, Bachelor of Surgery) MNCH maternal, newborn, and child health MoU memorandum of understanding MoH Ministry of Health MTP medical termination of pregnancy NCD noncommunicable disease OB/GYN Obstetrician/Gynecologist OSHF Oil Search Health Foundation PAC post-abortion care PMTCT prevention of mother-to-child transmission (of HIV) PNC post-natal care PSHi Private Sector Healthcare Initiative QA quality assurance RH reproductive health SF4Health Social Franchising for Health SRH sexual and reproductive health TB UCSF University of California, San Francisco VCT voluntary counseling and testing (for HIV) STI sexually transmitted infection

Acronyms | 3 GLOBAL OVERVIEW AND DATA HIGHLIGHTS

Scale and geographic reach of programs

Chart 2. Density of programs, by country, 2013 N=83*

1 program

2 programs

3 programs

4 programs

5 programs

6 programs

7 programs

*This includes programs that did not respond to the survey. Two programs are spread across two countries and are therefore counted twice. In addition, Merrygold Health Network Program data is aggregated for the reporting in the Global Overview and Data Highlights chapter. However, as there are variations in how its programs are implemented in Uttar Pradesh and Rajasthan, each state is presented in a separate profile in the Profiles chapter.

Global Overview and Data Highlights | 4 Chart 3. Regional distribution of all clinical social Chart 5. Number of franchised outlets, by type and franchise programs launched 2013 or earlier region, 2013 N=83* N=58*

2 12,000 15

Asia Pacific 10,260 28 East and Southern Africa Latin America 10,000 Middle East 15 South Asia Southeast Asia West and Central Africa 8,000 9 13 1

*This includes programs that did not respond to the survey. 6,000

Chart 4. Numbers of franchisees, by profession and 4,000 3,692 region, 2013 3,337 N=58

60,000 1,878 2,000 55,815 1,649

50,000 13 97 0 Asia East/ Latin Middle South South- West/ Pacific Southern America East Asia east Central Africa Asia Africa 40,000 Pharmacies or drug or chemical shops Health kiosks Stand-alone laboratories 30,000 Facilities operated by traditional healers 26,341 Clinics, maternity homes, or birthing homes

*This does not include distribution points for branded 20,000 commodities or referral centers, which are an integral part of many franchise networks.

10,000 6,944

3,481 2,219 25 200 0 Asia East/ Latin Middle South South- West/ Pacific Southern America East Asia east Central Africa Asia Africa

Traditional healers Informal providers or lay people Community health workers Counselors or social workers Diagnostics professionals, including lab technicians Pharmacy, chemical or drug shop owners Nurses, midwives, health officers, or clinic or medical assistant Doctors

Global Overview and Data Highlights | 5 Chart 6. Rural versus urban distribution of franchised outlets, 2013* N=58 Rural Urban

Bangladesh BlueStar Network

Republique du Bénin Protection de la Famile (ProFam) 201

Burundi, Uganda LifeNet International 81 9

Cambodia Sun Quality Health (SQH) 190 60

† Cameroon ProFam 29% 71%

Dem. Rep, of the Congo Réseau Confiance 123

Dominican Republic RedSegura 5

El Salvador Red Segura

Ethiopia BlueStar Healthcare Network 59 527

Ghana BlueStar Healthcare Network 128 176

Guatemala Red Segura 356

Haiti Pils Kontwôl 5

India Merrygold Health Network

India Plan.it Healthcare Network 58 114

India Sky 100% †

India Ujjwal Network 152 79

India Women’s Health Program 1,139

Kenya AMUA

Kenya CFW Clinics 59 7

Kenya Huduma Poa Health Network 47 27

Kenya Tunza Family Health Network 36 48

Lao PDR Sun Quality Health (SQH) 80

Madagascar BlueStar and CSB Star 85 56

Madagascar Top Réseau 38 235

Malawi BlueStar Healthcare Network

Malawi Tunza Family Health Network 14 14

Mali BlueStar

Mali ProFam 71

Myanmar The Sun Quality Health Network 63 1,516

Nepal OK 182 46

Nepal Sangini Networks

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Global Overview and Data Highlights | 6 Nicaragua Red Segura 134

Nigeria BlueStar Healthcare Network

Nigeria Healthy Family Network (HFN) 607

Pakistan Integration with Private Practitioners

Pakistan Sabz Sitara Network 2,832 4,822

Pakistan Suraj 326

Papua New Guinea Marasin Stoa Kipas (Medicine Store Keepers – MSK) 13

Peru RedPlan Salud 145 1,175

Philippines BlueStar Pilipinas 160 107

Philippines Well Family Midwife Clinic 85

Senegal BlueStar 24

Sierra Leone BlueStar Healthcare Network 4 27

Somaliland BulshoKaab Pharmacy Network 5 161

South Africa General Practitioner Referral Programme 10% 90% †

Tanzania Familia 81 189

† Togo POMEFA 100%

Uganda BlueStar Healthcare Network - Uganda 320 80

Uganda ProFam 116 65

Uganda, Kenya Living Goods 544 363

Vietnam BlueStar Vietnam 586 195

Vietnam Good Health, Great Life

Vietnam Mat Troi Be Tho 48 102

Vietnam Tinh Chi Em 161 40

Yemen Rayaheen 95 2

Zambia BueStar Healthcare Network 21

† Zambia New Start 100%

Zimbabwe BlueStar Healthcare Network 8 32

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*Numbers may not exactly add up to total numbers of outlets due to rounding error. †Program reported rural vs. urban percentage distribution, but not total franchise outlet numbers. 020406080100

Global Overview and Data Highlights | 7 Chart 7. Year of program launch, 2013 Health services N=58

60 Chart 8. Health services offered by programs, 2013* N=58

50 FP 54 2011–13

STIs 20 40

HIV/AIDS 19

30 PAC 19 2006–10

Safe motherhood 19 20 Number of programs launched Number of programs

Other 19

10 2000–05 Newborn or pediatric care 14

1996-00 1991-95 Safe abortion 13 0 Year launched 10

NCDs 9

The 58 programs that responded to the survey TB 8 report a total of 19,161,260 client visits for franchised services in 2013. Vision or dental care 2

0102030405060

*Of the 58 programs that responded, many reported offering multiple health services.

Chart 9. A snapshot of service integration, 2013

STIs 20 10 programs offer both services HIV/AIDS 19 ]

PAC 19 9 programs offer both services Safe motherhood 19 ]

Global Overview and Data Highlights | 8

0102030405060 0102030405060 Public sector linkages, technology, and financing

How are programs using technology?

As a performance incentive Thirty-seven of 58 programs report having formal A program operating in both Uganda and Burundi linkages with the public health sector. This does is financing medical equipment for high performing not include the three programs that report that franchisees. their networks include only public sector clinics. To transfer cash payments A program in Kenya is using mobile money transfer technology to channel payments from franchisees to Chart 10. Types of formal linkages (through a written or the franchisor; one in Madagascar is using the same verbal contract or MoU) with the public health sector, technology to transfer voucher payments. 2013* N=58 To store and transfer survey data from the field QR codes are being tested for use in a population- based survey in Kenya. 40

36 To bring the lab to the client Point of care CD4 testing is speeding up the 35 provision of test results in Zambia.

30 To bring sophisticated medical care to rural clients Web-based telemedicine technology is enabling lay providers to take client diagnostics, transmit that 25 information to skilled healthcare workers, and 22 facilitate remote consultations in India. 20

15

Number of linkages 15 12 Chart 11. Primary source of financing, 2013 N=58

10 3

5 5 4 Donor Revenue from sales/services

0 None Linked Referral Other Franchisees Common patient links receive accredita- data between social tion and manage- franchisees health quality ment and local insurance oversight system public financing system health for the 55 facilities provision of health services

*This does not include data from the three programs that report that their networks include only public sector clinics. Of the 58 programs that responded, many reported having multiple types of linkages.

Global Overview and Data Highlights | 9 Chart 12. Top five most commonly reported donors, Chart 14. Types of demand-side financing mechanisms 2013* used, 2013 N=58 N=58*

10 15 14 21 USAID Anonymous Donor 11 UK Aid 12 Bill & Melinda Gates Foundation Norwegian Agency for Development Corporation

9 14 20 7

6 *Most programs with an affiliation to an international parent agency 5 Number of programs report that this agency plays a donor role. This chart does not 4 include these parent agencies.

In addition to donating funds directly, some donors have also 3 channeled funds to programs through pooled donor contribution mechanisms.

0 Vouchers Social health Government Other insurance reimbursement Chart 13. Programs that report using demand-side financing mechanisms, 2013 N=58 *Of the 58 programs that responded, many reported the use of multiple demand-side financing mechanisms.

Yes 22 No

36

Global Overview and Data Highlights | 10 A CALL TO SOCIAL FRANCHISE PROGRAMS TO USE STANDARDIZED AND CONSISTENT METRICS

Since 2009, a group of technical and operational experts in social franchising has been building consensus toward the HEALTH IMPACT standardization and simplification of metrics for assessing the performance of social franchise programs. This group Metric is known as the Social Franchising Metrics Working Group Disability-Adjusted Life Years (DALYs) averted (SFMWG). Learn more about this group at sf4health.org/ measuring-performance/metrics-working-group. Methodology Estimates of morbidity and mortality averted per program SFMWG members represent organizations that support are generated by running service statistics through a model and run social franchise programs, donor agencies, and that attaches a specific health impact value to each service academic and research institutions. The SFMWG develops that was provided in a given year. This model makes differ- metrics to evaluate the progress of programs toward the ent assumptions about the health impact value of services five goals of social franchising: equity, health impact, quality, offered in different countries. cost-effectiveness, and health market expansion. Limitations Each of the five SFMWG metrics is in a different stage DALYs averted, though gaining in acceptance, can be diffi- of development. What follows is a brief introduction to cult to understand, and the use of DALYs to measure health each metric, its implementation methodology, limitations, impact is contentious. In the absence of a preprogrammed and updates regarding the availability of tools for calculator, the modeling required to calculate DALYs avert- implementation. ed is time consuming, and at the time of writing, models do not exist to estimate the health impact of every health service, nor do models exist for every country.

EQUITY Tool update Population Services International has developed an online Metric Impact Calculator to estimate the potential impact of health The proportion of clients receiving franchised services who interventions. The calculator can be found at are within the lowest two national wealth quintiles impactcalculator.psi.org.

Methodology National surveys (like the Demographic and Health Surveys) yield insights into the distribution of a population across five wealth quintiles. Exit surveys that are administered to a rep- QUALITY resentative sample of clients can provide findings that can be compared to the national wealth distribution, thereby Metric allowing a program to understand the wealth status of its The percentage of franchise providers complying with clientele in relation to the national wealth distribution. infection prevention protocols, adequately supplied with key commodities, able to treat or refer complications, and Limitations adhering to franchise program protocols Asset ownership and household characteristics, both prox- ies of client wealth, may not entirely reflect the wealth status Methodology of clients. Additionally, some of the survey questions are Each dimension of quality will be assessed using a check- difficult for surveyors to ask and for participants to answer. list-based tool that can be routinely administered by trained Future iterations of the tool will require adjustment. surveyors. Scores from each checklist will be weighted and used to generate an overall score, which can be used to set Tool update standards and track performance. The SFMWG, with funding from the International Finance Corporation, has developed a toolkit that includes all the Limitations information, surveys, and tools (including a kit to train data In order to create a tool that is cost-effective to adminis- collectors, a sample size calculator, and a preprogrammed ter, yields data that is comparable across programs, and is data analysis tool) that programs need to calculate client applicable across programs that deliver different types of wealth distribution. The toolkit is available at health services, the SFMWG approach primarily focuses on presentationofdata.com.

A Call to Social Franchise Programs to Use Standardized and Consistent Metrics | 11 the availability of structures and skills that are essential for the provision of high-quality health services. In contrast, HEALTH MARKET EXPANSION assessments that focus on the processes or outcomes of care (for instance, mystery client or household surveys) are Currently no metrics, methods, or tools exist for the valuable and may deliver more rigorous assessments of measurement of Health Market Expansion. Please check quality, but they are often more expensive and require high for updates in the later portion of 2014 as the SFMWG levels of staff training. continues to tackle the challenges related to measuring the added value of expanding service provision to new clientele Tool update At the time of release of this report, three of four check- and of bringing better health services to existing clientele. list-based tools are being piloted, and will be available for use in the third quarter of 2014. A fourth tool to assess competence in clinical service provision is under develop- ment. The combined tool will be made available through Updates on metrics sf4health.org. For updates on all metrics and to participate in discussions around performance measurement and social franchising, please join our Community of Practice’s online discussion forum at: knowledge-gateway.org/sf4health. COST

Metric Cost (to the franchisor) per Disability Adjusted Life Years We believe that it is important for programs to (DALYs) averted establish a baseline and demonstrate their commitment to transparency through measurement,

Methodology and we applaud the efforts of every program that Under this approach, costs in the three following areas are was able to measure and report on equity. taken into account: (1) direct costs of administering and op- erating a social franchise program; (2) the costs to provide technical assistance to the social franchise program (this form of technical assistance is typically offered by parent agencies that are responsible for supporting a portfolio of health-related programs); and (3) the costs of subsidizing commodities that are in turn given to franchisees or sold at reduced rates. These aggregate costs can be divided by the health impact value (expressed in DALYs averted) to generate an estimation of cost-effectiveness. The methods to gather and analyze these data are under development.

Limitations Costs are by and large estimated by using inputs from inter- nal accounting systems, which can be highly variable from program to program. However, lessons from pilot testing of costing instruments are leading to valuable insights that are shaping the methodology, which is still being refined.

Note: Although the SFMWG continues to improve methods for capturing comprehensive cost data, for many programs in the 2014 Compendium, the reported cost data are not comprehensive. The reported information may not include costs for donated or subsidized commodities when those costs are associated with in-country support for franchises that are a part of larger country programs.

Tool update A tool is under development.

A Call to Social Franchise Programs to Use Standardized and Consistent Metrics | 12 PILOT DATA: HEALTH IMPACT

In this report, we are pleased to present pilot data from Chart 16. DALYs averted attributed to long-acting several franchise programs on health impact, equity, and family planning (FP) methods versus short-acting FP cost. Summary data on health impact is presented in this methods, 2013 section. Equity and cost data are presented in the individual N=50 program profiles.

Equity data can inform readers regarding the extent to which social franchise programs are reaching the poor. When interpreting these data, programs cannot be Percent assessed on the basis of performance in this area alone. 81.7% 18.3% Programs that are most capable of reaching the poor may of FP be more likely to operate in rural areas, likely raising pro- DALYs gram costs. Similarly, programs operating in urban centers with different, but no less important, public health challenges may show better results in terms of health impact, yet may suffer by comparison in their ability to reach the poor.

020406080100

Chart 15. Trend in CYPs, 2011–2013 Long acting FP methods N=29* Short acting FP methods

9,969,689 10,000,000

8,253,271 8,000,000 7,689,443 7,598,172 Chart 17. DALYs averted by service areas, 2013 N=50 6,000,000 6,348,625 3.0% 1.5% 0.1% 1.0% FP 4,953,578 2.1% 1.0% MNCH 4,000,000 0.4% STIs HIV/AIDS Diarrhea/clean water 2,000,000 ARI TB Malaria 0 2011 CYPs 2012 CYPs 2013 CYPs 91% includes BlueStar Madagascar data excludes BlueStar Madagascar data Total DALYs averted: 7,299,618

*BlueStar Madagascar’s contribution to impact reporting from 2011 to 2013 was both significant and highly variable, thus we are also showing the trend when BlueStar Madagascar’s data is excluded.

Pilot Data: Health Impact | 13 Chart 18. DALYs averted by all services except FP, 2013 N=50

4.0% 11% 1.0% MNCH 23% STIs HIV/AIDS Diarrhea/clean water ARI TB 33% Malaria 11%

17%

Total DALYs averted: 661,072

Pilot Data: Health Impact | 14 PROFILES

Anatomy of a profile

Country Services offered by program Service abbreviations used in profile

FP Family planning BANGLADESH Safe motherhood STIs Sexually tranmitted diseases BlueStar Network TB Tuberculosis Social Marketing Company (SMC) SMC

Name of the Program at a glance Metrics data as social franchise COST it relates to the 1998 program Launch year Cost to operate the franchise program in services offered 2013 (in USD): - Franchisee 7 divisions and 64 districts by the program Name of distribution organization Geographic spread - that manages EQUITY - the program Franchised outlets* % of clients in each wealth quintile Franchisees* 114 doctors 1 (lowest) - 2 (second lowest) - Affiated Health service areas FP, safe motherhood, STIs, and TB international 3 (middle) - Primary source of Donor 4 (second highest) - agency program financing acronym 5 (highest) - Total # of visits -

Total # of 345,786 individual clients HEALTH IMPACT served DALYs averted: 10,048 CYPs: 345,000 Total # of 23 full-time staff % contribution to overall health impact (DALYs averted) Total # of - 3.17% community FP outreach workers MNCH The MNCH 45.17% Diarrhea/clean water 50.77% category covers Source of payments 100% out-of-pocket TB for health services the following 0.88% service areas: *This program also includes 4,600 pharmacies or drug shops that serve as product distribution outlets. newborn and pediatric care, QUALITY post abortion care, Program description Dimension assessed Times/year safe abortion, safe BlueStar reports the following implementing partners: - Client experience - motherhood and Missing Facility 2 cervical cancer care The program is organized in the following way: - information Competence of provider 1 from programs All referrals, both within and outside of the franchise Patient safety 2 is represented network, were tracked in the following ways: through Adherence to clinical protocol 2 with a dash referral slips retained by BlueStar providers, along with regular collection of referral data by the Program Officer for monthly reporting.

