SCALING UP EARLY CHILDHOOD DEVELOPMENT (ECD) (0-4 YEARS) IN SOUTH AFRICA

Support Structures

Dena Lomofsky

Managing Director / Senior Consultant Southern Hemisphere Consultants ([email protected]) Valerie Flanagan

Director Development Alternatives ([email protected]) Liezl Coetzee

Senior Consultant Southern Hemisphere Consultants ([email protected])

July 2008

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Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

Human Sciences Research Council July 2008

Acknowledgements We gratefully acknowledge the support of the Interdepartmental Committee for Early Childhood Development and the Director-General's Social Cluster. This project was co-funded by the Department of Education, the W.K. Kellogg Foundation and the HSRC. The Interdepartmental Committee for Early Childhood Development acted as a Reference Group for the project. This committee is chaired by the Department of Social Development and includes representatives from the Departments of Education, Health, Arts and Culture, and Public Works, and the Office on the Rights of the Child in the Presidency.

The authors' views expressed in this publication do not necessarily reflect the views of the Interdepartmental Committee for Early Childhood Development, the Department of Education or the W.K. Kellogg Foundation.

The authors would particularly like to thank members of the HSRC research team Miriam Altman, Linda Biersteker, Prof. Andy Dawes, Judith Streak and members of the Interdepartmental Committee for Early Childhood Development for their input and guidance on this report. We would also like to thank all the organisations that participated in the primary research and shared their valuable insights with us.

Produced by: Dena Lomofsky, Valerie Flanagan and Liezl Coetzee Contact: Dr Miriam Altman Executive Director: CPEG, HSRC E-mail: [email protected] Tel: +27 12 302 2402

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Contents

Figures ...... 4 Boxes ...... 5 Acronyms ...... 6 Executive summary ...... 7 1. Introduction ...... 14 1.1 Brief description of the context...... 16 1.1.1 Extent of provision ...... 16 1.1.2 Role-players and linkages in the sector ...... 17 1.1.3 Funding and capacity ...... 20 2. Support organisations as intermediaries providing linkages in the sector 27 3. Models or supervisory structures for scaling up ECD provision in South Africa ...... 34 3.1 Social franchising ...... 34 3.1.1 What is social franchising? ...... 34 3.1.2 How social franchises roll out ...... 36 3.1.3 Monitoring and quality assurance...... 37 3.1.4 Forms of social franchising – standardisation ...... 38 3.1.5 Funding franchises ...... 40 3.1.6 Making franchises sustainable ...... 41 3.1.7 Crucial considerations and lessons learnt in choosing a franchise model ...... 46 3.2 Networks and associations ...... 49 3.2.1 Advantages ...... 52 3.2.2 Limitations ...... 52 3.3 Capacity building and resource models ...... 53 3.3.1 Advantages ...... 54 4. Approaches to service delivery ...... 57 5. Conclusions and considerations for model(s) of support...... 59 References ...... 63 Appendix 1 – Case studies ...... 67 6. International case studies ...... 67 6.1 Social franchise model ...... 67 6.1.1 Green Star – Pakistan ...... 67 6.1.2 Green Key – Pakistan ...... 70 6.1.3 Biruh Tesfa – Ethiopia ...... 70 6.1.4 Mobile for Good (M4G) – Kenya ...... 71 6.1.5 NFTE – New York to Global ...... 73 6.1.6 Mary Stopes International (MSI) – Honduras and Nicaragua ...... 73

3 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

6.1.7 Integrated Maternal Child Care Services and Development Inc. (IMCCSDI) Philippines ...... 75 6.1.8 Janani – India...... 79 6.1.9 Planned Parenthood Federation of America (PPFA) ...... 84 6.1.10 The STRIVE programme – USA ...... 85 6.1.11 MS Society – London ...... 85 6.2 Joint venture model ...... 86 6.2.1 Fundacion Mexicana para la Planeacion Familiar (Mexfam) – Mexico ...... 86 6.3 Community model ...... 88 6.3.1 FAD, Teens Healthquarters – Manila, Philippines ...... 88 6.4 Private provider model ...... 90 6.4.1 K-MET, Kenya ...... 90 6.4.2 TOP Reseau, Madagascar ...... 91 6.5 Governmental model ...... 93 6.5.1 Gold Star Project, Egypt ...... 93 7. South African examples ...... 95 7.1 NOAH ...... 95 7.1.1 The NOAH social franchising system ...... 95 7.1.2 Support provided to NOAH franchisees ...... 97 7.1.3 Benefits associated with this franchising model ...... 98 7.1.4 Some pitfalls of social franchising and lessons learned ...... 98 7.2 loveLife ...... 99 7.2.1 The loveLife social franchising system ...... 100 7.2.2 Support provided to loveLife franchisees ...... 100 7.2.3 Benefits associated with this franchising model ...... 101 7.2.4 Some pitfalls of social franchising and lessons learned ...... 101 References ...... 102 Figures

Figure 1 – Role-players in the ECD sector ...... 19 Figure 2 – Cluster map in relation to an ECD site, for example, a formal ECD centre ...... 24 Figure 3 – Needs of children at home ...... 25 Figure 4 – Cluster map with intermediary organisations ...... 29 Figure 5 – Model where the ECD centre is central to support for vulnerable children at community level ...... 33 Figure 6 – Continuum of social franchising ...... 40 Figure 7 – The NOAH model ...... 46 Figure 8 – Example of a capacity building model ...... 54 Figure 9 – Structure of the Janani social franchise ...... 81 Figure 10 – NOAH model ...... 97

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Boxes

BOX 1 – Funding mechanisms and types as per the ISDM ...... 22 BOX 2 – Typical franchising techniques ...... 35 BOX 3 – Monitoring at the PPFA ...... 38 BOX 4 – loveLife case study of a pure social franchise model ...... 42 BOX 5 – Isibindi as an example of a pure social franchise model with core and elective components ...... 43 BOX 6 – NOAH as an adaptive approach to social franchising ...... 45 BOX 7 – The African Self Help Association ...... 50 BOX 8 – Ithemba Labantwana ...... 51 BOX 9 – Ntataise Network Support Project ...... 51 BOX 10 – C.A.P.E...... 51 BOX 11 – Setting up of franchises ...... 74 BOX 12 – Introduction into the community ...... 76 BOX 13 – Janani financial schemes ...... 82 BOX 14 – Monitoring at the PPFA ...... 84