The program raised demand for health services by imple- menting the following strategies: billboards and posters, community outreach by paid employees, and gifts.

The network is linked to the public sector through the following mechanisms: through joint certification for conducting training to BlueStar providers as well as through joint monitoring visits.

In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees.

Email contact: [email protected] Profiles | 15 Website: smc-bd.org

Contact information

Profiles | 15 FP Family planning BANGLADESH Safe motherhood STIs Sexually tranmitted infections BlueStar Network TB Tuberculosis Social Marketing Company (SMC) SMC

Program at a glance COST Launch year 1998 Cost to operate the franchise program in 2013 (in USD): - Franchisee 7 divisions and 64 districts distribution - Geographic spread EQUITY Franchised outlets 4,600 pharmacies or drug shops % of clients in each wealth quintile

Franchisees* 114 doctors 1 (lowest) - 2 (second lowest) - Health service areas FP, safe motherhood, STIs, and TB 3 (middle) - Primary source of Donor 4 (second highest) - program financing 5 (highest) - Total # of visits -

Total # of 345,786 individual clients HEALTH IMPACT served DALYs averted: 10,048 CYPs CYPs: 345,000: 345,000 Total # of 23 full-time staff % contribution to overall health impact (DALYs averted) 3.17% 3.17%0.88% Total # of - FPFP ARI community MNCHMNCH TB outreach workers 45.17% Diarrhea/cleanSTIs water Malaria 50.77% TBHIV/AIDS Other Source of payments 100% out-of-pocket Clean water for health services D 50.77% 0.88% *This program also includes 4,600 non-graduate medical practitioners.

Program description QUALITY BlueStar reports the following implementing partners: - Dimension assessed Times/yearTimes/year Client experience - - The program is organized in the following way: - Facility 2 2 All referrals, both within and outside of the franchise Competence of provider 1 1 network, were tracked in the following ways: through Patient safety 2 2 referral slips retained by BlueStar providers, along with Adherence to clinical protocol 2 2 regular collection of referral data by the Program Officer for monthly reporting.

The program raised demand for health services by implementing the following strategies: billboards and posters, community outreach by paid employees, and gifts.

The network is linked to the public sector through the following mechanisms: joint certification for conducting training to BlueStar providers, as well as through joint monitoring visits.

In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees.

Email contact: [email protected] Profiles | 16 Website: smc-bd.org FP Family planning REPUBLIQUE DU BÉNIN HIV/AIDS PAC Post abortion care Protection de la Famille (ProFam) Safe motherhood Association Béninoise Pour le Marketing Social STIs Sexually transmitted infections PSI

Program at a glance COST Launch year 2004 Cost to operate the franchise program in 2013 2013(in USD) (in :USD) $242,462: - Franchisee 7 provinces distribution 100% urban Geographic spread EQUITY Franchised outlets* 195 clinics or maternity homes and 6 % of clients in each wealth quintile stand-alone laboratories 1 (lowest) - Franchisees 53 doctors; 42 nurses, midwives, or 2 (second lowest) - clinical assistants; 10 diagnostics 3 (middle) - professionals; and 60 community health 4 (second highest) - workers (CHWs) 4 (second highest) - 5 (highest) - Health service areas FP, HIV/AIDS, PAC, safe motherhood, and STIs

Primary source of Donor program financing HEALTH IMPACT DALYs averted: 10,048217,277 CYPs: 183,576345,000 Total # of visits 118,590 DALYs averted CYPs (DALYs averted) Total # of 79,762 % contribution to overall health impact 5.44%0.88% individual clients 3.17% FP served 19.61% MNCHFP ARI HIV/AIDSMNCH TB Total # of 5 2.3% Diarrhea/cleanSTIs waterMalaria full-time staff HIV/AIDS Other Clean water 115 72.64% Total # of D community 50.77% *This program also includes 4,600 pharmacies or drug shops that serve as productoutreach distribution workers outlets. Source of payments 100% out-of-pocket for health services QUALITY *This program also includes 180 pharmacies or drug shops that serve as Dimension assessed Times/year product distribution outlets. Client experience -1 Facility 20 Program description Competence of provider 12 ProFam reports the following implementing partners: - Patient safety 2 Adherence to clinical protocol 2 The program is organized in the following way: labs offer HIV serology, blood grouping, blood balance, urine analysis, and biochemical tests. Franchised clinics offer direct services to clients. 180 pharmacies serve as points of The network is linked to the public sector through the distribution for branded commodities. following mechanisms: a common accreditation and quality oversight system. All referrals, both within and outside of the franchise network, were tracked in the following ways: through In 2013, the program generated revenue through the paper documentation, telephone, and email. following strategies: the sale of commodities to franchisees and franchisor fees. The program raised demand for health services by implementing the following strategies: radio advertising, TV advertising, and billboards and posters.

Email contact: [email protected] Profiles | 17 Website: abms-bj.org FP Family planning BURUNDI/UGANDA HIV/AIDS Malaria Newborn or pediatric care LifeNet International NCDs Noncommunicable diseases Safe motherhood STIs Sexually transmitted infections TB Tuberculosis Vision or dental care

Program at a glance COST Launch year 2009 Cost to operate the franchise program in 2013 (in USD): $711,000 Franchisee - distribution 90% rural and 10% urban Geographic spread EQUITY Franchised outlets 45 hospitals, clinics, or maternity homes % of clients in each wealth quintile and 45 pharmacies or drug shops 1 (lowest) - Franchisees 37 doctors; 400 nurses, midwives, or 2 (second lowest) - clinical assistants; 45 pharmacists or drug 3 (middle) - vendors; and 45 diagnostics professionals 4 (second highest) - Health service areas FP, HIV/AIDS, malaria, newborn or 5 (highest) - pediatric care, NCDs, safe motherhood, STIs, TB, vision or dental care, and other services

Primary source of Donor HEALTH IMPACT program financing DALYs averted: - CYPs: - Total # of visits 822,008 % contribution to overall health impact (DALYs averted) - Total # of N/A individual clients served

Total # of 19 full-time staff QUALITY

Total # of - Dimension assessed Times/year community Client experience 2 outreach workers Facility 4 Source of payments - Competence of provider 4 for health services Patient safety 4 Adherence to clinical protocol 4 Program description LifeNet reports the following implementing partners: -

The program is organized in the following way: LifeNet The program raised demand for health services by partners/franchisees are faith-based nonprofit organizations implementing the following strategies: word-of-mouth that operate both in the private and public sectors. Because advertisement. of this hybrid status, they are able to purchase drugs from sources of their choosing; host publicly employed health The network is linked to the public sector through the practitioners as well as their own staff; and participate following mechanisms: referral links between franchisees in performance-based financing, the national insurance and local public health facilities, social health insurance program, and mandates such as free care for children <5 remuneration to franchisees, and a common accreditation and pregnant women. Most network clinics and hospitals and quality oversight system. operate an in-house pharmacy. All network partners/fran- In 2013, the program generated revenue through the chisees stock approved, essential medicines in addition to following strategies: the sale of commodities to franchisees, medicines supplied by provincially run vertical schemes. franchisor fees, and interest payments on loans to franchisees. All referrals, both within and outside of the franchise network, were tracked in the following ways: not tracked.

Email contact: [email protected] Profiles | 18 Website: lninternational.org FP Family planning CAMBODIA Safe abortion STIs Sexually tranmitted infections Sun Quality Health (SQH) Population Services Khmer (PSK) PSI

Program at a glance COST Launch year 2002 Cost to operate the franchise program in 2013 (in USD): - Franchisee 19 provinces distribution 76% rural and 24% urban Geographic spread EQUITY Franchised outlets 250 clinics or maternity homes 2,059 clients were surveyed in 2012.

Franchisees* 12 doctors and 241 nurses, midwives, or % of clients in each wealth quintile clinical assistants 1 (lowest) 30 Health service areas FP, safe abortion, STIs, and other 2 (second lowest) 0 services 3 (middle) 32

Primary source of Donor 4 (second highest) 0 program financing 5 (highest) 38

Total # of visits 42,678 - Total # of HEALTH IMPACT individual clients served DALYs averted: 37,553 CYPs: 83,458

Total # of 304* % contribution to overall health impact (DALYs averted) full-time staff 0.06% 0.13% FP Total # of - 0.64% 2.96% MNCH community HIV/AIDS outreach workers Diarrhea/clean water ARI Source of payments 100% out-of-pocket for health services 96.21% *This includes 266 full-time community mobilizers that are employees of the program. QUALITY Program description Dimension assessed Times/year SQH is run in partnership with eight local NGOs in three Client experience 0 provinces, under the umbrella of United Health Network Facility 5 (UHN). Competence of provider 5 Patient safety 5 The program is organized in the following way: - Adherence to clinical protocol 5 All referrals, both within and outside of the franchise network, were tracked in the following ways: CHWs sent monthly reports to the PSK office. As a way of verifying monthly reports, program staff collected referral slips at the The network is linked to the public sector through the SQH facilities and sent them to the main office on a monthly following mechanisms: through linked patient data basis. management systems. PSK also has a Memorandum of Un- derstanding with select public health facilities that serve as The program raised demand for health services by referral sites for complications/adverse event management. implementing the following strategies: radio advertising, TV advertising, billboards and posters, community outreach In 2013, the program generated revenue through the by paid employees, and community outreach by volunteers. following strategies: none.

Email contact: [email protected] Profiles | 19 Website: - FP Family planning CAMEROON PAC Post abortion care ProFam Association Camerounaise Pour le Marketing Social (ACMS) PSI

Program at a glance COST Launch year 2004 Cost to operate the franchise program in 2013 (in USD): - Franchisee 3 regions distribution 29% rural and 71% urban Geographic spread EQUITY Franchised outlets - % of clients in each wealth quintile

Franchisees 10 doctors and 96 nurses, midwives, or 1 (lowest) - clinical assistants 2 (second lowest) - 3 (middle) - Health service areas FP and PAC 4 (second highest) - Donor Primary source of 5 (highest) - program financing

Total # of visits -

Total # of 12,508 HEALTH IMPACT individual clients : 65,665 : 56,380 served DALYs averted CYPs

Total # of 106 % contribution to overall health impact (DALYs averted) full-time staff 0.08% FP Total # of 50 MNCH community outreach workers

Source of payments 100% out-of-pocket for health services 99.92%

Program description QUALITY ProFam reports the following implementing partners: - Dimension assessed Times/year Client experience 0 The program is organized in the following way: - Facility 12 All referrals, both within and outside of the franchise net- Competence of provider - work, were tracked in the following ways: through use of a Patient safety 12 referral reporting form. Adherence to clinical protocol 12

The program raised demand for health services by imple- menting the following strategies: radio advertising and community outreach by paid employees.

The network is linked to the public sector through the following mechanisms: referral links between franchisees and local public health facilities.

In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees and franchisor fees.

Email contact: [email protected] Profiles | 20 Website: - Family planning FP Family planning Post abortion care DEMOCRATIC REPUBLIC OF THE CONGO Réseau Confiance Association de Santé Familiale PSI

Program at a glance COST Launch year 2003 Cost to operate the franchise program in 2013 (in USD): 2,000,000 Franchisee 9 provinces distribution 100% urban Geographic spread EQUITY Franchised outlets 123 clinics or maternity homes % of clients in each wealth quintile

Franchisees 68 doctors and 208 nurses, midwives, or 1 (lowest) - clinical assistants 2 (second lowest) - 3 (middle) - Health service areas FP 4 (second highest) - Donor Primary source of 5 (highest) - program financing

Total # of visits 491,250

Total # of 143,740 HEALTH IMPACT individual clients : 190,827 : 166.103 served DALYs averted CYPs

Total # of 16 % contribution to overall health impact (DALYs averted) full-time staff FP Total # of 154 community 100% outreach workers

Source of payments - for health services

Program description QUALITY* Réseau Confiance reports the following implementing Dimension assessed Times/year partners: - Client experience 0 Facility 0 The program is organized in the following way: - Competence of provider 0 All referrals, both within and outside of the franchise Patient safety 0 network, were tracked in the following ways: healthcare Adherence to clinical protocol 0 providers recorded referral data in client files. On a monthly basis and during supervisory visits, these providers reported *This program reports that it collaborates with the national program for health for adherence to quality standards and referral data to program staff. protocols.

The program raised demand for health services by implementing the following strategies: radio advertising, TV advertising, billboards and posters, community outreach by volunteers, and an FP hotline.

The network is linked to the public sector through the following mechanisms: linked patient data management systems.

In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees.

Email contact: [email protected] Profiles | 21 Website: - FP Family planning DOMINICAN REPUBLIC STIs Sexually transmitted infections RedSegura Population Services International DR PSI

Program at a glance COST Launch year 2013* Cost to operate the franchise program in 2013 (in USD): $622,045 Franchisee 4 provinces distribution 100% urban Geographic spread EQUITY Franchised outlets 4 clinics or maternity homes and 1 health % of clients in each wealth quintile kiosk 1 (lowest) - Franchisees 15 doctors and 1 nurse, midwife, or 2 (second lowest) - clinical assistant 3 (middle) - Health service areas FP, STIs, and other services 4 (second highest) - 5 (highest) - Primary source of Donor program financing

Total # of visits - HEALTH IMPACT Total # of 237 individual clients DALYs averted: - CYPs: - served % contribution to overall health impact (DALYs averted) Total # of 4 N/A full-time staff

Total # of 7 community outreach workers QUALITY

Source of payments 25% out-of-pocket and 75% through Dimension assessed Times/year for health services vouchers or subsidies Client experience 0 *This program was launched in October 2013. Facility - Competence of provider - Program description Patient safety - Adherence to clinical protocol 0 RedSegura reports the following implementing partners: -

The program is organized in the following way: -

All referrals, both within and outside of the franchise network, were tracked in the following ways: not tracked.

The program raised demand for health services by implementing the following strategies: the distribution of referral slips and use of IPCs to raise awareness in the community.

The network is linked to the public sector through the following mechanisms: referral links between franchises and local public health facilities.

In 2013, the program generated revenue through the following strategies: none.

Email contact: [email protected] Profiles | 22 Website: - FP Family planning EL SALVADOR HIV/AIDS Red Segura Asociación Panamericana de Mercadeo Social (PASMO) PSI

Program at a glance COST Launch year 2011 Cost to operate the franchise program in 2013 (in USD): $571,000 Franchisee 13 departments distribution - Geographic spread EQUITY Franchised outlets 58 clinics or maternity homes % of clients in each wealth quintile

Franchisees 58 doctors and 6 nurses, midwives, or 1 (lowest) - clinical assistants 2 (second lowest) - 3 (middle) - Health service areas FP and HIV/AIDS 4 (second highest) - Donor Primary source of 5 (highest) - program financing

Total # of visits -

Total # of 5,000 HEALTH IMPACT individual clients : 2,889 : 23,299 served DALYs averted CYPs

Total # of 17 % contribution to overall health impact (DALYs averted) full-time staff 2.73% FP Total # of 12 HIV/AIDS community outreach workers

Source of payments 100% out-of-pocket for health services 97.27%

Program description QUALITY : - Red Segura reports the following implementing partners Dimension assessed Times/year The program is organized in the following way: - Client experience 0 Facility - All referrals, both within and outside of the franchise Competence of provider - network, were tracked in the following ways: CHWs Patient safety - distributed referral coupons to clients. Program staff tracked Adherence to clinical protocol - referrals by comparing provider reports to referral coupon numbers.

The program raised demand for health services by implementing the following strategies: radio advertising, billboards and posters, community outreach by paid employees, and clinic-based outreach.

The network is linked to the public sector through the following mechanisms: none

In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees.

Email contact: [email protected] Profiles | 23 Website: redseguraclinicas.com FP Family planning ETHIOPIA HIV/AIDS PAC Post abortion care BlueStar Healthcare Network Safe abortion Marie Stopes International Ethiopia MSI

Program at a glance COST Launch year 2008 Cost to operate the franchise program in 2013 (in USD): $1,222,230 Franchisee 6 regional states and 2 administrative distribution towns 10% rural and 90% urban Geographic spread EQUITY* Franchised outlets 585 clinics or maternity homes % of clients in each wealth quintile

Franchisees 91 doctors; 490 nurses, midwives, or 1 (lowest) - clinical assistants; and 659 counselors or 2 (second lowest) - social workers 3 (middle) - Health service areas FP, HIV/AIDS, PAC, safe abortion, and 4 (second highest) - other services 5 (highest) -

Primary source of Donor *This program measured client wealth status through the use of the program financing Progress Out of Poverty Index, which measures the percentage of clientele that earn less than $1.25/day, a value used to gauge poverty. A 1,022,890 study conducted in October 2012 suggests that 15.7% of clients at that Total # of visits time were poor. Total # of - individual clients served HEALTH IMPACT Total # of 21 : 245,917 : 240,102 full-time staff DALYs averted CYPs (DALYs averted) Total # of 25 % contribution to overall health impact community 6.49% 0.15% outreach workers FP MNCH Source of payments 100% out-of-pocket HIV/AIDS for health services

93.36% Program description BlueStar reports the following implementing partners: - QUALITY The program is organized in the following way: all network Dimension assessed Times/year clinics offer FP methods. Safe abortion services are offered Client experience 1 by clinics that are categorized as medium and above (categories are determined by the number and qualifications Facility 4 of staff). Competence of provider 2 Patient safety 2 All referrals, both within and outside of the franchise Adherence to clinical protocol 2 network, were tracked in the following ways: not tracked.

The program raised demand for health services by implementing the following strategies: billboards and posters, community outreach by paid employees, and road In 2013, the program generated revenue through the shows. following strategies: the sale of commodities to franchisees and franchisor fees. The network is linked to the public sector through the following mechanisms: none.

Email contact: [email protected] Profiles | 24 Website: mariestopes.org.et Family planning FP Family planning HIV/AIDS GHANA Malaria Post abortion care PAC Post abortion care Safe abortion BlueStar Healthcare Network Safe abortion Safe motherhood, Marie Stopes International Ghana STIs Sexually transmitted infections MSI

Program at a glance COST Launch year 2008 Cost to operate the franchise program in 2013 (in USD): $353,423 Franchisee 3 regions distribution 42% rural and 58% urban Geographic spread EQUITY Franchised outlets* 304 clinics or maternity homes % of clients in each wealth quintile

Franchisees 74 doctors; 78 nurses, midwives, or clin- 1 (lowest) - ical assistants; 70 diagnostic profession- 2 (second lowest) - als; and 125 counselors or social workers 3 (middle) - Health service areas FP, malaria, PAC, safe abortion, safe 4 (second highest) - motherhood, STIs, and other services 5 (highest) -

Primary source of Donor program financing

Total # of visits 208,404 HEALTH IMPACT : 47,050 : 53,906 Total # of 194,102 DALYs averted CYPs individual clients % contribution to overall health impact (DALYs averted) served 1.86% 12 0.25% FP Total # of 14.0% 1.63% full-time staff MNCH HIV/AIDS Total # of 125 Diarrhea/clean water community Malaria outreach workers 81.77% *ThisSource program of payments also includes 4,60065% pharmaciesout-of-pocket or drug and shops 35% that through serve as product distribution outlets. for health services vouchers or subsidies

*This program also includes 16 pharmacies or drug shops that serve as QUALITY product distribution outlets. Dimension assessed Times/year Program description Client experience 1 Facility 2 BlueStar Healthcare Network is run in partnership with the Competence of provider 4 International Finance Corporation. Patient safety 2 The program is organized in the following way: network Adherence to clinical protocol 2 hospitals, clinics, and maternity homes provide primary care services to clients, including those for FP/SRH, IMCI, ANC, and others. Network pharmacies and chemical shops sell short-term FP methods and STI drugs to clients. The and the distribution of vouchers or subsidies for health network also uses pharmacies and chemical shops as services. referral points. The network is linked to the public sector through the All referrals, both within and outside of the franchise following mechanisms: referral links between franchisees network, were tracked in the following ways: through refer- and local public health facilities, social health insurance ral coupons that were distributed by CHWs and tracked by remuneration for health services, and through a common franchisees. accreditation and quality oversight system.

The program raised demand for health services by In 2013, the program generated revenue through the implementing the following strategies: radio advertising, following strategies: the sale of commodities to franchisees billboards and posters, community outreach by volunteers, and franchisor fees.

Email contact: [email protected] Profiles | 25 Website: mariestopes.org/where-in-the-world#ghana GUATEMALA FP Family planning Red Segura Asociación Panamericana de Mercadeo Social (PASMO) PSI

Program at a glance COST Launch year 2010 Cost to operate the franchise program in 2013 (in USD): $1,099,022 Franchisee 19 departments distribution 100% urban Geographic spread EQUITY Franchised outlets 356 clinics or maternity homes % of clients in each wealth quintile

Franchisees* 323 doctors and 11 nurses, midwives, or 1 (lowest) - clinical assistants 2 (second lowest) - 3 (middle) - Health service areas FP 4 (second highest) - Donor Primary source of 5 (highest) - program financing

Total # of visits -

Total # of - HEALTH IMPACT individual clients : 17,158 : 66,526 served DALYs averted CYPs

Total # of 73* % contribution to overall health impact (DALYs averted) full-time staff 0.74% FP Total # of 0 HIV/AIDS community outreach workers

Source of payments 100% out-of-pocket for health services 99.26% *This includes IPCs.

Program description QUALITY Dimension assessed Times/year Red Segura reports the following implementing partners: - Client experience 2 The program is organized in the following way: - Facility 2 Competence of provider 2 All referrals, both within and outside of the franchise Patient safety 2 network, were tracked in the following ways: CHWs Adherence to clinical protocol 2 distributed referral coupons to clients. Program staff tracked referrals by comparing provider reports to referral coupon numbers.

The program raised demand for health services by implementing the following strategies: radio advertising, billboards and posters, community outreach by paid employees, and clinic-based outreach.

The network is linked to the public sector through the following mechanisms: none

In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees.

Email contact: [email protected] Profiles | 26 Website: redseguraclinicas.com Family planning HAITI FP Family planning Plis Kontwòl Population Services International Haiti PSI

Program at a glance COST Launch year 2013 Cost to operate the franchise program in 2013 (in USD): $288,034 Franchisee 3 departments distribution 100% urban Geographic spread EQUITY Franchised outlets 3 clinics or maternity homes and 2 health % of clients in each wealth quintile kiosks 1 (lowest) - Franchisees* 8 doctors and 15 informal providers 2 (second lowest) - 3 (middle) - Health service areas FP 4 (second highest) - Donor Primary source of 5 (highest) - program financing

Total # of visits -

Total # of 109 HEALTH IMPACT individual clients served DALYs averted: 1,398 CYPs: 1,991

Total # of 0* % contribution to overall health impact (DALYs averted) full-time staff FP Total # of 15 community 100% outreach workers

Source of payments 100% out-of-pocket for health services

*All employees (IPCs) are part-time. QUALITY Program description Dimension assessed Times/year Plis Kontwòl reports the following implementing partners: - Client experience 0 Facility 3 The program is organized in the following way: - Competence of provider 3 Patient safety 3 All referrals, both within and outside of the franchise network, were tracked in the following ways: IPC agents Adherence to clinical protocol 3 provided referral vouchers to clients that were subsequently handed to providers and collected by program staff.

The program raised demand for health services by implementing the following strategies: providing incentives to create support groups, conducting outreach activities, and generating referrals.

The network is linked to the public sector through the following mechanisms: none.

In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees.

Email contact: [email protected] Profiles | 27 Website: - FP Family planning INDIA Newborn or pediatric care Safe motherhood Merrygold Health Network (Rajasthan) Hindustan Latex Family Planning Promotion Trust (HLFPPT)

Program at a glance COST Launch year 2013 Cost to operate the franchise program in 2013 (in USD): $693,440* Franchisee Rajasthan distribution *Conversion based on rate from www.XE.com, March 23, 2014.

Geographic spread -

Franchised outlets 26 clinics or maternity homes and 12 pharmacies or drug shops EQUITY % of clients in each wealth quintile Franchisees 19 doctors; 65 nurses, midwives, or clinical assistants; 12 pharmacists or drug 1 (lowest) - vendors; 14 diagnostic professionals; 13 2 (second lowest) - counselors or social workers; and 352 CHWs 3 (middle) - 4 (second highest) - FP, newborn or pediatric care, safe Health service areas 5 (highest) - motherhood, and other services

Primary source of Donor program financing HEALTH IMPACT Total # of visits 12,119 DALYs averted: 28,205* CYPs: 36,347 Total # of 7,962 individual clients % contribution to overall health impact (DALYs averted) served FP Total # of 16 full-time staff 100% *Does not include estimates for antenatal care, breast- Total # of 0 feeding promotion, and safe community delivery services outreach workers

Source of payments 40% out-of-pocket, 10% through social health insurance, 30% through vouchers for health services QUALITY or subsidies, and 20% unreported Dimension assessed Times/year Client experience 4 Program description Facility 4 Merrygold Health Network reports the following Competence of provider 2 implementing partners: - Patient safety 1 Adherence to clinical protocol 5 The program is organized in the following way: Merrygold Hospital (urban) provides services that include hysterecto- mies, sterilizations, pediatric care, infertility treatment, and cancer surveillance. Merrygold Hospital (rural) provides services including safe deliveries, ANC, PNC, IUDs, and The network is linked to the public sector through the referrals to the urban facilities. following mechanisms: a common accreditation and quality oversight system. All referrals, both within and outside of the franchise network, were tracked in the following ways: through use In 2013, the program generated revenue through the of referral slips. following strategies: franchisor fees. The program raised demand for health services by implementing the following strategies: conducting health outreach camps and baby showers for expecting mothers.

Email contact: [email protected] Profiles | 28 Website: hlfppt.org FP Family planning INDIA HIV/AIDS Newborn or pediatric care Merrygold Health Network (Uttar Pradesh) Safe motherhood Hindustan Latex Family Planning Promotion Trust (HLFPPT) STIs Sexually transmitted infections

Program at a glance COST Launch year 2007 Cost to operate the franchise program in 2013 (in USD): $253,781 Franchisee Uttar Pradesh distribution - Geographic spread EQUITY Franchised outlets 240 clinics or maternity homes and 2 % of clients in each wealth quintile pharmacies or drug shops 1 (lowest) - Franchisees 280 doctors; 1,540 nurses, midwives, 2 (second lowest) - or clinical assistants; 20 pharma- 3 (middle) - cists or drug vendors; 64 diagnostic professionals; 12 counselors or social 4 (second highest) - workers; 9,186 CHWs; and 42 infor- 5 (highest) - mal providers

Health service areas FP, HIV/AIDS, newborn or pediatric care, safe motherhood, STIs, and other services HEALTH IMPACT DALYs averted: 14,157* CYPs: 19,580 Primary source of Program revenue program financing % contribution to overall health impact (DALYs averted)

Total # of visits 145,430 9.1% 0.44% FP Total # of individual 124,659 3.55% MNCH clients served 13.74% STIs HIV/AIDS Total # of full-time staff 40 Diarrhea/clean water 73.18% *Does not include estimates Total # of community -- forantenatal care, breast- outreach workers feeding promotion, and safe delivery services Source of payments for -- health services

QUALITY Program description Dimension assessed Times/year Merrygold Health Network reports the following Client experience 4 implementing partners: - Facility 4 Competence of provider 1 The program is organized in the following way: the Merry- Patient safety 1 gold network includes three levels of providers. The Level 1 Adherence to clinical protocol 1 Merrygold hospitals are fully franchised and provide mater- nal and child health services and emergency obstetric care. The Level 2 Merrysilver clinics are partially franchised and provide basic obstetric care, FP services, counseling, and immunization services. The Level 3 Merrytarang members The program raised demand for health services by are based in the community and refer clients to the net- implementing the following strategies: community work clinics and hospitals. Merrytarang members also offer outreach by workers who receive commissions for referrals. health counseling along with packages of commodities that include condoms, oral contraceptives, oral rehydration salts, The network is linked to the public sector through the and iron-folic acid tablets. following mechanisms: a common accreditation and quality oversight system. All referrals, both within and outside of the franchise network, were tracked in the following ways: through use In 2013, the program generated revenue through the of referral slips. following strategies: franchisor fees.

Email contact: [email protected] Profiles | 29 Website: hlfppt.org FP Family planning INDIA PAC Post abortion care Safe abortion Plan.it Healthcare Network Marie Stopes India MSI

Program at a glance COST Launch year 2012 Cost to operate the franchise program in 2013 (in USD): $400,682 Franchisee 1 state distribution 34% rural and 66% urban Geographic spread EQUITY Franchised outlets* 172 clinics or maternity homes % of clients in each wealth quintile

Franchisees 227 doctors 1 (lowest) - 2 (second lowest) - Health service areas FP, PAC, and safe abortion 3 (middle) - Primary source of - 4 (second highest) - program financing 5 (highest) - Total # of visits -

Total # of 27,759 individual clients HEALTH IMPACT served DALYs averted: 36,021 CYPs: 49,018 Total # of 13 full-time staff % contribution to overall health impact (DALYs averted) 1.51% Total # of 105 FP community MNCH outreach workers

Source of payments 100% out-of-pocket for health services 98.49% *This program also includes 18,000 pharmacies or drug shops that serve as product distribution outlets.

Program description QUALITY Dimension assessed Times/year Plan.it Healthcare Network is run in partnership with Population Health Services India (PHSI), which provides Client experience 1 social marketing products. Facility 1 Competence of provider 0 The program is organized in the following way: the Patient safety 1 network is comprised of Obstetrics/Gynecology specialists Adherence to clinical protocol 1 and general medical practitioners who provide consultations and clinical health services. Network-affiliated pharmacies serve as points of sale for short-term FP and medical abortion products. The pharmacies also provide referrals billboards and posters, community outreach by workers to franchise clinics for services. who receive commissions for referrals, and through health camps. All referrals, both within and outside of the franchise network, were tracked in the following ways: through refer- The network is linked to the public sector through the ral slips, though plans are underway to set up a call-in line following mechanisms: a common accreditation and quality for determining whether clients accessed referred services. oversight system.

The program raised demand for health services by In 2013, the program generated revenue through the implementing the following strategies: radio advertising, following strategies: the sale of commodities to franchisees.

Email contact: [email protected] Profiles | 30 Website: mariestopes.org.in Family planning FP Family planning Post abortion care INDIA Safe abortion Safe abortion Safe motherhood Sky TB Tuberculosis World Health Partners WHP

Program at a glance COST Launch year 2009 Cost to operate the franchise program in 2013 (in USD): - Franchisee distribution 2 states

Geographic spread 100% rural EQUITY Franchised outlets* - 3,023 clients were surveyed in 2012 and 2013 Franchisees 401 CHWs and 5,070 informal provid- ers % of clients in each wealth quintile 1 (lowest) 20 Health service areas FP, safe abortion, safe motherhood, TB, and other services 2 (second lowest) 31 3 (middle) 24 Primary source of Donor program financing 4 (second highest) 14 5 (highest) 11 Total # of visits 25,836

Total # of 18,471 individual clients served HEALTH IMPACT - Total # of full-time staff DALYs averted: 116,137* CYPs: 82,087 590 Total # of community % contribution to overall health impact (DALYs averted) outreach workers 0.38% Majority out-of-pocket FP Source of payments for MNCH health services HIV/AIDS 45.19% 47.03% *This does not include the 30 clinics or maternity homes, 12 diagnostics facili- Diarrhea/clean water ties, and 13,800 pharmacies or drug shops that are linked with the network as TB referral/consultation centers or points of distribution for Skymed commodities. *Does not include estimates 1.1% 6.29% for primary health care visits Program description

Sky reports the following implementing partners: - QUALITY The program is organized in the following way: Rural health Dimension assessed Times/year providers operate telemedicine kiosks (purchased from the Client experience 4 Sky program) and charge clients for access to the service. The Facility 1 kiosks take readings of basic parameters like blood pressure, Competence of provider 1 and can connect clients to urban medical practitioners for Patient safety 0 web-based consultations. Clients who need additional support Adherence to clinical protocol 1 can get services from medical centers that have agreements with the Sky Network. Skymed branded medications and commodities are carried by network-affiliated pharmacies.

All referrals, both within and outside of the franchise The network is linked to the public sector through the network, were tracked in the following ways: in-network following mechanisms: Contraceptive Social Marketing referrals were tracked through the WHP patient records Programme in India provides subsidized contraceptives and system. Out-of-network referrals were not closely tracked. financial support for marketing expenses. Through a formal relationship with the public sector, Sky has access to free The program raised demand for health services by Visceral Leishmaniasis diagnostic kits and free TB treatment. implementing the following strategies: radio advertising, billboards and posters, community outreach by workers who In 2013, the program generated revenue through the received commissions for referrals, the distribution of vouchers following strategies: the sale of commodities to franchisees or subsidies for health services, and mobile film screenings. and franchisor fees.

Email contact: [email protected] Profiles | 31 Website: worldhealthpartners.org FP Family planning INDIA PAC Post abortion care Safe abortion Ujjwal Network Futures Group

Program at a glance COST Launch year 2013 Cost to operate the franchise program in 2013 (in USD): - Franchisee 2 states distribution 66% rural and 34% urban Geographic spread EQUITY Franchised outlets* 231 clinics or maternity homes % of clients in each wealth quintile

Franchisees 231 doctors; 231 nurses, midwives, or 1 (lowest) - clinical assistants; and 4,172 counsel- 2 (second lowest) - ors or social workers 3 (middle) - Health service areas FP, PAC, and safe abortion 4 (second highest) - 5 (highest) - Primary source of Donor program financing

Total # of visits - HEALTH IMPACT Total # of 350,000 : 37,380 : 60,564 individual clients served DALYs averted CYPs

Total # of full-time staff 238 % contribution to overall health impact (DALYs averted) 12.28% Total # of community 4,000 1.86% FP outreach workers MNCH HIV/AIDS Source of payments for 75% out-of-pocket and 25% through health services vouchers or subsidies

*This program also includes 7,777 pharmacies or drug shops that serve as 85.86% product distribution outlets.