5 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

Acronyms

ASHA African Self Help Association C.A.P.E. Cape Action for People and the Environment CBO Community-based Organisation CSO Civil Society Organisation DBSA Development Bank of Southern Africa DEA&DP Department of Environmental Affairs and Development Planning DEAT Department of Environmental Affairs and Tourism DoA Department of Agriculture DoE Department of Education DoH Department of Health DoL Department of Labour DoSD Department of Social Development DWAF Department of Water Affairs and Forestry ECD Early Childhood Development ELRU Early Learning Research Unit EPWP Expanded Public Works Programme ETDP SETA Education, Training and Development Practices Sector Education and Training Authority FBO Faith-based Organisation FET Further Education and Training HCBC Home- and Community-based Care HIPPY Home Interaction Programme HSRC Human Sciences Research Council ISDM Integrated Service Delivery Model M&E Monitoring and Evaluation MRN Mentoring Resource Network NACCW National Association of Child Care Workers NGO Non-governmental Organisation NIP National Integrated Plan (for ECD) NOAH Nurturing Orphans of AIDS for Humanity NPO Not-for-Profit Organisation OD Organisational Development OVC Orphans and Vulnerable Children PEPFAR President’s Emergency Plan for AIDS Relief (USAID) PPFA Planned Parenthood Federation of America PVO Private Volunteer Organisation RTO Resource and Training Organisation SACECD South African Congress of Early Childhood Development SANPARKS South Africa National Parks TREE Training and Resources in Early Education UNICEF United Nations Children’s Fund

6 Support Structures

Executive summary

Support structures for scaling up the National Integrated Plan (NIP) for Early Childhood Development (ECD)

This paper forms part of a larger research project concerning Early Childhood Development, commissioned by the Human Sciences Research Council (HSRC) in 2007. The various papers in this series present the considerations for scaling up ECD, ranging from budgeting to monitoring outcomes. The aim of this paper is to consider various options for support structures and mechanisms that could facilitate the implementation of the NIP for ECD, and to address the strategic priorities contained therein for scaling up of ECD in South Africa. In particular, we focus on how state and civil society institutions can work together using different models of support, including social franchising, networks and associations, and capacity building and resource organisations.

Findings

In order to reach the sheer numbers of children and caregivers as intended by the NIP, government is likely to have to employ a number of different strategies. This paper highlights that support structures could be useful to facilitate the integration that is foreseen in the NIP. The use of support structures should assist government to extend the reach and quality of ECD services, considering the gap that exists between the large state bureaucracy and community-level organisations. The use of support structures does not preclude the need for government to bolster its own service delivery capacity, which in fact may be necessary anyway, or for government to engage effectively with intermediaries It should be noted that ‘intermediary support’ does not necessarily refer to the establishment of new institutions, but rather to mobilising the support of existing organisations and service providers to the sector.

This paper identifies the different role-players in the sector and the range of services needed for centre- and home-based (child minder / primary caregiver) provision in order to understand the type of linkages that improved integration should facilitate. Understanding the context in which ECD organisations operate is also important to inform the role of support organisations. Two critical constraints in the sector are funding and capacity constraints, which is typical of the not-for-profit sector generally. To facilitate access to centre-based care, ECD centres can qualify for subsidies, but many find it difficult to navigate the red tape and meet the requirements for registration. There are also backlogs in registration with the Department of Social Development (DoSD). Regarding funding, even though there are massive state resources allocated to ECD, they are not reaching the grassroots as effectively as intended, and provincial Departments have to choose between scale and quality of service provision. Further, many not-for-profit organisations (NPOs) such as the well-established resource and training organisations that could assist the sector do not have sufficient funds to reach enough of the target and beneficiary groups. The Integrated Service Delivery Model (ISDM) of the DoSD provides six different funding mechanisms to engage the non-state sector, and these mechanisms should be harnessed for the ECD sector. Other means of ensuring the flow of funding to the

7 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

sector should also be considered. Quality is another critical consideration; again the DoSD currently does not have sufficient internal capacity to monitor registered centres as per their legal mandate. Support organisations could facilitate improvements in three key areas – support to organisations and to government regarding registration of providers, seeing that funds and capacity flow to the sector, and monitoring and supervising quality implementation. Facilitating access to capacity building and resources will also be critical.

There is also a need to develop more programmes and means to reach the caregivers and children who are not linked to formal centres, as well as to upgrade the quality of service provision in these centres. Support organisations could be critical for rolling out tested models into the sector.

Support organisations could facilitate critical linkages within and between the state, NPO and private sector service providers, academic institutions, local government, community structures and the ECD site (for example, family, community and formal). Support organisations can serve primarily as brokers of information and appropriate technologies, mobilisers of resources, networkers to strengthen institutional linkages, and trainers and product enhancers. The specific services that need to be rendered in the sector are professional and personal development for improving caregiving and management, access to improved nutrition and welfare services, materials and resources, organisational development (including fundraising), and networking and external relations. Although professionalising the sector may be controversial, it is unavoidable where massification and upscaling quality are concerned.

Three main models of support structures are investigated in this paper: 1) social franchises; 2) networks, associations and support organisations; and 3) capacity- building and resource organisations. Each of these could be used in different ways to support the integration envisaged in the NIP, and in fact already exists in the sector in various forms.

Social franchising is a term used fairly loosely to describe a number of different methodologies related to scaling up delivery of a particular social programme concept. Social franchising facilitates a situation where an organisation has developed a blueprint model and then seeks to scale-up or scale-out its model using a hub-and- spoke approach. It is based on the business-franchising concept, but has social rather than profit-making goals. Social franchising should be viewed on a continuum where the degree of replication of the model is the key differentiator. Examples of franchises in the ECD sector in South Africa are Nurturing Orphans of AIDS for Humanity (NOAH) and the Isibindi model of the National Association of Child Care Workers (NACCW). Another well-known example of a social franchise in South Africa is loveLife. Pure social franchising occurs when the model is replicated exactly no matter where the programme is delivered, while adaptive social franchising occurs where the model is adapted to degrees. However, the common denominators within a franchise should always be branding, adherence to norms and standards, working towards common objectives, and collecting and reporting on monitoring data. In social franchising situations, institutions or organisations are able to step into a social franchise-type model quickly without having to bear the development costs of designing the model, and avoids other pitfalls such as duplication. In addition, because the model has already been proven to be effective, this allows the organisation to tap into funding resources on its own account without necessarily

8 Support Structures

having to rely only on the central organisation to access these. Franchisees can either be stand-alone organisations or a franchised product could be added to an existing offering. Typical social franchising techniques include promotion and marketing, training and capacity building, quality assurance and standardisation of services, information sharing and referral mechanisms, cost recovery mechanisms (if possible), and use of franchise contracts. Although very useful for extending the reach of a social programme concept, social franchising itself needs a pool of suitable potential franchisees, and particular skill sets are needed for implementation. It must be noted that only a small number of examples in the literature refer to reaching the vast numbers of beneficiaries that the NIP envisages. In fact, one of the main challenges with social franchising is maintaining quality standards as networks rapidly expand and as supervision structures become stretched. A possible solution is to have a number of franchises that operate in different geographical locations and/or that offer a particular set of services. Further, franchises can decentralise aspects (such as training) to local non-governmental organisations (NGOs), which also allows the programme to support local capacity for service.