Program description QUALITY The UKaid-funded Ujjwal network includes clinics and Dimension assessed Times/year outreach workers in the states of Bihar and Odisha. The net- Client experience 0 work is run by Futures Group, in partnership with Hindustan Facility 1 Latex Family Planning Promotion, the Public Health Founda- Competence of provider 1 tion, and the Johns Hopkins Center for Communication. Patient safety 1 The program is organized in the following way: the Adherence to clinical protocol 1 program is establishing a tiered network of clinics. Level 1 (district headquarters): trained gynecologist; full range of FP and MTP. Level 2 (block headquarters): MBBS-qualified billboards and posters, a toll-free helpline to promote physician; short-term FP methods, mini-lap, MTP. Level 3 franchisee clinics, market activation events (entertainment (community-based workers): increase FP awareness, encour- education shows) and conducting outreach in the community age clients to use network. Program includes distribution and in clinics. network for subsidized contraceptives. Program plans to expand traditional and nontraditional outlets across Odisha. The network is linked to the public sector through the following mechanisms: social health insurance remuneration All referrals, both within and outside of the franchise for the provision of clinical services, and a common network, were tracked in the following ways: not tracked accreditation and quality oversight system. in 2013. In 2013, the program generated revenue through the The program raised demand for health services by following strategies: the sale of commodities to franchisees implementing the following strategies: promotional and franchisor fees.

Email contact: [email protected] Profiles | 32 Website: projectujjwal.com Family planning FP Family planning Post abortion care INDIA Safe abortion Safe abortion Women’s Health Program Population Services International PSI

Program at a glance COST Launch year 2008 Cost to operate the franchise program in 2013 (in USD): $2,300,000 Franchisee 30 districts across 3 states distribution 100% urban Geographic spread EQUITY Franchised outlets* 1,139 clinics or maternity homes 6,012 clients were surveyed in 2012 and 2013.

Franchisees 1,146 doctors; 21 counselors or social % of clients in each wealth quintile workers; and 300 CHWs 1 (lowest) 17 Health service areas FP and safe abortion 2 (second lowest) - 3 (middle) 18 Primary source of Donor program financing 4 (second highest) 25 5 (highest) - Total # of visits -

Total # of 76,437 individual clients HEALTH IMPACT served DALYs averted: 270,046 CYPs: 543,980 Total # of - full-time staff % contribution to overall health impact (DALYs averted) 0.3% Total # of - community FP MNCH outreach workers

Source of payments 100% out-of-pocket for health services

*This program also includes 8,203 pharmacies or drug shops that serve as 99.7% product distribution outlets.

QUALITY Program description Dimension assessed Times/year Women’s Health Program reports the following Client experience 0 implementing partners: - Facility 12 Competence of provider 1 : - The program is organized in the following way Patient safety 2 All referrals, both within and outside of the franchise Adherence to clinical protocol - network, were tracked in the following ways: outreach workers gave referral coupons to potential clients of FP services. Clients deposited these coupons in franchised clinics upon receipt of service, and program staff collected the coupons for tracking purposes. In 2013, the program generated revenue through the following strategies: the sale of commodities to The program raised demand for health services by franchisees. implementing the following strategies: radio advertising, TV advertising, billboards and posters, and community outreach by paid employees.

The network is linked to the public sector through the following mechanisms: none.

Email contact: [email protected] Profiles | 33 Website: - FP Family planning KENYA HIV/AIDS Newborn or pediatric care AMUA NCDs Noncommunicable diseases PAC Post abortion care Marie Stopes Kenya Safe abortion Safe motherhood MSI STIs Sexually transmitted infections

Program at a glance COST Launch year 2004 Cost to operate the franchise program in 2013 (in USD): $1,000,000 Franchisee 40 counties distribution - Geographic spread EQUITY Franchised outlets - % of clients in each wealth quintile

Franchisees 5 doctors; 275 nurses, midwives, or 1 (lowest) - clinical assistants; and 600 CHWs 2 (second lowest) - 3 (middle) - Health service areas FP, HIV/AIDS, newborn or pediatric care, NCDs, PAC, safe abortion, safe mother- 4 (second highest) - hood, and STIs 5 (highest) -

Primary source of Donor program financing

Total # of visits - HEALTH IMPACT : 778,186 : 997,809 Total # of - DALYs averted CYPs individual clients % contribution to overall health impact (DALYs averted) served 1.27% 0.03% Total # of - FP full-time staff MNCH STIs Total # of - community outreach workers 98.7% Source of payments - for health services

QUALITY Program description Dimension assessed Times/year Client experience 2 AMUA is run in partnership with the African Health Markets for Equity project, the Kenya Urban Reproductive Health Facility 2 Initiative project, the National Hospital Insurance Fund, and Competence of provider 2 the Output-Based Aid voucher scheme (R-OBA). Patient safety 2 Adherence to clinical protocol 2 The program is organized in the following way: -

All referrals, both within and outside of the franchise network, were tracked in the following ways: -

The program raised demand for health services by implementing the following strategies: -

The network is linked to the public sector through the following mechanisms: -

In 2013, the program generated revenue through the following strategies: none.

Email contact: - Profiles | 34 Website: mariestopes.or.ke FP Family planning KENYA HIV/AIDS Malaria CFW clinics Newborn or pediatric care Safe motherhood The HealthStore Foundation STIs Sexually transmitted infections

Program at a glance COST Launch year 2000 Cost to operate the franchise program in 2013 (in USD): $480,000 Franchisee 17 districts distribution 90% rural and 10% urban Geographic spread EQUITY Franchised outlets 56 clinics or maternity homes and 10 % of clients in each wealth quintile pharmacies or drug shops 1 (lowest) - Franchisees 56 nurses, midwives, or clinical assis- 2 (second lowest) - tants; 10 pharmacists or drug vendors; 3 (middle) - 2 diagnostic professionals; and 10 CHWs 4 (second highest) - 5 (highest) - Health service areas FP, HIV/AIDS, malaria, newborn or pediatric care, safe motherhood, STIs, and other services

Primary source of Donor HEALTH IMPACT program financing DALYs averted: - CYPs: - Total # of visits 509,229 % contribution to overall health impact (DALYs averted) - Total # of N/A individual clients served

Total # of 17 full-time staff QUALITY

Total # of 0 Dimension assessed Times/year community Client experience 0 outreach workers Facility - Source of payments 99% out-of-pocket and 1% through Competence of provider 0 vouchers or subsidies for health services Patient safety 4 Adherence to clinical protocol 4 Program description CFW reports the following implementing partners: -

The program is organized in the following way: CFW’s The network is linked to the public sector through the network includes two facility types: (1) clinics which are run following mechanisms: referral links between franchisees by nurses and offer a wider range of products and services; and local public health facilities. and (2) CFW shops which are run by CHWs. In 2013, the program generated revenue through the All referrals, both within and outside of the franchise following strategies: the sale of commodities to network, were tracked in the following ways: - franchisees, franchisor fees, and interest payments on loans to franchisees. The program raised demand for health services by implementing the following strategies: clinic-based outreach.

Email contact: [email protected] Profiles | 35 Website: healthstore.org FP Family planning KENYA HIV/AIDS Newborn or pediatric care Huduma Poa Health Network STIs Sexually transmitted infections Kisumu Medical and Education Trust (KMET)

Program at a glance COST Launch year 2012 Cost to operate the franchise program in 2013 (in USD): $679,022 Franchisee 15 counties distribution 63% rural and 37% urban Geographic spread EQUITY Franchised outlets 74 clinics or maternity homes % of clients in each wealth quintile

Franchisees 18 doctors; 168 nurses, midwives, or 1 (lowest) - clinical assistants; 4 pharmacists or drug 2 (second lowest) - vendors; 52 diagnostic professionals; 3 (middle) - and 56 counselors or social workers 4 (second highest) - Health service areas FP, HIV/AIDS, newborn or pediatric care, 5 (highest) - and STIs

Primary source of Donor program financing HEALTH IMPACT Total # of visits - DALYs averted: 21,431 CYPs: 12,289 Total # of 32,743 % contribution to overall health impact (DALYs averted) individual clients 4.54% served 4.86% 4.91% FP Total # of 126 MNCH full-time staff 43.95% STIs HIV/AIDS Total # of 120 Diarrhea/clean water community 41.75% outreach workers

Source of payments 91% out-of-pocket and 9% through for health services social health insurance QUALITY Dimension assessed Times/year Program description Client experience 2 Huduma Poa Health Network is run in partnership with Facility 12 Population Services Kenya Goldstar Network and the Competence of provider 6 MoH–Kenya. Patient safety 6 Adherence to clinical protocol 12 The program is organized in the following way: CHWs refer clients to franchised facilities for services that are part of the network’s sexual and reproductive health package. The MoH acquires and supplies commodities to franchised facilities. ers, community outreach by paid employees, community KMET also procures and supplies commodities to frachised outreach by volunteers, community outreach by workers clinics, particulary during stock-out periods at the MoH-Kenya. who receive commissions for referrals, clinic-based outreach, and community referral mechanisms. All referrals, both within and outside of the franchise network, were tracked in the following ways: Network The network is linked to the public sector through the CFWs used referral books with duplicate forms. At referral, following mechanisms: franchisees receive reporting tools, one form was issued to the client, and one was maintained commodities, joint support supervision, and capacity- by the Health Worker and used for tracking and documen- building support from the MoH. tation purposes. In 2013, the program generated revenue through the The program raised demand for health services by following strategies: the sale of commodities to implementing the following strategies: billboards and post- franchisees.

Email contact: [email protected] Profiles | 36 Website: kmet.co.ke FP Family planning KENYA HIV/AIDS Malaria Tunza Family Health Network NCDs Noncommunicable diseases Population Services Kenya PSI

Program at a glance COST Launch year 2008 Cost to operate the franchise program in 2013 (in USD): $6,854,655 Franchisee 36 counties distribution 43% rural and 57% urban Geographic spread EQUITY Franchised outlets 84 clinics or maternity homes 1,312 clients were surveyed in 2012.

Franchisees 4 doctors and 301 nurses, midwives, or % of clients in each wealth quintile clinical assistants 1 (lowest) 20.7 Health service areas FP, HIV/AIDS, malaria, and NCDs 2 (second lowest) 19.7 3 (middle) 24.7 Primary source of Donor program financing 4 (second highest) 15 5 (highest) 19.9 Total # of visits 710,468

Total # of - individual clients HEALTH IMPACT served DALYs averted: 249,897 CYPs: 310,665 Total # of 29 full-time staff % contribution to overall health impact (DALYs averted) Total # of 300 3.48% 0.29% community FP HIV/AIDS outreach workers Diarrhea/clean water Source of payments Majority out-of-pocket and minority for health services through vouchers or subsidies

96.23% Program description Tunza Family Health Network reports the following QUALITY : - implementing partners Dimension assessed Times/year Client experience 1 The program is organized in the following way: - Facility 2 All referrals, both within and outside of the franchise Competence of provider 2 network, were tracked in the following ways: voucher Patient safety 2 referrals were tracked by comparing voucher records from Adherence to clinical protocol 2 the IPC distribution staff and the Community Health Workers to the number of clients who end up at the service-delivery points.

The program raised demand for health services by In 2013, the program generated revenue through the implementing the following strategies: radio advertising, following strategies: franchisor fees. TV advertising, community outreach by volunteers, clinic-based outreach, and the distribution of vouchers or subsidies for health services.

The network is linked to the public sector through the following mechanisms: commodity linkage (mainly FP products and HIV testing kits) and reporting books for all the health areas.

Email contact: [email protected] Profiles | 37 Website: - FP Family planning LAO PEOPLE’S DEMOCRATIC REPUBLIC TB Tuberculosis Sun Quality Health (SQH) Population Services International Laos PSI

Program at a glance COST Launch year 2010 Cost to operate the franchise program in 2013 (in USD): - Franchisee 12 provinces distribution 100% urban Geographic spread EQUITY Franchised outlets 80 clinics or maternity homes % of clients in each wealth quintile

Franchisees 80 doctors 1 (lowest) - 2 (second lowest) - Health service areas FP and TB 3 (middle) - Primary source of Donor 4 (second highest) - program financing 5 (highest) - Total # of visits -

Total # of 1,530 individual clients HEALTH IMPACT served DALYs averted: - CYPs: - Total # of 8 full-time staff % contribution to overall health impact (DALYs averted) 19.95% Total # of 0 FP community TB outreach workers

Source of payments - for health services 80.05%

Program description QUALITY SQH reports the following implementing partners: - Dimension assessed Times/year The program is organized in the following way: - Client experience 0 Facility 1 All referrals, both within and outside of the franchise Competence of provider 1 network, were tracked in the following ways: not tracked. Patient safety 1 The program raised demand for health services by Adherence to clinical protocol 1 implementing the following strategies: billboards and posters, and community outreach by paid employees.

The network is linked to the public sector through the following mechanisms: referral links between franchises and local public health facilities.

In 2013, the program generated revenue through the following strategies: none.

Email contact: [email protected] Profiles | 38 Website: - Family planning FP Family planning Tuberculosis MADAGASCAR BlueStar and CSB Star Marie Stopes Madagascar MSI

Program at a glance COST Launch year 2009 Cost to operate the franchise program in 2013 (in USD): $560,304 Franchisee 12 regions distribution 60% rural and 40% urban Geographic spread EQUITY Franchised outlets 141 clinics or maternity homes 192 clients were surveyed in 2013.

Franchisees 141 doctors and 16 nurses, midwives, or % of clients in each wealth quintile clinical assistants 1 (lowest) 28 Health service areas FP 2 (second lowest) 21 3 (middle) 17 Primary source of Donor program financing 4 (second highest) 21 5 (highest) 15 Total # of visits 128,810

Total # of 55,000 individual clients HEALTH IMPACT served DALYs averted: 59,413 CYPs: 91,270 Total # of 9 full-time staff % contribution to overall health impact (DALYs averted) 0.12% Total # of 74 community FP HIV/AIDS outreach workers

Source of payments - for health services

99.88

Program description BlueStar and CSB reports the following implementing QUALITY partners: - Dimension assessed Times/year Client experience 1 The program is organized in the following way: - Facility 1 All referrals, both within and outside of the franchise Competence of provider 1 network, were tracked in the following ways: franchised Patient safety 1 facilities checked redeemed coupons and vouchers that had Adherence to clinical protocol 1 been distributed by CHWs to clients.

The program raised demand for health services by implementing the following strategies: radio advertising, TV advertising, and community events.

The network is linked to the public sector through the following mechanisms: referral links between franchisees and local public health facilities. There are also seven public facilities in the franchise program.

In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees and franchisor fees.

Email contact: [email protected] Profiles | 39 Website: mariestopes.mg FP Family planning MADAGASCAR HIV/AIDS Malaria Top Réseau Newborn or pediatric care PAC Post abortion care Population Services International Madagascar STIs Sexually transmitted infections PSI

Program at a glance COST Launch year 2001 Cost to operate the franchise program in 2013 (in USD): $1,767,395 Franchisee 22 regions and 54 districts distribution 14% rural and 86% urban Geographic spread EQUITY Franchised outlets 56 clinics or maternity homes and 217 % of clients in each wealth quintile health kiosks 1 (lowest) - Franchisees 268 doctors; 67 nurses, midwives, or 2 (second lowest) - clinical assistants; 4 diagnostic 3 (middle) - professionals; and 14 counselors or social workers 4 (second highest) - 5 (highest) - Health service areas FP, HIV/AIDS, malaria, newborn or pediatric care, PAC, STIs, and other services

Primary source of Donor HEALTH IMPACT program financing DALYs averted: 105,597 CYPs: 152,381 Total # of visits 197,729 % contribution to overall health impact (DALYs averted) Total # of - 1.83% 1.34% 0.16% individual clients FP served MNCH STIs Total # of 40 HIV/AIDS full-time staff

Total # of 485 96.66% community outreach workers 70% out-of-pocket and 30% through Source of payments QUALITY for health services vouchers or subsidies Dimension assessed Times/year Client experience 1 Program description Facility 1 Top Réseau is run in partnership with two non-governmen- Competence of provider 1 tal organizations: Sampan’Asa momba ny Fampandrosoana/ Patient safety 1 Fiangonan’i Jesoa Kristy eto Madagasikara and Sampan’Asa Adherence to clinical protocol 4 Loterana momba ny Fahasalamana.

The program is organized in the following way: some network clinics offer a full range of services, while others The program raised demand for health services by offer a limited range. Referral links exist across franchised implementing the following strategies: radio advertising, facilities to meet gaps in care. Additionally, referral links TV advertising, billboards and posters, community outreach exist between franchisees and separate public or private by paid employees, and the distribution of vouchers or referral centers for the management of adverse events or subsidies for health services. complications. The network is linked to the public sector through the All referrals, both within and outside of the franchise following mechanisms: referral links between franchises and network, were tracked in the following ways: adverse local public health facilities. events were tracked through mobile phone-based software. Other referrals were not tracked. In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees and franchisor fees.

Email contact: [email protected] Profiles | 40 Website: psi.org/madagascar MALAWI FP Family planning BlueStar Healthcare Network (BHN) Banja La Mtsogolo MSI

Program at a glance COST Launch year 2008 Cost to operate the franchise program in 2013 (in USD): - Franchisee 3 regions distribution - Geographic spread EQUITY Franchised outlets 79 clinics or maternity homes % of clients in each wealth quintile

Franchisees 158 nurses, midwives, or clinical 1 (lowest) - assistants; 76 CHWs; and 60 informal 2 (second lowest) - providers 3 (middle) - Health service areas FP 4 (second highest) - 5 (highest) - Primary source of Donor program financing

Total # of visits 64,300 HEALTH IMPACT Total # of - : 36,413 : 39,930 individual clients DALYs averted CYPs served % contribution to overall health impact (DALYs averted) Total # of 4 0.5% full-time staff FP MNCH Total # of 22 community outreach workers

Source of payments 55% out-of-pocket and 45% through 99.95% for health services vouchers or subsidies

QUALITY Program description Dimension assessed Times/year Client experience 1 BHN reports the following implementing partners: - Facility 2 The program is organized in the following way: - Competence of provider 2 Patient safety 2 All referrals, both within and outside of the franchise Adherence to clinical protocol 2 network, were tracked in the following ways: redeemed vouchers were collected, documented and reported to the franchisor by CHWs and franchisees.

The program raised demand for health services by In 2013, the program generated revenue through the implementing the following strategies: radio advertising, following strategies: the sale of commodities to franchisees billboards and posters, community outreach by workers who and franchisor fees. receive commissions for referrals, and the distribution of vouchers or subsidies for health services.

The network is linked to the public sector through the following mechanisms: referral links between franchises and local public health facilities and agreements with public health system facilities for referrals in the event of complications.

Email contact: [email protected]; [email protected] Profiles | 41 Website: - MALAWI FP Family planning Tunza Family Health Network Population Services International Malawi PSI

Program at a glance COST Launch year 2012 Cost to operate the franchise program in 2013 (in USD): $441,173 Franchisee 6 districts distribution 50% rural and 50% urban Geographic spread EQUITY Franchised outlets 27 clinics or maternity homes % of clients in each wealth quintile

Franchisees 39 nurses, midwives, or clinical assistants 1 (lowest) - and 31 informal providers 2 (second lowest) - 3 (middle) - Health service areas FP 4 (second highest) - Donor Primary source of 5 (highest) - program financing

Total # of visits 8,153

Total # of - HEALTH IMPACT individual clients : 9,427 : 9,878 served DALYs averted CYPs

Total # of 6 % contribution to overall health impact (DALYs averted) full-time staff 2.99% FP Total # of 13 HIV/AIDS community outreach workers

Source of payments 100% out-of-pocket for health services 97.01%

Program description QUALITY Tunza Family Health Network reports the following Dimension assessed Times/year implementing partners: - Client experience 1 Facility 4 The program is organized in the following way: - Competence of provider 4 All referrals, both within and outside of the franchise Patient safety 4 network, were tracked in the following ways: - Adherence to clinical protocol 4

The program raised demand for health services by implementing the following strategies: radio advertising, community outreach by workers who receive commissions for referrals, and clinic-based outreach.

The network is linked to the public sector through the following mechanisms: referral links between franchisees and local public health facilities.

In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees and franchisor fees.

Email contact: [email protected] Profiles | 42 Website: - Family planning FP Family planning MALI HIV/AIDS BlueStar Marie Stopes International Mali MSI

Program at a glance COST Launch year 2011 Cost to operate the franchise program in 2013 (in USD): $896,571 Franchisee 2 regions distribution - Geographic spread EQUITY* Franchised outlets 102 clinics or maternity homes and 10 % of clients in each wealth quintile health kiosks 1 (lowest) - Franchisees 46 doctors and 56 nurses, midwives, or 2 (second lowest) - clinical assistants 3 (middle) - Health service areas FP and HIV/AIDS 4 (second highest) - 5 (highest) - Primary source of Donor program financing *This program measured client wealth status through the use of the Progress Out of Poverty Index, which measures the percentage 103,839 of clientele that earn less than $1.25/day, a value used to gauge Total # of visits poverty. A study conducted in December 2013 suggests that 30.1% of clients were poor. Total # of 84,705 individual clients served

Total # of 30 HEALTH IMPACT full-time staff DALYs averted: 141,313 CYPs: 88,231 Total # of 0 % contribution to overall health impact (DALYs averted) community outreach workers 0.12% FP Source of payments 10% out-of-pocket, 90% through free, HIV/AIDS for health services donor-subsidized commodities

Program description 99.88% BlueStar reports the following implementing partners: -

The program is organized in the following way: - QUALITY Dimension assessed Times/year All referrals, both within and outside of the franchise Client experience 1 network, were tracked in the following ways: - Facility 2 The program raised demand for health services by Competence of provider - implementing the following strategies: radio advertising, Patient safety 2 TV advertising, billboards and posters, community outreach Adherence to clinical protocol 0 by paid employees, and clinic-based outreach.

The network is linked to the public sector through the following mechanisms: referral links between franchises and local public health facilities.

In 2013, the program generated revenue through the following strategies: none.

Email contact: [email protected] Profiles | 43 Website: - FP Family planning MALI HIV/AIDS PAC Post abortion care ProFam STIs Sexually transmitted infections Population Services International Mali PSI

Program at a glance COST Launch year 2011 Cost to operate the franchise program in 2013 (in USD): $248,976 Franchisee 4 regions distribution 100% urban Geographic spread EQUITY Franchised outlets 71 clinics or maternity homes 293 clients were surveyed in 2012.

Franchisees 29 doctors; 60 nurses, midwives, or clini- % of clients in each wealth quintile cal assistants; and 89 CHWs 1 (lowest) 0 Health service areas FP, HIV/AIDS, PAC, and STIs 2 (second lowest) 0 3 (middle) 0.3 Primary source of Donor program financing 4 (second highest) 13.9 5 (highest) 85.7 Total # of visits 42,170

Total # of 39,379 individual clients HEALTH IMPACT served DALYs averted: 75,358 CYPs: 45,630 Total # of 99 full-time staff % contribution to overall health impact (DALYs averted) 0.02% Total # of 0 0.07% 0.06% FP community MNCH outreach workers HIV/AIDS Diarrhea/clean water Source of payments 100% out-of-pocket for health services

99.85% Program description ProFam is run in partnership with Socitété Malienne des QUALITY Gyneco-Obstétriciens (SOMAGO). Dimension assessed Times/year Client experience 2 The program is organized in the following way: - Facility - All referrals, both within and outside of the franchise Competence of provider 2 network, were tracked in the following ways: - Patient safety 1 Adherence to clinical protocol 2 The program raised demand for health services by implementing the following strategies: radio advertising, TV advertising, billboards and posters, and clinic-based outreach.

The network is linked to the public sector through the following mechanisms: referral links between franchisees and local public health facilities.

In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees.

Email contact: [email protected] Profiles | 44 Website: - FP Family planning MYANMAR HIV/AIDS Malaria The Sun Quality Health (SQH) Network Newborn or pediatric care PAC Post abortion care Population Services International Myanmar STIs Sexually transmitted infections PSI TB Tuberculosis

Program at a glance COST Launch year 2001 Cost to operate the franchise program in 2013 (in USD): - Franchisee 14 administrative units distribution 4% rural and 96% urban Geographic spread EQUITY Franchised outlets 1,525 clinics or maternity homes and 375 clients were surveyed in 2012. 54 stand-alone laboratories % of clients in each wealth quintile 1,594 doctors; 57 diagnostic pro- Franchisees 1 (lowest) 19.2 fessionals; 5 counselors or social workers; and 2,145 CHWs 2 (second lowest) 19.7 3 (middle) 21.9 Health service areas FP, HIV/AIDS, malaria, newborn or pediatric care, PAC, STIs, TB, and 4 (second highest) 17.1 other services 5 (highest) 22.1

Primary source of Donor program financing HEALTH IMPACT Total # of visits 3,396,078 DALYs averted: 326,953 CYPs: 290,642 Total # of individual - clients served % contribution to overall health impact (DALYs averted)

Total # of full-time staff 421 7.65% 21.13% FP ARI MNCH TB Total # of community 260 1.04% STIs Malaria outreach workers 0.44% 0.71% HIV/AIDS 42.73% 4.40% Source of payments for 49% out-of-pocket and 51% covered Diarrhea/clean water health services by SQH itself 21.9%

Program description QUALITY : - SQH reports the following implementing partners Dimension assessed Times/year The program is organized in the following way: the tiered Client experience 2 franchise network includes SQH doctors that provide Facility 12 integrated and comprehensive case management, and Sun Competence of provider 1 Primary Health (SPH) CHWs that offer primary health care Patient safety 1 and referral services in villages. Adherence to clinical protocol 1

All referrals, both within and outside of the franchise network, were tracked in the following ways: franchisors received reports from SQH providers regarding referrals community outreach by volunteers, and the distribution of to public sector OB/GYNs for the management of compli- vouchers or subsidies for health services. cations and adverse events. The franchisors subsequently followed up with the OB/GYNs to ensure clients made use The network is linked to the public sector through the of referred services. following mechanisms: a verbal contract with public sector OB/GYNs for the management of adverse events in SQH’s The program raised demand for health services by IUD program. implementing the following strategies: radio advertising, TV advertising, community outreach by paid employees, In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees.

Email contact: [email protected] Profiles | 45 Website: psi.org/myanmar#health_areas NEPAL FP Family planning OK Population Services International Nepal PSI

Program at a glance COST Launch year 2009 Cost to operate the franchise program in 2013 (in USD): $360,000 Franchisee 50 districts distribution 80% rural and 20% urban Geographic spread EQUITY Franchised outlets 228 clinics or maternity homes % of clients in each wealth quintile

Franchisees 7 doctors; 640 nurses, midwives, or 1 (lowest) - clinical assistants; and 241 pharmacists 2 (second lowest) - or drug vendors 3 (middle) - Health service areas FP 4 (second highest) - 5 (highest) - Primary source of Donor program financing

Total # of visits 47,747 HEALTH IMPACT Total # of 35,566 : - : - individual clients DALYs averted CYPs served % contribution to overall health impact (DALYs averted) Total # of 8 N/A full-time staff

Total # of 400 community outreach workers QUALITY

Source of payments 100% out-of-pocket Dimension assessed Times/year for health services Client experience 1 Facility 2 Competence of provider 2 Program description Patient safety 2 OK has partnered with the National Health Training Center Adherence to clinical protocol 2 (NHTC) to provide Basic IUCD training and certification to OK franchisees.

The program is organized in the following way: -

All referrals, both within and outside of the franchise The network is linked to the public sector through the : none. network, were tracked in the following ways: referral cards following mechanisms issued by CHWs to people in the community were collected In 2013, the program generated revenue through the at the points of service-delivery (the franchise clinics) and following strategies: the sale of commodities to franchisees tracked. and franchisor fees. The program raised demand for health services by implementing the following strategies: radio advertising, TV advertising, billboards and posters, household interper- sonal communications by female community mobilizers, and community-based activities including advocacy meetings, the use of information stalls, street dramas, and other cultural events.

Email contact: [email protected] Profiles | 46 Website: - Family planning FP Family planning NEPAL Safe motherhood Sangini Networks Nepal CRS Company

Program at a glance COST Launch year 1994 Cost to operate the franchise program in 2013 (in USD): $196,882 Franchisee 75 districts distribution - Geographic spread EQUITY Franchised outlets* 92 clinics or maternity homes % of clients in each wealth quintile

Franchisees 3,100 nurses, midwives, or clinical 1 (lowest) - assistants 2 (second lowest) - 3 (middle) - Health service areas FP, safe motherhood, and other services 4 (second highest) - Donor Primary source of 5 (highest) - program financing

Total # of visits -

Total # of 100,000 HEALTH IMPACT individual clients : 150,520 : 357,049 served DALYs averted CYPs

Total # of 30 % contribution to overall health impact (DALYs averted) full-time staff 13.98% FP Total # of 25 MNCH community HIV/AIDS outreach workers 20.44% Diarrhea/clean water 64.46% Source of payments 100% out-of-pocket 1.11% for health services *This program also includes 3,100 pharmacies or drug shops that serve as product distribution outlets. QUALITY Program description Dimension assessed Times/year Sangini Networks reports the following implementing Client experience 0 partners: - Facility 3 Competence of provider 4 The program is organized in the following way: - Patient safety 4 Adherence to clinical protocol 4 All referrals, both within and outside of the franchise network, were tracked in the following ways: piloting is underway in three districts to use program staff to monitor and follow up with referrals. able, long-term, reversible contraceptives. If the patient is The program raised demand for health services by unable to pay for the services, the costs are subsidized at implementing the following strategies: use of referral slips the franchise outlets. and outreach through women’s groups. In 2013, the program generated revenue through the The network is linked to the public sector through the following strategies: sales of commodities to franchises and following mechanisms: referral links between franchisees the sale of specific commodities priced to generate revenue and local public health facilities for free services of inject- in non-franchise outlets.

Email contact: [email protected] Profiles | 47 Website: crs.org.np FP Family planning NICARAGUA NCDs Noncommunicable diseases Red Segura PASMO PSI

Program at a glance COST Launch year 2008 Cost to operate the franchise program in 2013 (in USD): $805,910 Franchisee 11 departments distribution 100% urban Geographic spread EQUITY Franchised outlets 134 clinics or maternity homes % of clients in each wealth quintile

Franchisees 133 doctors; 1 nurse, midwife, or clinical 1 (lowest) - assistant; and 10 counselors or social 2 (second lowest) - workers 3 (middle) - Health service areas FP and NCDs 4 (second highest) - 5 (highest) - Primary source of Donor program financing

Total # of visits 25,354 HEALTH IMPACT Total # of 14,955 8,383 43,652 individual clients DALYs averted: CYPs: served % contribution to overall health impact (DALYs averted) Total # of 18 0.01% full-time staff FP HIV/AIDS Total # of 0 community outreach workers

Source of payments 45% out-of-pocket and 55% through 99.99% for health services social health insurance

QUALITY Program description Dimension assessed Times/year Red Segura reports the following implementing partners: - Client experience 1 Facility - The program is organized in the following way: - Competence of provider 2 All referrals, both within and outside of the franchise Patient safety 2 network, were tracked in the following ways: - Adherence to clinical protocol 2

The program raised demand for health services by implementing the following strategies: radio advertising, TV advertising, billboards and posters, and clinic-based outreach.

The network is linked to the public sector through the following mechanisms: none.

In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees.

Email contact: [email protected] Profiles | 48 Website: redseguraclinicas.com FP Family planning NIGERIA HIV/AIDS Malaria BlueStar Healthcare Network PAC Post abortion care Safe motherhood Marie Stopes Nigeria STIs Sexually transmitted infections MSI

Program at a glance COST Launch year 2012 Cost to operate the franchise program in 2013 (in USD): - Franchisee 6 states distribution - Geographic spread EQUITY Franchised outlets 160 clinics or maternity homes % of clients in each wealth quintile

Franchisees 44 doctors; 116 nurses, midwives, or 1 (lowest) - clinical assistants; and 76 counselors or 2 (second lowest) - social workers 3 (middle) - Health service areas FP, HIV/AIDS, malaria, PAC, safe 4 (second highest) - motherhood, STIs, and other services 5 (highest) -

Primary source of Donor program financing

Total # of visits - HEALTH IMPACT : 73,414* : 45,475 Total # of - DALYs averted CYPs individual clients % contribution to overall health impact (DALYs averted) served 0.15% Total # of 10 1.0% 0.3% FP full-time staff 0.32% MNCH STIs Total # of 76 HIV/AIDS community Diarrhea/clean water outreach workers *Does not include estimates for antenatal care, acute 98.22% Source of payments - respiratory infection services, for health services and safe delivery services

Program description QUALITY The Network reports the following implementing partners: - Dimension assessed Times/year Client experience 1 : - The program is organized in the following way Facility 1 All referrals, both within and outside of the franchise Competence of provider 2 network, were tracked in the following ways: - Patient safety 2 Adherence to clinical protocol 2 The program raised demand for health services by implementing the following strategies: community outreach by paid employees, community outreach by workers who receive commissions for referrals, clinic-based outreach, and the distribution of vouchers or subsidies for health services.

The network is linked to the public sector through the fol- lowing mechanisms: referral links between franchisees and local public health facilities.

In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees and franchisor fees.

Email contact: [email protected] Profiles | 49 Website: - FP Family planning NIGERIA HIV/AIDS Malaria Healthy Family Network (HFN) NCDs Noncommunicable diseases PAC Post abortion care Society for Family Health (SFH) Safe motherhood SFH/PSI

Program at a glance COST Launch year 2009 Cost to operate the franchise program in 2013 (in USD): - Franchisee 22 states distribution 100% urban Geographic spread EQUITY Franchised outlets 308 clinics or maternity homes and 299 % of clients in each wealth quintile pharmacies or drug shops 1 (lowest) - Franchisees 87 doctors; 221 nurses, midwives, or 2 (second lowest) - clinical assistants; and 299 pharmacists 3 (middle) - or drug vendors 4 (second highest) - Health service areas FP, HIV/AIDS, malaria, NCDs, and PAC 5 (highest) - and safe motherhood

Primary source of Donor program financing HEALTH IMPACT Total # of visits 709,688 DALYs averted: 406,809 CYPs: 254,525 Total # of 632,644 (DALYs averted) individual clients % contribution to overall health impact served 0.08% FP Total # of 31 MNCH full-time staff

Total # of 185 community outreach workers 99.92%

Source of payments Mostly out-of-pocket with some for health services discounts for referred patients QUALITY Dimension assessed Times/year Program description Client experience 2 HFN reports the following implementing partners: - Facility 2 Competence of provider 2 : clinics The program is organized in the following way Patient safety 2 deliver clinical services and prescribe medications and Adherence to clinical protocol 2 health/medical commodities. Network pharmacies dis- tribute prescribed commodities, including FP products, diarrhea prevention products, malaria prevention products, including LLINs, malaria treatment medicine, and antibiot- The program raised demand for health services by ics for pneumonia treatment. Network medicine vendors implementing the following strategies: community dispense prescribed diarrhea prevention commodities, oral outreach by paid employees, community outreach by contraceptive pills and condoms, and long lasting insecti- volunteers, community outreach by workers who receive cidal nets and artemisinin combination therapy for malaria. commissions for referrals, and clinic-based outreach.