Networks and associations are another modality of support that exist in the sector. Here organisations associate with each other yet are not required to implement a specific model. Networks can have differing degrees of formality, ranging from highly structured and formalised to loose associations. Networks typically facilitate information exchange, collaboration, mutual support, capacity building, research and/or distribution of funding to member bodies. Membership could include NGOs, community-based organisations (CBOs), relevant government departments, representatives of local government, community forums and faith-based groups. Prominent examples of networks in the ECD sector are the African Self Help Association (ASHA) that supports 40 pre-schools, Ikamva Labantu that supports the Ikamva Labantwana network of 350 member ECD sites, and the Ntataise Network Support Project which has 16 training organisations as members, all licensed to conduct the Ntataise training. The latter includes a social franchising component in terms of its training model. Networks are good means of creating linkages in the sector and can strengthen the organisations that participate in the network. Members of networks can also form consortia to tender for a range of government services. Grassroots networks can further assist to draw in home-based child minders. Networks and associations can also provide good monitoring mechanisms. Potential limitations of networks include the possibility of inducing competition for funding among member organisations, poor governance structures, and unequal power relations between members in the network. Networks can also give the appearance of providing greater coverage than is often the reality in practice, and need investment in their own capacity if they are to take on new responsibilities.

Capacity building and resource models are the third form of support that can be used in the sector. Capacity building is used in this document as incorporating a combination of training (including on-site, in-service and follow-up support), mentoring and monitoring. Capacity building and resource models would employ cascading-type methodologies to build a cadre of NPOs that can provide this type of support at the grassroots level. This type of capacity-building model is being piloted in the Home- and Community-Based Care (HCBC) sector by the DoSD (HCBC management capacity-building model). Capacity building and resource models are advantageous in that they can focus on building capacity in the sector, and can build a layer of capacity building and resource NGOs that will remain in under-serviced areas

9 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

and can assist organisations in other sectors as well. Capacity building organisations themselves are mostly NPOs, understand the challenges faced by the not-for-profit sector and have stronger community linkages than government departments. They can provide the ongoing mentoring needed to help organisations mature; through research, monitoring and evaluation they can apply best practices directly in their service delivery and training; and they can tailor make the intervention depending on the stage of development of the organisation that they are assisting. Despite these positives there are also numerous challenges that this type of support organisation face: professionalisation does not always have the desired impacts and at times can disrupt the organic cohesion that exists amongst small community-based organisations. As mentoring is a very personal process, personality differences between mentor and mentoree do occur. Mentoring is a specialised skill and it is difficult to find good mentors. There is also the possibility that a culture of dependency can occur whereby the organisation becomes reliant on the mentor and is not able to stand on its own feet.

Having looked at these possible models of support, it is clear that they often employ similar techniques and methods (that is, social franchisees can also form networks, and typically also employ capacity building for their members). Further, they are not mutually exclusive – a franchisee could belong to a community-based network and benefit from the services of a capacity-building and resource organisation. The key, however, is that each of these models provides inherent support and co-ordinating mechanisms that could be useful to assist government with the integration required to extend the reach of quality ECD.

In the last section, the importance of community participation and the use of partnerships is highlighted, irrespective of which model is employed. Various approaches to owning and operating social franchises are also covered – joint venture or partnership approaches, the private provider model and the governmental model.

Conclusions

In conclusion, the paper raises certain key issues for government stakeholders when considering the relevance and usefulness of support structures.

The contribution of this paper to the broader series is to explore whether support organisations as intermediaries between government and civil society organisations (CSOs) could assist with the rapid scaling up of quality ECD in South Africa. In this paper the role-players and linkages in the sector are presented in relation to the three levels of service provision as foreseen in the NIP – family, community and formal. Understanding the role-players, linkages and constraints in the sector helps to define the role that support organisatios could play. A full sector and situation analysis was, however, beyond the scope of this paper, but would be a useful exercise when planning the roll-out of the NIP. The purpose of support models or intermediary organisations would be to facilitate integration in the ECD sector between government, state and the civil society sector. The aim therefore has been to look for models of supervisory structures (franchise approaches, networks and associations, and capacity building and resource organisations) that can pull together and assist service providers so that more consistent delivery of agreed programmes of ECD could be delivered. The use and strengthening of support organisations do not preclude the bolstering of government’s own capacity to scale up ECD. Rather,

10 Support Structures

models of support should be seen as enablers, and used to unblock some of the constraints that arise from the structural gaps between government as a large bureaucracy and the CSOs working at community level. Support structures should facilitate the integration as envisaged in the NIP, particularly between government and civil society, and between CSOs, and build a stronger, more cohesive sector to allow government to meet its policy obligations as contained in the NIP and take quality ECD up to scale.

Support organisations could assist with integration

The inter-departmental structures envisaged in the NIP should co-ordinate the co-operation between government departments. The NIP refers to the important role of the non-governmental sector in helping to deliver on its objectives, and says that civil society organisations will be included, consulted and co-opted through appropriate legal procedures to assist the state with service delivery. However, it does not suggest any concrete mechanisms for doing this. The role of support structures, whichever form they take, could primarily be to provide these mechanisms, to facilitate the work of the inter-departmental committees and to structure the relationship between the state and civil society so that the ECD can be delivered in an integrated manner, with true inter-sectoral collaboration. The overall aim will be to facilitate ‘NIP in action’.

Support organisations could assist with the pace, reach and quality of scaling up ECD

Given current capacity, government alone is not likely to cope with extending the reach and pace of scaling up and maintaining or improving quality. The CSO sector and caregivers in the communities need assistance to be able to take advantage of the opportunities that the NIP provides. As such, support organisations could be instrumental in assisting with the reach and pace of scaling up; noting, however, that setting up the systems for support structures will in itself require some time, with lessons learnt along the way. In addition, there is the need to develop and test new and / or existing models of service provision for all three of the NIP sites (family, community and formal), which will also take some time.

Models will need to be 100% funded, as cost recovery will be low

As the budget for ECD at provincial level is already stretched (Streak, 2008) and the DoSD is engaging in a play-off between quality and reach, the provinces alone can not be expected to fund these supporting mechanisms from existing budgets. If intermediary organisations are deemed necessary, the feasibility of including them in the funding stream needs to be considered. Further, a National Funding Window should be considered, as this would allow for the roll-out of national programmes and avoid being restricted to applications for funding to provincial departments (this would also interfere with the replication of social franchises).

The main current funding mechanisms for NPOs include tendering and service level agreements.

As very little information is available on the actual costing of models, there is a need to obtain more information first.

11 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

Since cost recovery would be low, there is also a need to determine what level of sustainability can be expected, and the corresponding commitment from government needs to be sought.

What model would be most appropriate, relevant, sustainable and feasible?

The research suggests that there is not a “one size fits all” approach, but that it is important to create an integrated framework, environment and resourcing model to enable various mechanisms to emerge and take off.

Whatever approach is decided upon, the correct process for project cycle management and project design should be followed. This means that situation analysis, feasibility studies, and project development and design need to be conducted and proper monitoring and evaluation systems put in place. The feasibility studies would be able to determine which methods are most appropriate, sustainable and feasible, given the various NIP sites and contexts. Each of the models presented in this paper could facilitate government and civil society provision of the package of services as envisaged in the NIP, but the co-ordinating mechanisms and obligations would be different:

1. Social franchising – where a model is replicated in different geographic locations, and is supported and controlled by a centralised hub. The degree of replication (or the amount of flexibility) that will be required is a point to consider.

Should the package of services as envisaged in the NIP be implemented in a standard way in each site or would a greater degree of flexibility be more desirable? The main determining factors will be:

a. The extent to which there are enough funds to replicate the model, as the case studies suggest that standardised franchising requires a very significant investment in marketing and supervision; b. Whether there will be a strong enough intermediary organisation(s) (or hubs) that can manage the roll-out of a standardised model; c. Whether there will be receptivity in the sector, at all levels, to standardisation; d. Whether standardisation is realistic and can accommodate regional and local contextual concerns; e. The type of services to be offered; and f. Whether standardisation will in fact be beneficial for scaling up quality ECD.

2. Networks and associations – where organisations form a network of service provision around the package of services contained in the NIP, but there is no requirement for association with a particular brand or methodology. The network would rely on the integrity of the member organisations to adhere to norms and standards, as there is unlikely to be any way to compel network members to do so.

Should networks be used as mechanisms for implementing the NIP? In this model one should consider whether:

a. A network is a strong enough cohesive force to ensure quality delivery; and

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b. Networks are powerful enough co-ordination mechanisms. 3. Capacity building and resource models – where an intermediary organisation(s) would facilitate the provision of capacity building and resources to the sector in relation to the needs identified by the inter-departmental structures, and where a layer of capacity building and resource organisations could be developed through a cascading methodology.

Would a capacity building and resource model play enough of an integrating and co-ordinating role?

In this case, one should consider whether capacity building and resource organisations can play enough of an integrating and co-ordinating role or whether they should be used in combination with social franchising or networking techniques.

The fact that networks, associations and capacity building and resource organisations have existed in the ECD sector for many years may mean that they could be more easily introduced as means of scaling up. On the other hand, evidence shows that social franchising methods can be excellent for facilitating reach and quality in a fairly rapid manner.

This paper suggests that all models could be useful in different situations. Considering the large numbers that are intended to be reached, government could make use of a number of different models or modalities, depending on the circumstances, geographical location, type of service to be delivered and so forth.

Government can draw lessons from existing modes of implementation

It should be noted that government is familiar with all of these support formats, as it is either involved in directly piloting or in funding variations of these models. Thus there is a strong evidence base to draw on from within the Departments. Those responsible for ECD should harness experience developed in other sectors (for example, HCBC) in support of delivering the NIP. Government could consider facilitating a learning network / conference on models of provision and draw lessons based on this.

Proper strategy and planning presuppose the selection of appropriate models

The NIP suggests a three-phased approach, and different models could be appropriate in different stages and for different purposes. The NIP should be followed by a strategy for scaling up, as well as an implementation plan that can then be translated into annual performance plans and operational plans. Strategy and planning will indicate more clearly which models are best suited to assist with delivery. The situation analysis and feasibility studies suggested in this paper will be useful to inform implementation planning.

13 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

1. Introduction

This paper forms part of a larger research project concerning Early Childhood Development, commissioned by the HSRC in 2007. The aim of this paper is to consider various options for support structures and mechanisms that could facilitate the implementation of the NIP for ECD, and hence the scaling up of ECD in South Africa. In particular, we focus on how state and civil society institutions can work together to implement the NIP to scale, using different models of support including social franchising; networking, associations and support groups; and capacity building and resource organisations. The various papers in this series present the considerations for scaling up ECD, ranging from budgeting to monitoring outcomes. In this paper we look at how support structures could be used to address the strategic priorities contained in the NIP.

The state in South Africa has recognised that civil society organisations have a major role to play in delivering social programmes and are essential partners of government in delivering services to the needy in South Africa. They deliver effective programmes and projects, have greater experience in servicing communities’ needs and are often based within communities. CSOs have a strong appreciation of human rights issues, and in the ECD sector specifically, of child rights. In addition, NPOs are well placed to partner with government and the private sector in service delivery and to provide a range of employment opportunities at the community level. They can also frequently be found in social development forums where there is an opportunity to mentor one another within the sector.

The role of NPOs is recognised in the NIP, which states that, “… the non-profit sector plays a major role in ECD. Most of the early learning sites and programmes across South Africa were initiated by the non-profit sector working with communities. ECD NGOs in South Africa have accumulated expertise in the ECD field, giving them a rich legacy of innovative and creative experience with regard to ECD services to children. The public sector will tap into this expertise in developing and implementing the integrated approach. There is local and international evidence that ECD programmes and broader social and community development are strongly linked. Recognition of this can greatly enhance integrated ECD services, especially those targeting the deprived and vulnerable” (p 13).