All referrals, both within and outside of the franchise The network is linked to the public sector through the network, were tracked in the following ways: referral cards following mechanisms: none. that were deposited at the franchisee clinics were tracked and compared to records maintained by network providers. In 2013, the program generated revenue through the following strategies: none.

Email contact: [email protected], [email protected], [email protected] Profiles | 50 Website: sfhnigeria.org FP Family planning PAKISTAN HIV/AIDS Integration with Private Practitioners Rahnuma-Family Planning Association of Pakistan IPPF

Program at a glance COST Launch year - Cost to operate the franchise program in 2013 (in USD): $72,686 Franchisee 4 provinces distribution - Geographic spread EQUITY Franchised outlets* 96 traditional healer-operated facilities % of clients in each wealth quintile

Franchisees* - 1 (lowest) - 2 (second lowest) - Health service areas FP and HIV/AIDS 3 (middle) - Primary source of Donor 4 (second highest) - program financing 5 (highest) - Total # of visits 374,976

Total # of 368,538 individual clients HEALTH IMPACT served DALYs averted: 533,463* CYPs: 814.482 Total # of 259 full-time staff % contribution to overall health impact (DALYs averted) 0.1% 0.05% Total # of 259 FP community MNCH outreach workers HIV/AIDS

Source of payments - for health services *Does not include estimates for safe delivery services 99.85% *This network included a mix of franchisees and providers participating in public-private partnership arrangements, including 1,363 doctors; 523 nurses, midwives, or clinical assistants; 181 informal providers; and 66 traditional healers. These providers operated >4,000 clinical facilities. For the purposes of this report, it was not possible to distinguish franchisees from private QUALITY sector providers participating in alternate arrangements. Dimension assessed Times/year Client experience - Program description Facility - The network reports the following implementing partners: - Competence of provider - Patient safety - The program is organized in the following way: - Adherence to clinical protocol -

All referrals, both within and outside of the franchise network, were tracked in the following ways: -

The program raised demand for health services by implementing the following strategies: the use of a methodology called partnership-defined quality sessions that assesses provider quality and community perceptions and works to bridge the gap.

The network is linked to the public sector through the following mechanisms: -

In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees.

Email contact: [email protected] Profiles | 51 Website: fpapak.org FP Family planning PAKISTAN Newborn or pediatric care PAC Post abortion care Sabz Sitara Network Safe motherhood STIs Sexually transmitted infections Greenstar Social Marketing Pakistan (Guarantee) Limited TB Tuberculosis PSI

Program at a glance COST Launch year 1995 Cost to operate the franchise program in 2013 (in USD): $10,820,000 Franchisee 5 administrative units distribution 37% rural and 63% urban Geographic spread EQUITY Franchised outlets 7,543 clinics or maternity homes; % of clients in each wealth quintile 99 stand-alone laboratories; and 12 health kiosks 1 (lowest) - 2 (second lowest) - 2,552 doctors; 4,991 nurses, midwives, Franchisees 3 (middle) - or clinical assistants; 1,170 diagnostic professionals; and 55 counselors or 4 (second highest) - social workers 5 (highest) -

Health service areas FP, newborn or pediatric care, PAC, safe motherhood, STIs, and TB

Primary source of Donor HEALTH IMPACT program financing DALYs averted: 1,414,855 CYPs: 2,490,728 Total # of visits 3,529,186 % contribution to overall health impact (DALYs averted) Total # of individual 647,296 0.21% 2.24% clients served 0.88% FP MNCH Total # of full-time staff 1,148 HIV/AIDS TB Total # of community 459 outreach workers 96.67% Source of payments for 91.8% out-of-pocket and 8.2% health services through vouchers or subsidies

QUALITY Program description Dimension assessed Times/year Sabz Sitara Network is run in partnership with the Society Client experience - of Obstetricians and Gynaecologists of Pakistan and Aga Facility - Khan Health Services. Competence of provider - Patient safety - The program is organized in the following way: network Adherence to clinical protocol - doctors, Lady Health Visitors, and midwives offer clinical, nonsurgical FP services. Network doctors with access to an operating theater provide surgical contraception procedures. Network labs offer TB diagnostics services. outreach by workers who receive commissions for referrals, All referrals, both within and outside of the franchise clinic-based outreach, and the distribution of vouchers or network, were tracked in the following ways: CHWs dis- subsidies for health services. tributed referral tokens to women in the community for use of services at a franchisee clinic. The tokens were collected The network is linked to the public sector through the : a common accreditation and quality at the points of service delivery, and then collected and following mechanisms oversight system. tracked by the CHW supervisors. In 2013, the program generated revenue through the The program raised demand for health services by following strategies: the sale of commodities to implementing the following strategies: TV advertising, franchisees. community outreach by paid employees, community

Email contact: [email protected] Profiles | 52 Website: greenstar.org.pk PAKISTAN FP Family planning Suraj Marie Stopes Society MSI

Program at a glance COST Launch year 2008 Cost to operate the franchise program in 2013 (in USD): - Franchisee 3 provinces distribution 98% rural and 2% peri-urban Geographic spread EQUITY Franchised outlets 326 clinics or maternity homes % of clients in each wealth quintile

Franchisees 20 doctors; 306 nurses, midwives, or 1 (lowest) - clinical assistants; 326 counselors or social 2 (second lowest) - workers; and 747 informal providers 3 (middle) - Health service areas FP 4 (second highest) - 5 (highest) - Primary source of Donor program financing

Total # of visits 350,000 HEALTH IMPACT Total # of 338,526 : 153,874 : 669,698 individual clients DALYs averted CYPs served % contribution to overall health impact (DALYs averted) Total # of 384 full-time staff FP

Total # of 747 100% community outreach workers

Source of payments 67% out-of-pocket and 33% through for health services vouchers or subsidies QUALITY Program description Dimension assessed Times/year Client experience 1 The Suraj Social Franchise network is a partnership Facility 2 between MSS and a private local health service provider, to Competence of provider 2 improve the quality of services and increase choice and Patient safety 2 access to healthy timing and spacing of pregnancies for Adherence to clinical protocol 2 rural, underserved, and poor communities.

The program is organized in the following way: 89% of network facilities are categorized as A-type Suraj Centers. A-type facilities are run by mid-level healthcare providers The program raised demand for health services by that provide short- and long-term IUDs. The remaining implementing the following strategies: use of referral slips 11% (B-type facilities) are run by MBBS-certified doctors and word-of-mouth referrals by FHEs, and other demand or through on-call MBBS-certified doctors. B-type facilities generation activities and giveaways. provide comprehensive FP services, including procedures such as implants and voluntary sterilization. The network is linked to the public sector through the following mechanisms: none. All referrals, both within and outside of the franchise network, were tracked in the following ways: Field Health In 2013, the program generated revenue through the Educators (FHEs) and franchisees maintained referral following strategies: none. records that were audited periodically.

Email contact: [email protected] Profiles | 53 Website: mariestopkespk.org PAPUA NEW GUINEA Malaria Marasin Stoa Kipas (Medicine Store Keepers – MSK) Oil Search Health Foundation (OSHF)

Program at a glance COST Launch year 2007 Cost to operate the franchise program in 2013 (in USD): $314,003 Franchisee 1 distribution 100% rural Geographic spread EQUITY Franchised outlets 13 health kiosks % of clients in each wealth quintile

Franchisees 1 doctor; 8 nurses, midwives, or clinical 1 (lowest) - assistants; 13 pharmacists or drug 2 (second lowest) - vendors; and 3 diagnostic professionals 3 (middle) - Health service areas Malaria 4 (second highest) - 5 (highest) - Primary source of Donor program financing

Total # of visits 1,182 HEALTH IMPACT Total # of 996 : - : - individual clients DALYs averted CYPs served % contribution to overall health impact (DALYs averted) Total # of 10 13.06% full-time staff FP HIV/AIDS Total # of 42 18.43% Diarrhea/clean water community outreach workers

Source of payments -- 68.52% for health services

Program description QUALITY Dimension assessed Times/year MSK is run in partnership with the Evangelical Church of Papua New Guinea. Client experience 12 Facility 12 The program is organized in the following way: MSK Competence of provider 12 outlets provide two categories of services: (1) malaria Patient safety 12 diagnosis, treatment, and referral; and (2) over-the-counter Adherence to clinical protocol 12 sale of hygiene and health products.

All referrals, both within and outside of the franchise network, were tracked in the following ways: MSK used The network is linked to the public sector through the paper-based forms to manually track referrals between following mechanisms: referral links between franchisees network medicine store keepers and health facilities. Data and local public health facilities. from these forms is uploaded into an electronic database. In 2013, the program generated revenue through the The program raised demand for health services by following strategies: the sale of commodities to implementing the following strategies: billboards and franchisees. posters.

Email contact: [email protected] Profiles | 54 Website: oilsearchhealthfoundation.org/programs/malaria Malaria FP Family planning PERU HIV/AIDS Newborn or pediatric care RedPlan Salud Safe motherhood Instituto Peruano Paternidad Responsable (INPPARES) IPPF

Program at a glance COST Launch year 2002 Cost to operate the franchise program in 2013 (in USD): $648,250 Franchisee 6 regions distribution 11% rural and 89% urban Geographic spread EQUITY Franchised outlets 1,320 clinics or maternity homes % of clients in each wealth quintile

Franchisees 48 doctors; 1,320 nurses, midwives, or 1 (lowest) - clinical assistants; 1,218 diagnostic pro- 2 (second lowest) - fessionals; and 314 counselors or social 3 (middle) - workers 4 (second highest) - Health service areas FP, HIV/AIDS, newborn or pediatric care, 5 (highest) - and safe motherhood

Primary source of Self-funded/revenue program financing HEALTH IMPACT Total # of visits - DALYs averted: 19,472* CYPs: 127,655 Total # of - % contribution to overall health impact (DALYs averted) individual clients served 0.05% FP Total # of 24 MNCH full-time staff *Does not include estimates Total # of -- for cervical cancer treatment and safe delivery services community outreach workers 99.95%

Source of payments 100% out-of-pocket for health services

QUALITY Program description Dimension assessed Times/year RedPlan Salud reports the following implementing Client experience 0 partners: - Facility 1 Competence of provider 0 : facilities The program is organized in the following way Patient safety 0 classified as Associated Medical Centers offer general Adherence to clinical protocol 0 practice, gynecology, and other specialized services. Some are equipped with clinical laboratories, and others are equipped to handle a higher level of complexity. Professional Midwives’ offices offer primary care services The network is linked to the public sector through the and emphasize the provision of sexual and reproductive following mechanisms: none. health services. In 2013, the program generated revenue through the All referrals, both within and outside of the franchise following strategies: the sale of commodities to network, were tracked in the following ways: not tracked. franchisees.

The program raised demand for health services by implementing the following strategies: community outreach by workers who receive commissions for referrals.

Email contact: [email protected] Profiles | 55 Website: inppares.org FP Family planning PHILIPPINES STIs Sexually transmitted infections BlueStar Pilipinas Population Services Pilipinas, Incorporated MSI

Program at a glance COST Launch year 2008 Cost to operate the franchise program in 2013 (in USD): $626,328 Franchisee 37 provinces distribution 60% rural and 40% urban Geographic spread EQUITY Franchised outlets 267 clinics or maternity homes % of clients in each wealth quintile

Franchisees 267 nurses, midwives, or clinical assis- 1 (lowest) - tants 2 (second lowest) - 3 (middle) - Health service areas FP and STIs 4 (second highest) - Donor Primary source of 5 (highest) - program financing

Total # of visits -

Total # of 119,815 HEALTH IMPACT individual clients : 66,799 : 306,526 served DALYs averted CYPs

Total # of 11 % contribution to overall health impact (DALYs averted) full-time staff 0.19% FP Total # of 0 STIs community outreach workers

Source of payments 50% out-of-pocket and 50% through social health insurance for health services 99.81%

Program description QUALITY BlueStar Pilipinas reports the following implementing Dimension assessed Times/year : - partners Client experience 4 The program is organized in the following way: - Facility 4 Competence of provider 2 All referrals, both within and outside of the franchise Patient safety 2 network, were tracked in the following ways: routine Adherence to clinical protocol 2 reports from the franchisees.

The program raised demand for health services by implementing the following strategies: billboards and posters, and community outreach by workers who receive commissions for referrals.

The network is linked to the public sector through the following mechanisms: referral links between franchisees and local public health facilities, social health insurance remuneration for health services provided, and a common accreditation and quality oversight system.

In 2013, the program generated revenue through the following strategies: franchisor fees and interest payments on loans to franchisees.

Email contact: [email protected] Profiles | 56 Website: - FP Family planning PHILIPPINES Newborn or pediatric care Safe motherhood Well Family Midwife Clinic Well Family Midwife Clinic Partnerships Foundation Inc.

Program at a glance COST Launch year 2002 Cost to operate the franchise program in 2013 (in USD): $11,045 Franchisee 6–8 regions distribution 100% urban Geographic spread EQUITY Franchised outlets 85 midwife clinics or maternity/birthing % of clients in each wealth quintile homes 1 (lowest) 10 Franchisees 85 professional midwives 2 (second lowest) 30- 3 (middle) 50 Health service areas FP, newborn or pediatric care, and safe motherhood 4 (second highest) 10 5 (highest) - Primary source of Program revenue program financing

Total # of visits 51,744 HEALTH IMPACT Total # of 43,982 individual clients DALYs averted: - CYPs: - served % contribution to overall health impact (DALYs averted) Total # of 2 N/A full-time staff

Total # of 170 per NGO cluster community outreach workers QUALITY

Source of payments 50% out-of-pocket and 50% through Dimension assessed Times/year for health services social health insurance Client experience 4 Facility 4 Competence of provider 4 Program description Patient safety 4 Well Family Midwife Clinic reports the following Adherence to clinical protocol 4 implementing partners: City/Provincial Health Units; Private/Government Hospitals, Association of Doctors, Pharmaceutical Companies, Industrial Suppliers. The program raised demand for health services by The program is organized in the following way: social implementing the following strategies: clinic-based preparation by establishing working relationships with the outreach, health events and promotions, clinic anniversaries, Department of Health and local chief executives of the and owner birthdays. local political structure, including provincial and local areas, in order to encourage private-government partnerships; The network is linked to the public sector through the fol- recruitment of qualified midwives following the criteria for lowing mechanisms: referral links between franchisees and the selection of midwife and its clinic location; training of local public health facilities and a common accreditation selected midwives for technical and business operation; and quality oversight system. equipping clinics for operation in the locality. In 2013, the program generated revenue through the : the sale of technical or program All referrals, both within and outside of the franchise following strategies assistance to franchisees, franchisor fees, and interest from network, were tracked in the following ways: through the use of referral forms with removable sections that are bank accounts. returned to the franchisor for documentation and tracking purposes.

Email contact: [email protected]; [email protected] Profiles | 57 Website: wfmc.com.ph SENEGAL FP Family planning BlueStar Marie Stopes International Senegal MSI

Program at a glance COST Launch year 2012 Cost to operate the franchise program in 2013 (in USD): $77,000 Franchisee 1 region distribution 100% urban Geographic spread EQUITY Franchised outlets 51 clinics or maternity homes % of clients in each wealth quintile*

Franchisees 11 doctors and 40 nurses, midwives, or 1 (lowest) - clinical assistants 2 (second lowest) - 3 (middle) - Health service areas FP 4 (second highest) - Donor Primary source of 5 (highest) - program financing *A survey was conducted in 2013 that revealed that 6% 9,154 Total # of visits of FP clients live on less than $1.25 a day, and 42% on less than $2.50 a day. Total # of 5,500 (estimate) individual clients served

Total # of 5 HEALTH IMPACT full-time staff DALYs averted: 11,973 CYPs: 14,062 Total # of 75 (DALYs averted) community % contribution to overall health impact outreach workers FP Source of payments 100% out-of-pocket for health services 100%

Program description BlueStar reports the following implementing partners: - QUALITY The program is organized in the following way: - Dimension assessed Times/year All referrals, both within and outside of the franchise Client experience 1 : service network, were tracked in the following ways Facility - coupons that were given to clients were recorded and Competence of provider - tracked by program staff. Patient safety - The program raised demand for health services by Adherence to clinical protocol - implementing the following strategies: referral slips, word-of-mouth referrals, and community demand generation in collaboration with community health workers as an important component and service delivery channel in (house visits, community talks, and sensitisation events). the 2012 National Family Planning Action Plan of the MoH of Senegal. The network is linked to the public sector through the following mechanisms: integration for franchisees to access In 2013, the program generated revenue through the public system commodities and data sharing with the public following strategies: cost recovery from the sale of com- sector is underway. The franchise program is also identified modities to franchisees and annual franchisee fees.