Government departments already use the non-state sector (including NPOs) to assist with service delivery in many areas and have many different types of arrangements with service providers. The DoSD, for instance, has Service Level Agreements with NPOs throughout the country. What this paper seeks to do is encourage those in the ECD sector within the Department to think about ways to use these mechanisms, and propose some models that could be considered to extend the reach of ECD services while maintaining quality.

However, the gap between the large state bureaucracy and small community-based service providers is a challenge that needs to be addressed in scaling up. One of the

14 Support Structures

problems associated with this is the different perspectives of the state and CSOs. Most ECD organisations work at community level, and one of the critical distinctions between state institutions and CSOs1 is that the state must necessarily take a broader view of delivery to ensure that social spending reaches the majority of the population, while CSOs and CBOs in particular must primarily take into account the needs of the community around them. Thus the state may put less emphasis on accommodating community peculiarities (in favour of a more generalised approach), while CSOs may be more sensitive to culture, economic diversity and local attitudes toward social spending. Supporting organisations should be able to help build bridges between the two.

Another challenge associated with the gap between state and community organisations is the flow of funding. Massive resources are being directed towards ECD, yet the scale of need is so large and there are such considerable barriers to implementation that despite massive state resources, funds for social development are not reaching the grassroots as effectively as intended. This is compounded by blockages in delivery of those resources to NPOs and communities, which have difficulty accessing the funds or are constrained by requirements that are too prescriptive to qualify for easily. To address this problem, it may be necessary to use organisations that can help to bridge the gap between institutional delivery goals and community-based delivery on the ground.2

This paper thus seeks to present potential solutions to improve access to ECD services by using a combination of approaches that take into account the important role of CBOs while at the same time looking at support organisations as bridging organisations that can accommodate the developmental objectives of both the state and the people it serves.

The various models for support investigated are social franchising, networks and associations, and capacity building and resource organisations. Even though these can be described as distinct models, they have overlapping elements and can be used in combination. For instance, a social franchise can also promote networking amongst franchisees and can bring in the services of a capacity building and resource organisation. In this paper, we present the social franchising model on a continuum from pure franchising to adaptive models of support, with the degree of replication of the model or blueprint being the main differentiator. Social franchising as a model could be beneficial as it allows a tested methodology to be rolled out fairly quickly and to be replicated by organisations that do not have to invest in their own model development. It is also easier to monitor and evaluate effectiveness and impact if the means of implementation are the same or similar. Organisations that focus on promoting networks are beneficial as they strengthen the social capital in the sector, and allow organisations and individuals that are not necessarily implementing a model to benefit from interacting with others. Capacity building and resource organisations are useful as support structures as they can focus on upgrading the capacity of the sector in terms of management and educational aspects.

1 The definition of CSO includes Not-for-Profit Organisations (NPOs), Civil Society Organisations and Faith-based Organisations (FBOs). 2 Presentation drafted by Miriam Altman, 2007.

15 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

The research suggests that there is not a ‘one size fits all’ solution, and the various NIP service sites could benefit from a range of support options. What the implementing Departments could consider is how best to harness the strengths of the sector and to direct funding in efficient and appropriate ways to scale up ECD through the use of appropriate support structures. The use of support structures does not preclude the Departments from improving their own internal capacity to deliver on the NIP and strengthen their ECD teams; in fact, this will probably be a necessary prerequisite to the successful utilisation of support structures.

This paper begins with a brief sector analysis to gain a better understanding of where support organisations could contribute to the pace of scaling up integrated quality ECD in the light of the NIP. The research involved a comprehensive review of both local and international experience, and interviews with key informants and organisations that could provide insight into how the various models could work in the South African context. In the conclusion, some questions, rather than recommendations, are then posed for consideration by the decision-makers.

1.1 Brief description of the context

1.1.1 Extent of provision

It is estimated that there are currently 5.16-million children aged from zero to four years in South Africa, 86% of whom are African. The largest numbers are located in KwaZulu-Natal, Gauteng and the Eastern Cape (Biersteker and Streak, 2008). This represents 9.9% of the country’s total population, according to the conceptual framework of the document ECD Centres as Resources of Care and Support for Poor and Vulnerable Young Children and their Families (including OVCs) (July, 2006). In 2006 there were 8,920 ECD centres registered by the DoSD in South Africa, of which 5,103 received subsidies from the Department (ibid). A Department of Education (DoE) audit conducted in 2000 identified 23,482 ECD sites (ibid), which means that 37.9% of ECD sites in the country were not registered, and could not access any state subsidies. There were 18,268 community- or home-based ECD centres in the country. Most ECD sites are poorly resourced and serve children who are affected by poverty, malnutrition or poor nutrition, and HIV and AIDS. ECD practitioners and school principals / supervisors are often poorly paid and weakly educated, even though many may have years of experience in the sector. The monitoring of the quality of service provision in registered sites is also lacking, as the DoSD struggles to reach registered providers.

The majority of children from zero to five (84%) are not accessing any formal ECD provision at all and rely on their parents / primary caregivers for stimulation and development needs (ibid). Paper 1 of this series, titled ECD in South Africa: Policy, Demographics, Child Outcomes, Service Provision and Targeting (Biersteker and Streak, 2008) details the challenges faced by caregivers in multiple risk environments (for example, poverty, illness and substance abuse) and how this negatively affects the quality of care for young children. Services that focus on the wellbeing of the caregivers are also severely lacking.

The NIP was introduced to address a range of problems in the sector, and highlights the following challenges that it attempts to address:

16 Support Structures

. “A fragmented legislative and policy framework for ECD, resulting in uncoordinated service delivery; . Limited access to ECD services; . Inequities in current ECD provision; . Variable quality of ECD services; . Insufficient human and financial resources to meet the high demand of the ECD sector at national, provincial and local levels; . Limited interdepartmental and intersectoral collaboration to ensure adequate, efficient and quality provisioning for children; and . The different local boundaries for different provincial departments that determine where staff of the departments can provide their services” (NIP, p.13).

The NIP envisages three main sites for ECD support – the family, the community and formal services. Support organisations would need to facilitate the delivery of services in each of these domains. The NIP aims to extend ECD services to 2.5-million to three million poor and vulnerable children. The first phase will focus on targeting those children already receiving services from the DoSD and the DoE to consolidate these services.