Email contact: [email protected] Profiles | 58 Website: - Family planning SIERRA LEONE FP Family planning BlueStar Healthcare Network Marie Stopes Sierra Leone (MSSL) MSI

Program at a glance COST Launch year 2008 Cost to operate the franchise program in 2013 (in USD): $169,942 Franchisee 4 distribution 12% rural and 88% urban Geographic spread EQUITY Franchised outlets 25 clinics or maternity homes and 6 % of clients in each wealth quintile stand-alone laboratories 1 (lowest) - Franchisees 10 doctors; 25 nurses, midwives, or clini- 2 (second lowest) - cal assistants; 6 diagnostic professionals; 3 (middle) - 15 counselors or social workers; and 25 informal providers 4 (second highest) - 5 (highest) - Health service areas FP

Primary source of Donor program financing HEALTH IMPACT Total # of visits - DALYs averted: 45,169 CYPs: 32,012 Total # of - (DALYs averted) individual clients % contribution to overall health impact served 2.13% FP Total # of 5 MNCH full-time staff

Total # of 18 community outreach workers 97.87%

Source of payments 100% through vouchers or subsidies for health services QUALITY Dimension assessed Times/year Program description Client experience - BlueStar reports the following implementing partners: - Facility 1 Competence of provider 1 : - The program is organized in the following way Patient safety 1 All referrals, both within and outside of the franchise Adherence to clinical protocol 1 network, were tracked in the following ways: referrals for the management of complications were tracked through the use of incident reports generated by program staff and submitted to a Clinical Services Manager. The network is linked to the public sector through the following mechanisms: - The program raised demand for health services by implementing the following strategies: community In 2013, the program generated revenue through the outreach by volunteers, door-to-door visitation, and use of following strategies: none. megaphones and hand-bells to alert community members to service availability.

Email contact: [email protected] Profiles | 59 Website: - FP Family planning SOMALILAND Newborn or pediatric care BulshoKaab Pharmacy Network Population Services International Somaliland PSI

Program at a glance COST Launch year 2011 Cost to operate the franchise program in 2013 (in USD): $158,773 Franchisee 5 regions distribution 3% rural and 97% urban Geographic spread EQUITY Franchised outlets 166 pharmacies or drug shops % of clients in each wealth quintile

Franchisees 166 pharmacists or drug vendors 1 (lowest) - 2 (second lowest) - Health service areas FP and newborn or pediatric care 3 (middle) - Primary source of Donor 4 (second highest) - program financing 5 (highest) - Total # of visits -

Total # of - individual clients HEALTH IMPACT served DALYs averted: CYPs: Total # of 7 full-time staff % contribution to overall health impact (DALYs averted)

Total # of 0 N/A community outreach workers

Source of payments 100% out-of-pocket QUALITY for health services Dimension assessed Times/year Client experience 1 Program description Facility 3 Competence of provider 3 BulshoKaab Pharmacy Network reports the following Patient safety 0 implementing partners: - Adherence to clinical protocol 2 The program is organized in the following way: -

All referrals, both within and outside of the franchise network, were tracked in the following ways: -

The program raised demand for health services by implementing the following strategies: radio advertising, TV advertising, and interpersonal communication sessions.

The network is linked to the public sector through the following mechanisms: none.

In 2013, the program generated revenue through the following strategies: none.

Email contact: [email protected] Profiles | 60 Website: - HIV/AIDS SOUTH AFRICA NCDs Noncommunicable diseases STIs Sexually transmitted infections General Practitioner Referral Programme TB Tuberculosis BroadReach Healthcare and North West Department of Health

Program at a glance COST Launch year 2005 Cost to operate the franchise program in 2013 (in USD): - Franchisee 1 distribution 10% rural and 90% urban Geographic spread EQUITY Franchised outlets - % of clients in each wealth quintile

Franchisees 35 doctors 1 (lowest) - 2 (second lowest) - Health service areas HIV/AIDS, NCDs, STIs, and TB 3 (middle) - Primary source of Donor 4 (second highest) - program financing 5 (highest) - Total # of visits 35,880

Total # of 2,760 individual clients HEALTH IMPACT served DALYs averted: - CYPs: - Total # of 4 full-time staff % contribution to overall health impact (DALYs averted)

Total # of 0 HIV/AIDS community outreach workers 100%

Source of payments - for health services

Program description QUALITY General Practitioner Referral Programme reports the Dimension assessed Times/year following implementing partners: - Client experience 4 Facility 12 : - The program is organized in the following way Competence of provider 12 All referrals, both within and outside of the franchise Patient safety 24 network, were tracked in the following ways: - Adherence to clinical protocol 24

The program raised demand for health services by implementing the following strategies: clinic-based outreach.

The network is linked to the public sector through the following mechanisms: the network of general practitioners maintain an agreement with the public sector to receive “downstream” referrals of patients living with HIV or AIDS who have been stabilized.

In 2013, the program generated revenue through the following strategies: none.

Email contact: [email protected] Profiles | 61 Website: - FP Family planning TANZANIA Newborn or pediatric care Safe motherhood Familia Population Services International PSI

Program at a glance COST Launch year 2009 Cost to operate the franchise program in 2013 (in USD): $1,480,000 Franchisee 13 regions distribution 30% rural and 70% urban Geographic spread EQUITY Franchised outlets 245 clinics or maternity homes % of clients in each wealth quintile

Franchisees 58 doctors and 276 nurses, midwives, or 1 (lowest) - clinical assistants 2 (second lowest) - 3 (middle) - Health service areas FP, newborn or pediatric care, cervical cancer screening and treatment, other 4 (second highest) - 5 (highest) - Primary source of Donor program financing

Total # of visits - HEALTH IMPACT Total # of - : 270,185 : 272,608 individual clients DALYs averted CYPs served % contribution to overall health impact (DALYs averted) Total # of 37 0.09% full-time staff FP MNCH Total # of 223 community outreach workers

Source of payments 100% out-of-pocket 99.81% for health services

Program description QUALITY Dimension assessed Times/year Familia is run in partnership with the Association of Private Client experience 1 Health Facilities of Tanzania and the Private Nurse Midwives Facility 4 Association of Tanzania. Competence of provider 4 The program is organized in the following way: - Patient safety 4 Adherence to clinical protocol 4 All referrals, both within and outside of the franchise network, were tracked in the following ways: program staff tracked referrals from CHWs to network clinics via paper-based referral cards. They tracked referrals to public The network is linked to the public sector through the health facilities only in the case of complications/adverse following mechanisms: linked patient data management events and, in those events, tracking was accomplished systems and referral links between the franchisor and through the use of paper-based referral cards and doctors from public health facilities. government referral forms. In 2013, the program generated revenue through the The program raised demand for health services by following strategies: franchisor fees. implementing the following strategies: radio advertising, billboards and posters, community outreach by paid employees, and community outreach by volunteers.

Email contact: [email protected] Profiles | 62 Website: - TOGO FP Family planning POMEFA Population Services International Togo PSI

Program at a glance COST Launch year 2009 Cost to operate the franchise program in 2013 (in USD): $795,136 Franchisee 3 provinces distribution 100% urban Geographic spread EQUITY Franchised outlets - % of clients in each wealth quintile

Franchisees 4 doctors; 25 nurses, midwives, or clinical 1 (lowest) - assistants; and 25 counselors or social 2 (second lowest) - workers 3 (middle) - Health service areas FP 4 (second highest) - 5 (highest) - Primary source of Donor program financing

Total # of visits 2,500 HEALTH IMPACT Total # of 2,500 : 2,552 : 3,030 individual clients DALYs averted CYPs served % contribution to overall health impact (DALYs averted) Total # of 29 full-time staff FP

Total # of 9 100% community outreach workers

Source of payments - for health services QUALITY Program description Dimension assessed Times/year Client experience - : - POMEFA reports the following implementing partners Facility - The program is organized in the following way: - Competence of provider 52 Patient safety 12 All referrals, both within and outside of the franchise Adherence to clinical protocol 4 network, were tracked in the following ways: -

The program raised demand for health services by implementing the following strategies: community outreach by paid employees.

The network is linked to the public sector through the following mechanisms: referral links between franchisees and local public health facilities.

In 2013, the program generated revenue through the following strategies: the sale of technical or program assistance to franchisees.

Email contact: [email protected] Profiles | 63 Website: - FP Family planning UGANDA PAC Post abortion care Safe motherhood BlueStar Healthcare Network - Uganda STIs Sexually transmitted infections Marie Stopes Uganda MSI

Program at a glance COST Launch year 2011 Cost to operate the franchise program in 2013 (in USD): $2,551,944 Franchisee 102 districts, 4 regions distribution 80% rural and 20% urban Geographic spread EQUITY Franchised outlets 400 clinics or maternity homes 800 clients surveyed.

Franchisees 28 doctors; 592 nurses, midwives, or % of clients in each wealth quintile clinical assistants; and 400 diagnostic 1 (lowest) 31 professionals 2 (second lowest) 58 Health service areas FP, PAC, safe motherhood, STIs, and 3 (middle) 11 other services 4 (second highest) - Primary source of Donor 5 (highest) - program financing

Total # of visits 144,256 HEALTH IMPACT Total # of 117,281 individual clients DALYs averted: 456,872 CYPs: 401,005 served % contribution to overall health impact (DALYs averted) Total # of 37 0.09% 0.49% full-time staff FP MNCH Total # of 729 HIV/AIDS community outreach workers

Source of payments 10% out-of-pocket and 90% through for health services vouchers or subsidies 99.42%

Program description QUALITY BlueStar reports the following implementing partners: - Dimension assessed Times/year Client experience 4 The program is organized in the following way: doctor-run Facility 4 franchise facilities provide a full range of FP methods, Competence of provider 5 including permanent methods. The other franchise facilities, Patient safety 4 which are not managed by medical doctors, provide all FP Adherence to clinical protocol 2 services excepting permanent methods.

All referrals, both within and outside of the franchise network, were tracked in the following ways: through clinic-based outreach, and the distribution of vouchers or referral forms that were submitted to the franchisor on a subsidies for health services. monthly basis. Referrals were also generated using an SMS based platform (MarieTXT). This platform is also used by the The network is linked to the public sector through the franchisees to report each referral to the franchisor. following mechanisms: referral links between franchisees and local public health facilities, and linked patient data The program raised demand for health services by management systems. implementing the following strategies: radio advertising, community outreach by paid employees, community In 2013, the program generated revenue through the outreach by workers who receive commissions for referrals, following strategies: the sale of commodities to franchisees and franchisor fees.

Email contact: [email protected] Profiles | 64 Website: - FP Family planning UGANDA PAC Post abortion care Safe motherhood ProFam Program for Accessible Health Communication and Education (PACE) PSI

Program at a glance COST Launch year 2008 Cost to operate the franchise program in 2013 (in USD): $3,600,000 Franchisee 56 districts and 5 regions distribution 64% rural and 36% urban Geographic spread EQUITY Franchised outlets 181 clinics or maternity homes % of clients in each wealth quintile

Franchisees 41 doctors; 140 nurses, midwives, or 1 (lowest) - clinical assistants 2 (second lowest) - 3 (middle) - Health service areas FP, PAC, safe motherhood, and STIs 4 (second highest) - Donor Primary source of 5 (highest) - program financing

Total # of visits -

Total # of 119,985 HEALTH IMPACT individual clients : 436,899* : 362,107 served DALYs averted CYPs

Total # of 28 % contribution to overall health impact (DALYs averted) full-time staff 6.34% 0.38% FP Total # of 370 HIV/AIDS community Diarrhea/clean water outreach workers

Source of payments - *Does not include estimates for antenatal care and safe for health services 93.28% delivery services

Program description QUALITY ProFam’s partners include the MoH, Uganda Private Midwives Association, Association of Obstetricians and Dimension assessed Times/year Gynecologists of Uganda, and Uganda Family Planning Client experience 1 Consortium. Facility 1 Competence of provider 1 The program is organized in the following way: all facilities Patient safety 1 provide the full range of FP methods and cervical cancer Adherence to clinical protocol 1 screening. 66% of the clinics offer maternal health services.

All referrals, both within and outside of the franchise network, were tracked in the following ways: CHWs documented all contacts on a form that was submitted to The network is linked to the public sector through the the franchisor on a monthly basis. Each contact received a following mechanisms: radio advertising, community referral card, which they submitted to the franchisee at the outreach by volunteers, and clinic-based outreach. The point of service delivery. volunteers receive a stipend for transport and refreshments. The stipend is based on the number of referrals made. The program raised demand for health services by implementing the following strategies: radio advertising, In 2013, the program generated revenue through the community outreach by volunteers, community outreach following strategies: none. by workers who receive commissions for referrals, and clinic-based outreach.

Email contact: [email protected] Profiles | 65 Website: pace.org.ug FP Family planning UGANDA, KENYA Newborn or pediatric care Malaria Living Goods NCDs Noncommunicable diseases Safe motherhood Vision or dental care

Program at a glance COST Launch year 2007 Cost to operate the franchise program in 2013 (in USD): - Franchisee 23 provinces distribution 60% rural and 40% urban Geographic spread EQUITY Franchised outlets 907 health kiosks % of clients in each wealth quintile

Franchisees 907 CHWs 1 (lowest) - 2 (second lowest) - Health service areas FP, malaria, newborn or pediatric care, NCDs, safe motherhood, vision or dental 3 (middle) - care, and other services 4 (second highest) - 5 (highest) - Primary source of Donor program financing

Total # of visits 228,150 HEALTH IMPACT Total # of - : - : - individual clients DALYs averted CYPs served % contribution to overall health impact (DALYs averted) Total # of 50 N/A full-time staff

Total # of 0 community outreach workers QUALITY

Source of payments 100% out-of-pocket Dimension assessed Times/year for health services Client experience 0 Facility ≥ 12 Competence of provider ≥ 1 Program description Patient safety -- Living Goods reports the following implementing partners: - Adherence to clinical protocol --

The program is organized in the following way: -

All referrals, both within and outside of the franchise network, were tracked in the following ways: -

The program raised demand for health services by implementing the following strategies: billboards and posters, community outreach by paid employees, community outreach by workers who receive commissions for referrals, distribution of vouchers or subsidies for health services, and product demonstration events.

The network is linked to the public sector through the following mechanisms: none.

In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees.

Email contact: [email protected] Profiles | 66 Website: livinggoods.org FP Family planning VIETNAM Newborn or pediatric care NCDs Noncommunicable diseases BlueStar Vietnam PAC Post abortion cares Safe abortion Marie Stopes International in Vietnam Safe motherhood MSI STIs Sexually transmitted infections

Program at a glance COST Launch year 2008 Cost to operate the franchise program in 2013 (in USD): $360,411 Franchisee 7 provinces distribution - Geographic spread EQUITY* Franchised outlets 299 clinics or maternity homes % of clients in each wealth quintile

Franchisees 215 doctors; 84 nurses, midwives, or clin- 1 (lowest) - ical assistants; and 8 informal providers 2 (second lowest) - 3 (middle) - Health service areas FP, newborn or pediatric care, NCDs, PAC, safe abortion, safe motherhood, 4 (second highest) - STIs, and other services 5 (highest) -

Primary source of Donor *This program measured client wealth status through the use of the Progress Out of Poverty Index, which measures the percentage of program financing clientele that earn less than $1.25/day, a value used to gauge poverty. A study conducted in 2013 suggests that 95.37% of clients were poor. Total # of visits 758,392

Total # of - individual clients HEALTH IMPACT served DALYs averted: 16,397 CYPs: 139,514 Total # of 13 full-time staff % contribution to overall health impact (DALYs averted) - Total # of 20.38% community FP MNCH outreach workers STIs 57.24% 30% through vouchers or subsidies and Source of payments 22.39% for health services 70% unreported *Does not include estimates for cervical cancer screening and STI treatment services Program description

The BlueStar Vietnam Social Franchise is run in partnership QUALITY with local NGO partner Community Reproductive Health in Vietnam (VNCRH). Dimension assessed Times/year Client experience 2 The program is organized in the following way: - Facility 1 Competence of provider 1 All referrals, both within and outside of the franchise Patient safety 1 network, were tracked in the following ways: through client referral cards. Adherence to clinical protocol 2

The program raised demand for health services by implementing the following strategies: radio advertising, TV advertising, billboards and posters, community outreach The network is linked to the public sector through the by paid employees, community outreach by workers who following mechanisms: a common accreditation and quality receive commissions for referrals, clinic-based outreach, the oversight system. distribution of vouchers or subsidies for health services and gifts, and “other strategies.” In 2013, the program generated revenue through the following strategies: the sale of commodities to franchisees, the sale of technical or program assistance to franchisees, and franchisor fees.

Email contact: - Profiles | 67 Website: bluestar.org.vn NCDs Noncommunicable diseases VIETNAM TB Tuberculosis Good Health, Great Life Population Services International PSI

Program at a glance COST Launch year 2012 Cost to operate the franchise program in 2013 (in USD): $481,000 Franchisee 4 provinces distribution 32% rural and 68% urban Geographic spread EQUITY Franchised outlets 150 clinics or maternity homes % of clients in each wealth quintile

Franchisees 149 doctors and 1 nurse, midwife, or 1 (lowest) - clinical assistant 2 (second lowest) - 3 (middle) - Health service areas NCDs and TB 4 (second highest) - Donor Primary source of 5 (highest) - program financing

Total # of visits -

Total # of 18,315 HEALTH IMPACT individual clients : - : - served DALYs averted CYPs

Total # of 4 % contribution to overall health impact (DALYs averted) full-time staff Diarrhea/clean water Total # of 2 community 100% outreach workers

Source of payments 100% out-of-pocket for health services

QUALITY Program description Dimension assessed Times/year Good Health, Great Life reports the following Client experience 0 implementing partners: - Facility 2 Competence of provider 2 The program is organized in the following way: - Patient safety 2 All referrals, both within and outside of the franchise Adherence to clinical protocol 2 network, were tracked in the following ways: program staff tracked referrals through in-person or phone communication to follow up on referral results.

The program raised demand for health services by In 2013, the program generated revenue through the implementing the following strategies: community out- following strategies: the sale of commodities to reach by volunteers, community outreach by workers who franchisees. receive commissions for referrals, and clinic-based outreach.

The network is linked to the public sector through the following mechanisms: referral links between franchisees and local public health facilities, linked patient data man- agement systems, and a common accreditation and quality oversight system.

Email contact: [email protected] Profiles | 68 Website: - VIETNAM Newborn and pediatric care Mat Troi Be Tho Alive & Thrive project Save the Children

Program at a glance COST Launch year 2011 Cost to operate the franchise program in 2013 (in USD): $1,354,644 Franchisee 15 provinces distribution 75% rural and 25% urban Geographic spread EQUITY Franchised outlets 776 public sector facilities (1 at national, % of clients in each wealth quintile 48 provincial, 67 district and 660 com- mune) and 5 private sector providers 1 (lowest) - 2 (second lowest) - 650 doctors; 1700 nurses, midwives, Franchisees 3 (middle) - clinical assistants and counselors 4 (second highest) - Health service areas infant and young child feeding 5 (highest) - counseling package and other services

Primary source of Donor program financing HEALTH IMPACT Total # of visits 1,706,000 (from 1/2012 to 4/2014) DALYs averted: - CYPs: - Total # of 515,000 (from 1/2012 to 4/2014) (DALYs averted) individual clients % contribution to overall health impact served N/A Total # of 2,350 full-time staff

Total # of 14,100 QUALITY community outreach workers Dimension assessed Times/year Client experience 4 Public sector subsidized Source of payments Facility 4 for health services Competence of provider 4 Patient safety 4 Program description Adherence to clinical protocol 4 Mat Troi Be Tho (Alive and Thrive) is run in partnership with Save the Children International in Vietnam, the National Institute of Nutrition (in Vietnam), FHI 360, and the Department of Health (DoH) in 15 provinces of Vietnam. digital banners, mini-events, and community outreach by volunteers. The program is organized in the following way: a total of 9–15 counseling contacts (individual and/or group) are The network is linked to the public sector through the provided per mother/child over a 27 month period (from the following mechanisms: the social franchise program was set third trimester of pregnancy until the child is 24 months old). up in the public health system and operates in provincial, district, and commune level health facilities. The National All referrals, both within and outside of the franchise Institute of Nutrition (in Vietnam) is the co-franchisor, while network, were tracked in the following ways: follow-up the provincial Departments of Health operate as sub- with mothers and the use of cards to monitor services for franchisors. the mother and baby. In 2013, the program generated revenue through the The program raised demand for health services by following strategies: sale of mother-child booklets, fee-for- implementing the following strategies: community based service, and sale of micro-nutrient powders. loudspeaker systems, TV advertising, billboards and posters, bus wraps, LCD displays in supermarkets and hospitals,

Email contact: [email protected] Profiles | 69 Website: matroibetho.vn FP Family planning VIETNAM Safe abortion Safe motherhood Tinh Chi Em STIs Sexually transmitted infections Marie Stopes International in Vietnam/Provincial DoHs MSI

Program at a glance COST Launch year 2007 Cost to operate the franchise program in 2013 (in USD): $256,000 Franchisee 5 provinces distribution 80% rural and 20% urban Geographic spread EQUITY Franchised outlets 181 clinics or maternity homes and 20 % of clients in each wealth quintile health kiosks 1 (lowest) - Franchisees 171 doctors; 513 nurses, midwives, or 2 (second lowest) - clinical assistants; 171 pharmacists or 3 (middle) - drug vendors; 342 diagnostic professionals; 350 CHWs; and 151 4 (second highest) - traditional healers 5 (highest) -

Health service areas FP, safe abortion, safe motherhood, and STIs

Primary source of - HEALTH IMPACT program financing DALYs averted: 9,656* CYPs: 142,819 Total # of visits 3,804,258 % contribution to overall health impact (DALYs averted) Total # of - 2.35% 5.39% individual clients FP served MNCH HIV/AIDS Total # of - full-time staff *Does not include estimates for cervical cancer screening - and treatment, post-natal Total # of 92.26% care, and safe delivery community services outreach workers

Source of payments 30% out-of-pocket, 40% through social health insurance, and 30% through for health services QUALITY vouchers or subsidies Dimension assessed Times/year Client experience 3 Program description Facility 2 Competence of provider 2 Tinh Chi Em is run in partnership with provincial Patient safety 2 Departments of Health. Adherence to clinical protocol 2 The program is organized in the following way: -

All referrals, both within and outside of the franchise network, were tracked in the following ways: franchisees maintained records of client visits, including details on The network is linked to the public sector through the referrals. following mechanisms: -

The program raised demand for health services by In 2013, the program generated revenue through the implementing the following strategies: radio advertising, following strategies: - billboards and posters, community outreach by paid employees, community outreach by volunteers, community outreach by workers who receive commissions for referrals, and clinic-based outreach.

Email contact: [email protected] Profiles | 70 Website: - FP Family planning YEMEN Safe abortion Safe motherhood Rayaheen Marie Stopes International MSI

Program at a glance COST Launch year 2010 Cost to operate the franchise program in 2013 (in USD): - Franchisee 7 provinces distribution 98% rural and 2% urban Geographic spread EQUITY Franchised outlets 97 clinics or maternity homes % of clients in each wealth quintile

Franchisees 200 nurses, midwives, or clinical assis- 1 (lowest) - tants 2 (second lowest) - 3 (middle) - Health service areas FP, safe abortion, safe motherhood, and other services 4 (second highest) - 5 (highest) - Primary source of Donor program financing

Total # of visits 241,221 HEALTH IMPACT Total # of 187,132 : 11,354* : 20,501 individual clients DALYs averted CYPs served % contribution to overall health impact (DALYs averted) 1 Total # of 0.56% full-time staff FP MNCH Total # of 0 community outreach workers *Does not include estimates for breastfeeding promotion Source of payments 100% out-of-pocket and safe delivery services for health services 99.44%

Program description QUALITY Dimension assessed Times/year Rayaheen is run in partnership with the Yemeni National Midwives Association. Client experience 0 Facility 3 The program is organized in the following way: - Competence of provider 1 Patient safety 3 All referrals, both within and outside of the franchise Adherence to clinical protocol 0 network, were tracked in the following ways: through the use of monthly reports.

The program raised demand for health services by implementing the following strategies: billboards and posters, community outreach by paid employees, and distribution of brochures and promotional materials.

The network is linked to the public sector through the following mechanisms: none.

In 2013, the program generated revenue through the following strategies: -

Email contact: [email protected] Profiles | 71 Website: yemen.mariestopes.org FP Family planning ZAMBIA PAC Post abortion care BlueStar Healthcare Network Marie Stopes Zambia MSI

Program at a glance COST Launch year 2012 Cost to operate the franchise program in 2013 (in USD): - Franchisee 3 provinces distribution 100% urban Geographic spread EQUITY Franchised outlets 21 clinics or maternity homes % of clients in each wealth quintile

Franchisees 2 doctors and 21 nurses, midwives, or 1 (lowest) - clinical assistants 2 (second lowest) - 3 (middle) - Health service areas FP and PAC 4 (second highest) - Donor Primary source of 5 (highest) - program financing

Total # of visits 5,565

Total # of - HEALTH IMPACT individual clients : - : - served DALYs averted CYPs

Total # of 1 % contribution to overall health impact (DALYs averted) full-time staff 3.54% 14.54% FP Total # of 0 MNCH community HIV/AIDS outreach workers

Source of payments - for health services 81.92%

Program description QUALITY BlueStar reports the following implementing partners: - Dimension assessed Times/year Client experience 1 The program is organized in the following way: - Facility 1 All referrals, both within and outside of the franchise Competence of provider 1 network, were tracked in the following ways: not tracked. Patient safety 1 Adherence to clinical protocol 1 The program raised demand for health services by implementing the following strategies: billboards, posters, and other.

The network is linked to the public sector through the following mechanisms: some of the franchisees have a written or verbal agreement to refer complicated cases to the public health system.

In 2013, the program generated revenue through the following strategies: franchisor fees.

Email contact: [email protected]; [email protected],zm Profiles | 72 Website: - Family planning HIV/AIDS Post abortion care ZAMBIA New Start Society for Family Health, Zambia PSI

Program at a glance COST Launch year 2002 Cost to operate the franchise program in 2013 (in USD): - Franchisee 8 provinces distribution 100% urban Geographic spread EQUITY Franchised outlets - % of clients in each wealth quintile

Franchisees - 1 (lowest) - 2 (second lowest) - Health service areas HIV/AIDS 3 (middle) - Primary source of Donor 4 (second highest) - program financing 5 (highest) - Total # of visits -

Total # of 239,669 individual clients HEALTH IMPACT served DALYs averted: 59,318 CYPs: Total # of - full-time staff % contribution to overall health impact (DALYs averted)

Total # of - HIV/AIDS community outreach workers 100%

Source of payments - for health services

Program description QUALITY New Start reports the following implementing partners: - Dimension assessed Times/year Client experience 0 : - The program is organized in the following way Facility 1 All referrals, both within and outside of the franchise Competence of provider 2 network, were tracked in the following ways: not tracked. Patient safety 1 Adherence to clinical protocol 1 The program raised demand for health services by implementing the following strategies: community outreach by paid employees and community outreach by volunteers.

The network is linked to the public sector through the fol- lowing mechanisms: referral links between franchisees and local public health facilities, and a common accreditation and quality oversight system.

In 2013, the program generated revenue through the following strategies: strategy not defined.

Email contact: [email protected] Profiles | 73 Website: - FP Family planning ZIMBABWE PAC Post abortion care BlueStar Healthcare Network Population Services Zimbabwe MSI

Program at a glance COST Launch year 2012 Cost to operate the franchise program in 2013 (in USD): $467,237 Franchisee 8 provinces distribution 20% rural and 80% urban Geographic spread EQUITY Franchised outlets 40 clinics or maternity homes % of clients in each wealth quintile

Franchisees 42 doctors; 40 nurses, midwives, or clini- 1 (lowest) - cal assistants; and 4 informal providers 2 (second lowest) - 3 (middle) - Health service areas FP and PAC 4 (second highest) - Donor Primary source of 5 (highest) - program financing

Total # of visits 55,487

Total # of - HEALTH IMPACT individual clients : 19,740 : 35,284 served DALYs averted CYPs

Total # of 4 % contribution to overall health impact (DALYs averted) full-time staff 0.1% FP Total # of 0 MNCH community outreach workers

Source of payments 60% out-of-pocket, 25% through social health insurance, 15% through vouchers for health services 99.9% or subsidies

Program description QUALITY Dimension assessed Times/year BlueStar is run in partnership with the Zimbabwe National Client experience 1 Family Planning Council (ZNFPC). Facility 4 The program is organized in the following way: - Competence of provider 4 Patient safety 4 All referrals, both within and outside of the franchise Adherence to clinical protocol 4 network, were tracked in the following ways: all referrals were entered in a register and program staff conducted telephone follow-up to ensure the utilization of services.

The program raised demand for health services by In 2013, the program generated revenue through the implementing the following strategies: radio advertising, following strategies: the sale of commodities to franchisees billboards and posters, the distribution of vouchers or and franchisor fees. subsidies for health services, and participation in national events such as World Family Planning Day, International Youth Games, and the National Trade Fair.

The network is linked to the public sector through the fol- lowing mechanisms: referral links between franchisees and local public health facilities.

Email contact: [email protected] Profiles | 74 Website: - Family planning Post abortion care

APPENDIX: RESOURCES AND PUBLICATIONS

Programs reported that they produced the Overview of the Social Franchise Model for Delivering Counseling Services on Infant and Young Child Feeding (2013) following resources and publications on franchising and health within the past three years: http://www.aliveandthrive.org/resource/overview-social- franchise-model-delivering-counseling-services-infant- and-young-child-feedi CFW Clinics in Kenya: To Profit or Not for Profit. Rangan, V.K., Performance Improvement Recognition: Private Providers of et al., 2011. Reproductive Health Services in Peru. James, E., et al., 2012. http://hbr.org/product/cfw-clinics-in-kenya-to-profit-or-not- http://abtassociates.com/Reports/2012/Performance- for-profit/an/512006-PDF-ENG Improvement-Recognition--Private-Provi.aspx Case study on World Health Partners. Chavali, A., 2011 Physicians in private practice: reasons for being a social http://www.accessh.org/CaseStudies_Pdf/WorldHealth franchise member. Huntington, D., et al., 2012. Partners.pdf http://www.health-policy-systems.com/content/10/1/25 Determining the cost-effectiveness of managing acute diarrhea Rates of IUCD discontinuation and its associated factors among through social franchising of ORASEL: a randomized controlled the clients of a social franchising network in Pakistan. Azmat, trial. Bishai, B., et al., 2013. S.K., et al., 2012. http://www.sciencedirect.com/science/article/pii/ http://www.biomedcentral.com/1472-6874/12/8 S0140673613612714 Scaling Mobile Health Solutions the Hard Way. Slaughter C., Equity and the Sun Quality Health Private Provider Social 2013. Franchise: comparative analysis of patient survey data and a nationally representative TB prevalence survey. Montagu, D., http://www.ssireview.org/blog/entry/scaling_mobile_health_ et al., 2013. solutions_the_hard_way http://www.equityhealthj.com/content/12/1/5 Social Franchising and Vouchers to Promote Long-Term Methods of Family Planning in Rural Pakistan: A Qualitative Knowledge and perception of Intrauterine Devices (IUDs) Stocktaking with Stakeholders. Azmat, S.K., et al., 2013. among Family Planning Providers in Nepal. Chakraborty, N., et al., 2013. http://www.ncbi.nlm.nih.gov/pubmed/24386730 http://www.psi.org/resources/research-metrics/publications/ Social Franchise Case Study - Madagascar’s Top Réseau iuds/knowledge-and-perceptions-intrauterine- Network. Population Services International, 2012. devices-iuds-amo http://www.psi.org/resources/research-metrics/publications/ Impact of Social Franchising on Contraceptive Use when /social-franchising-case-study-madagascars- Completed by Vouchers: A Quasi-Experimental Study. Azmat, top-r%C3%A9seau-net S.K., et al., 2013. Spotlight on Living Goods: Uganda, 2013. http://www.plosone.org/article/info%3Adoi%2F10.1371%2F http://mobilemamaalliance.org/sites/default/files/1749- journal.pone.0074260 MAMA-Spotlight-June-v1-JH_1.pdf Incidence of pediatric diarrhea and public-private preferences Strengthening systems to support mothers in infant and young for treatment in rural Myanmar: a randomized cluster survey. child feeding. Sanghvi, T., et al., 2013. Aung, T., et al., 2012. http://www.ncbi.nlm.nih.gov/pubmed/24261074 http://www.ncbi.nlm.nih.gov/pubmed/22874876 The impact of a novel franchise clinic network on access to Incorporating elements of social franchising in government medicines and vaccinations in Kenya: a cross-sectional study. health services improves the quality of infant and young child Berk, J., et al., 2012. feeding counselling services at commune health centres in Vietnam. Rawat, R., et al., 2013. http://bmjopen.bmj.com/content/2/4/e000589.full http://heapol.oxfordjournals.org/content/early/2013/11/14/ Using and Joining a Franchised Private Sector Provider Network heapol.czt083.short in Myanmar. O’Connell, K., et al., 2011. Integration of Family Planning (FP) into HIV Care and Treatment http://www.plosone.org/article/info%3doi%2F10.1371%2F Services for PLHIV: Provider Experiences. Ng, C., et al., 2012. journal.pone.0028364 http://www.capacityplus.org/files/resources/integrating- family-planning-hiv-aids-services-health-workforce- considerations.pdf

Appendix: Resources and Publications | 75 Validation of a New Method for Testing Provider Clinical Quality Working Paper: Findings of an 18-month assessment of the in Rural Settings in Low- and Middle-Income Countries: The effectiveness of a rural-based social franchising programme Observed Simulated Patient. Aung, T., et al., 2012. using vouchers of long-term family planning services in http://www.plosone.org/article/info%3Adoi%2F10.1371%2F Pakistan. Azmat, S.K., 2012. journal.pone.0030196 http://mariestopespk.org/wp-content/uploads/Research- Monitoring-and-Evaluation.pdf What obstacles do rural Indian women face when attempting to end an unwanted pregnancy? Reichwein, B., et al., 2013. http://www.mariestopes.org/sites/default/files/What- obstacles-do%20-rural-indian-women-face-when- attempting-to-end-an-unwanted-pregnancy.pdf

Appendix: Resources and Publications | 76

globalhealthsciences.ucsf.edu/global-health-group sf4health.org

The Global Health Group at the University of California, SF4Health is a community of implementers, donors, San Francisco (UCSF) is an “action tank,” dedicated to and researchers from around the world. The community translating major new paradigms in global health into works together to increase the impact, reach, quality, large-scale action to positively impact the lives of millions and cost of clinical social franchising services. Visit the of people. The Global Health Group’s Private Sector sf4health.org website to learn about the community. Healthcare Initiative (PSHi) works to advance the sf4health.org is also home to many resources, including: understanding of private sector healthcare provision in developing countries, to strengthen the evidence base on • The 2009, 2010, 2011, 2012, 2013, and 2014 Clinical Social Franchising the private health sector, and to inform programmatic and editions of the Compendium policy innovations that improve healthcare delivery and public health. • Quality assurance tools used by franchise programs around the world, and a briefing paper on strategies to assess the quality of clinical services • Newsletters and updates on social franchising conferences, events, and research • Case studies that document social franchise programs from many countries

To view a directory of programs around the world that are applying health market innovations to improve privately delivered healthcare for the poor, visit the Center for Health Market Innovations (CHMI) website at healthmarketinnovations.org. The programs profiled in this publication will also be featured within the CHMI database of programs.