1.1.2 Role-players and linkages in the sector

Before looking more closely at intermediary or support organisations, an overview of the role-players in the sector and the linkages between them is provided (see figures 1, 2 and 3). Understanding these linkages helps to define the role of the support organisations, as one of their main contributions could be to provide the integration missing in the sector and to build bridges of support between the various role-players. The intersectoral committees proposed in the NIP should provide the necessary integration between government departments. One of the key gaps lies between government and the CSO sector (particularly the grassroots organisations and caregivers in the home) and in the co-ordination of services that should be provided for the upliftment of children and their caregivers. This is where a critical need for support organisations comes into play.

It is worthwhile looking at the definition of integration in the NIP and what it is intended to address:

“In this document, the term integration is used to describe the relationships and links that are being developed between government departments, NGOs and communities in order to provide comprehensive ECD programmes to the children of South Africa.

It is in this context that the NIP for ECD sets the following as mechanisms for advancing towards an integrated approach to ECD services:

17 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

. Intersectoral collaborative planning and service delivery for ECD; . Seeking agreement on the target of the services; . Creating inter-organisational activities, for example, training and materials development; . Ensuring that each department (national and provincial) makes a budgetary commitment to the task at hand to give them a stake in its success; . Co-ordinating and monitoring of the intersectoral comprehensive programme for children from zero to four; and . Developing ECD management systems and processes across government and non-government structures to ensure effective and efficient provisioning.

This should result in:

. An ability to expand service delivery; . Cost cutting through sharing resources and eliminating duplication; and . The faster and more efficient delivery of services” (NIP, p 16).

A situation analysis has not been conducted of the services available in the sector, which makes it difficult to come to definitive conclusions about the size and scope of the sector. There are many organisations working in the ECD sector that have various degrees of formality and expertise. Some of the main CSO/NPO and Resource and Training Organisation (RTO) providers are (this list is by no means exhaustive but indicates that there is capacity in the sector):

. Early Learning Research Unit (ELRU); . Training and Resources in Early Education (TREE); . Ntataise (franchise through network members); . Kululeka; . Ikamva Labantu; . Safe and Sound; . South African Congress of Early Childhood Development (SACECD); . African Self Help Association; . Limited learnerships from the Education, Training and Development Practices Sector Education and Training Authority (ETDP Seta) (100 per year); . NACCW (child care workers); and . National Association of Child Minders.

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Figure 1 – Role-players in the ECD sector

Figure 1 depicts the role-players in the ECD sector that could benefit from greater integration as per the NIP. The role of the state in the delivery of ECD (0-4) is to create an enabling environment for the ECD sector to thrive by providing legislation and policy, ensuring that funds flow into the sector, monitoring quality and evaluating child and caregiver outcomes, and facilitating expansion. In terms of the DoSD, the District Office is the key role-player for ensuring that ECD providers are registered so that they are able to qualify for state subsidies. Currently it is unclear what the roles will be with regard to community- and home-based programmes. To receive donor funding, organisations need to register as NPOs, and this is a national process.

To facilitate an understanding of the role-players in the sector, specifically regarding formal ECD provision, a map of a hypothetical community (that is, not a private provider) ECD centre is depicted in figure 2 and shows the range of services and requirements that the centre needs to provide quality programmes, and the linkages between them. Three of the key elements that are needed for improving quality in

19 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

such an ECD centre are 1) registration with the DoSD; 2) funds to purchase services, food, and materials/equipment, organisational running costs and for facility maintenance and upgrades3; and 3) regular monitoring of service provision. Each of these three aspects is provided by the DoSD at District Office level, yet there are fundamental backlogs and blockages in delivery. The ECD centre must also link with other ECD sites in networks or forums so that they can organise collectively for professional development (i.e. training, capacity building, further education, mentoring etc.) and support and for group buying of materials and foods at discounted prices, amongst other things. ECD practitioners may belong to membership bodies such as the SACECD which lobbies for the sector. Practitioners may also belong to Educare Forums, which are local structures of ECD practitioners that meet on matters of common interest and are frequently used by local authorities and provincial Education and Social Development Departments as conduits for information sharing.

The many children and caregivers in home-based settings also need a myriad of support systems and input regarding child stimulation and care. In this context we are mainly talking about providing services to primary caregivers where children are at home, as well as day mothers who may look after less than six children. Linking home-based children with a formal ECD site could be of assistance to them and their caregivers.

The type of services that could target primary caregivers includes home visiting programmes, playgroups and improved linkages with clinics (which may also provide early stimulation activities for children and caregivers as per the example used in the paper on ECD services in the Philippines, which forms part of this series of papers) (Koller, Lazzaretti de Souza, De Aquino Morais & De los Angeles-Bautista, 2008).

A greater connection between the formal ECD site and the home and family space could also be an important part of support to the sector; however, most ECD sites would need substantial support to enable them to play this role4. In addition, the ECD forums could provide a conduit for supporting ECD centre improvement, provided that they are constituted more formally. According to Linda Biersteker, these organisations can act as important gatekeepers or enablers for ECD interventions in communities. One of the problems cited, however, is that they do not always recognise home-based provision as important and could try to divert resources into their existing sites. Nevertheless, they are an important partner at community level and may need to be established or strengthened (including greater representivity) as part of an implementation model if they do not exist.

1.1.3 Funding and capacity

If the community ECD centre had a sustainable source of sufficient funding, including fee-paying parents, and the knowledge and capability required, they may be

3 Infrastructure provision is not a clear mandate of any government department or level – local government is usually responsible but ECD infrastructure is not specified in its legal obligations, which is why the DoSD has been accessing some funding for this. 4 This model is currently being piloted, and one such model being piloted by TREE is depicted below.

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able to procure much-needed services themselves. However, cost recovery in many poverty-stricken communities is low and often principals are not aware of or able to access the type of support needed. According to Biersteker, it is critical that the capacity and professionalism of centres are improved, since centres with inadequate care can be more harmful than no centres. There has been some resistance to professionalising the sector, as there are fears that it may disrupt the organic systems that have evolved; however, professionalisation is taking place, especially in terms of scaling up of services. The CSOs which could provide services (such as training and mentoring) to the ECD centre for free or at low cost are also hamstrung by a lack of sufficient funding, and the quality of their delivery varies. Raising quality and professionalism in the sector by requiring service providers to register (either as an ECD or as an NPO) would assist with transparency, accountability, quality control and good governance. This, however, raises two important issues. First, the barriers to entry are high – many NPOs and ECDs do not have the skills or means to register, leaving them at the margins of the sector where they operate with less legitimacy5. Secondly, once registered, the requirements put strain on organisations, many of which have limited capacity to deal with bureaucracy and little additional funds for administration, let alone to pay for auditors. In this regard, donors are often not willing to fund the operations or core functions of these NPOs, since funding is normally tied to programme outputs only.6

This adds further pressure to ECD providers, particularly since work in the NPO sector is incredibly demanding and levels of staff burnout are very high. There is a high reliance on volunteers in the sector because there is not enough money for hiring the required staff. A common problem is that once staff are trained and volunteers are capacitated, they become mobile in the employment market and will often leave for better opportunities or higher pay. This, unfortunately, leaves the sector without vital skills and services. Because of this and given the context of unemployment and poverty in South Africa, there are increasing calls for the provision of stipends to volunteers. Organisations or state departments who are able to remunerate their volunteers will draw away skilled volunteer capacity from those who are not (the question of formalisation of volunteers is discussed in detail in Biersteker’s paper Towards a Job Hierarchy for ECD Provision and Supervision in South Africa, and the Fit of Low- Skill Service Providers [2008], which forms part of this research series.)

When NPOs are contracted by government to provide services, there is a need to ensure that the inputs, activities and outputs lead to the desired quality outcomes of both service and beneficiary. The skills required for conducting outcomes-based monitoring and evaluation (M&E) are often not contained within NPOs and need to be outsourced. This is costly, and NPOs often do not have the required know-how to

5 Different types of registration are required. An ECD centre has to register as a partial care facility, ECD programme, and if it is an NPO as an NPO. With regard to NPO registration, “During 2005/06, 13,405 organisations applied for registration. Of these, 8,398 met the registration requirements. By March 2006, the total number of registered organisations was 37, 532.” (http://www.gcis.gov.za/docs/publications/pocketguide/022_social.pdf accessed April 2007). 6 “… NPOs must enter a world in which social relationships are replaced with contracts – a world designed and operating by the legal and accounting professions. The new public space is not just about the legal right to register in order to operate, but about the more important need to access resources” (Habid, Ed, 2002).

21 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

engage effectively with evaluators. Further, government M&E systems are still in the early stages of development, and there are already monitoring backlogs.

In terms of funding for NPOs from government, the DoSD, which is the largest conduit of funding, has acknowledged that its support to the NPO sector has been lacking, and that funding has been skewed towards social grants. At the launch of the new Integrated Service Delivery Model (ISDM) of the DoSD, Dr Jean Benjamin stated that:

“… it is also true that because of the focus on social security, attention to other services have been inadequate to date. The crowding out effect of the social security budget has led to significant pressure on social services provided by both government and the non-governmental organisation (NGO) sector. The budget for social services has therefore not kept pace with the demand for services. It has not been adequate to address the social conditions that are causes and consequences of poverty and vulnerability. This state of affairs has placed severe limitations on human, financial and physical resources in this sector” (November 2005).

The ISDM attempts to change all this and recognises NPOs as key partners in the implementation of social programmes. The ISDM provides various mechanisms for engaging NPOs as service delivery agents, and also allows for six different types of financing. Applications for financing can follow a sequential pattern to facilitate the development of services from seed funding through to long-term financing for programme implementation.

BOX 1 – Funding mechanisms and types as per the ISDM

There are three mechanisms for funding or purchasing services of NPOs: . Subsidy for programmes that meet department priorities and needs in line with government policy; . Purchasing and financing through closed tender; and . Purchasing and financing through open tender. There are also six different types of financing: . Seed financing; . Capital financing (for assets); . Venture financing (start-up funding till they become self-sustaining, for example, second- hand shops); . Partial financing (organisation will receive partial funding requested and will have to seek other sources as well. This can apply to any funding option); . Shared financing (different funders decide to jointly fund a programme or fund different parts of a comprehensive service); and . Long-term contractual financing (services that operate over a longer period of time and have long-term objectives, the achievement of which is reliant on financing from departments for typical ongoing, recurrent day-to-day operational costs.

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The Guidelines for Awards also emphasise that priority will be given to NPOs to render services, although not to the exclusion of Private Sector Organisations. These mechanisms can be used to enhance the capacity of ECD service providers and NPOs in the sector.

Launched in 2005, the implementation of the ISDM will take time. In the Western Cape, which is considered one of the strongest provinces of the DoSD, the implementation of the ISDM is only now being conceptualised and is yet to be devolved effectively to the District Office level, which will take over funding responsibility from the provincial Department.

Another constraint faced by NPOs is that if they are offering services in more than one province, they often have to apply in the province where the service is being provided. However, the provinces have different funding priorities and capabilities. This will be a barrier to scaling up ECD, especially if support organisations will be assisting to roll out national programmes or interventions.

23 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

Figure 2 – Cluster map in relation to an ECD site, for example, a formal ECD centre

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Figure 3 – Needs of children at home

25 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

In sum, there are a number of gaps in the sector that need to be addressed for integration to occur. These include improving systems for and access to registration for ECDs, funding to ECD sites and NPO service providers, improving the monitoring and evaluation of services, professionalisation of service provision and the formalisation of job hierarchies for ECD practitioners (including volunteers), ensuring linkages between different role-players in the sector, and improved flows of information within civil society groups and between civil society and government. Programmes need to be developed and existing programmes supported that will reach primary caregivers and link them to necessary services such as primary health care, welfare and parenting support programmes. Outreach to primary caregivers may be through ECD centres, local clinics, district offices or parenting programmes funded by CSOs.

In order to address the gaps highlighted in the previous sections, existing systems need to be strengthened, such as ECD units in district offices with registration assistants, funding support to the network of professional development organisations for more service provision, satellite campuses in undersupplied areas, development of new delivery models and so forth. At the same time, supporting organisations can assist to facilitate access to these systems, and act as conduits of funding, information and advice between role-players in the sector. The envisaged role of support organisations is discussed in more detail in the following section.

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2. Support organisations as intermediaries providing linkages in the sector

Figure 4 shows how an intermediary organisation could facilitate the integration of services needed to support ECD as envisaged in the NIP.

This diagram shows how the sector could benefit from support organisations that can co-ordinate and supervise many of these different aspects and provide a bridge between government, donors, academic institutions, CSOs and the ECD sector, while at the same time building the capability of each. Without creating new organisations or institutions unnecessarily, we believe there are existing service providers or intermediary organisations that can help to address these gaps, but their efforts need to be focused towards the integration of service provision as envisaged in the NIP.

In this regard, we see organisations as already providing various degrees of time, energy, knowledge, information, appropriate technology, perspectives, cultures and other multi-functional facets. These elements all help to define the interlocking dimensions that can create the conditions for injecting palpable changes in the processes of development. It is then a matter of harnessing these elements to create and hasten the desired results that would enable a system to influence or impact on the ECD environment. Identifying the need for support organisations does not mean that the existing capacity of government departments involved in ECD service delivery should not be improved. Rather, to reach the sheer numbers of children targeted for ECD services, government capacity will need to be strengthened, and this is in turn is likely to have a positive impact on government’s ability to support and interact with support organisations. Support organisations will complement government services and perhaps provide assistance in areas where government does not reach.

For instance, with regard to the registration of ECD sites, the role of government is to register the centres, whereas a support organisation may assist the centres to navigate the bureaucracy, negotiate with the various stakeholders involved (for example, local government) and help with some of the costs involved in registration (in some cases even the cost of taxi fare to reach government service points is prohibitive, especially considering the ‘back and forth’ that some organisations need to go through to get registered).

According to the Director of a national “If government would assist with infrastructural costs – building or association in South Africa that supports a refurbishing buildings – the initial network of 40 pre-schools, ECDs “… need stumbling blocks would be overcome. considerable support to access government Thereafter they could contract support, whether it be for registration to organisations like ours for a period of operate or for subsidies. Applications three to five years to assist with hands-on set-up activities.” require a sophisticated language capacity”. So, for example, the DoSD may also contract a support organisation to co-ordinate a network of ECD providers in a particular area, to conduct the required monitoring of the registered sites in the

27 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

network, and to assist with the professionalisation of these sites by contracting relevant service providers (such as RTOs, the Department of Health [DoH] and the DoSD), and to support the collective purchasing and distribution of materials and food. The Director of a local association suggests that organisations such as theirs could be contracted by government for three to five years to assist with the actual set- up activities for a formal ECD service, if government could provide funding for infrastructure-related set-up costs.

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Figure 4 – Cluster map with intermediary organisations

Academic Other funding Government (Inter-departmental Institutions coordinating committee) National & sources (donors, e.g. HEI, HSRC Corporate) provincial DSD , DoH, DoE Research,

evaluation

porting, porting,

. Fundraising & funding

Database of providers, . Branding & Marketing

Funding, Funding, Regulation, blueprint capacity building capacity procurement, capacity M&E & Re . M&E building . Strategy and planning Service Providers Intermediary Organisation . Research and development (CSO, FBO, (Franchisor, network, multi- . Norms & Standards Associations) stakeholder committee, Capacity . Learning conferences building organisation) . Networking . Advocacy Feedback, model development

Core & Elective Elements . Services e.g. nutrition, mentoring . Programmes Typical Obligations . Products . Pay Membership . Management Advice . Maintain quality standards . Training - technical skills & . Data collection management . M&E & Reporting . Tools for monitoring . Service provision . Funding

Local Government

Delivery Agent (franchisee) (e.g. ECD Community Site; Home based provider / caregiver, (e.g. ECD forums, Child Care Forums, FBOs, etc.) local clinic)

29 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

Given this interpretation, intermediary organisations can serve in the following roles: a. Brokers of information and appropriate technologies

Institutions and organisations such as media and educational institutions and other information and resource centres by their very nature play critical roles in harnessing the potentials for sustainable development. Across sectors, these specific groups are able to hasten the translation of content and processes into values, behaviours, attitudes and lifestyles. b. Mobilisers of resources

Intermediaries, such as business and industry groups that deal with the gathering of raw materials and inputs, ultimately serve as mobilisers of resources. As such, this group of stakeholders become major channels that can initiate and control possible trends and open opportunities towards proper management and utilisation of resources. They should not, however, upset the smooth flow of resources and impede the process towards the desired goals. c. Networkers to strengthen institutional linkages

Being part of a macro-system, intermediaries can build a network using existing structures and processes. Among networkers, they are able to link and interface among themselves. Through these linkages, complementary and/or supplementary functions are enhanced. For instance, information flow, technology transfer, resource sharing and exchange of information can facilitate strong partnerships amongst the institutions involved. d. Trainers and product enhancers

Intermediaries play a strategic role as trainers and product enhancers, using their expertise and the available technologies that, from time to time, are upgraded to respond effectively to the changing trends and demands. Via training designs, tools and methodologies, and product development, this group serves as a conduit of information, approaches and perspectives on development that can create the evolution of innovative designs and processes.

The specific services that support organisations could facilitate in the ECD sector (as depicted in figure 4) are:

Professional development a. Provide or facilitate access to training and professional development opportunities for ECD practitioners and principals in ECD sites, and for home- and community-based care practitioners and parents/caregivers, as well as follow-up support and mentoring at the site of service provision. b. Provide or facilitate ongoing professional development for ECD practitioners along identified career paths.

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Nutrition and welfare

c. Provide or facilitate nutritional support to ECDs and families in need through helping with the collective purchasing and distribution of food, and ensuring that families are accessing social security benefits. d. Distribute donations received in the forms of goods and clothing to the ECD centres and families in the communities. e. Link to social services in terms of helping families to access social grants, as well as assisting pre-schools with registration.

Materials and resources

f. Provide access to materials and resources for educational activities (for example, stationery, toys and educational games). g. Assist with infrastructure development for registration if necessary.

Organisational development

h. Provide support to ECD sites to meet registration requirements and to register with the DoSD. i. Fundraising and transferring funds on behalf of smaller, less-established originations that may not have the necessary systems in place to access funds directly. j. Assist with financial management, either through mentoring or providing financial services for a group or network of smaller NPOs or ECD centres. k. Training and assistance in managing human resources. l. Mentoring organisations and forums in terms of organisational governance and leadership. m. Supervision, quality assurance, monitoring and evaluation.

Networking and external relations

n. Support community-based networks of ECD sites and related organisations. o. Network with other providers to provide services in line with Integrated Development Needs as per the NIP, such as the social security, psychosocial support and health needs of Orphans and Vulnerable Children (OVCs), Childline (survivors of physical or sexual abuse), Isibindi (child and youth care workers who provide a range of critical support working in the Life Space of the child, for example, setting routines in the family, cooking, registrations for social grants, homework support, etc.). p. Communication with parents / caregivers.

There are a number of ways that supporting originations could be structured. If one were to standardise the model of support provided by these organisations, some of

31 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

these could be perceived as core modules which are non-negotiable elements, and others as electives or desirables.

An example of a model that integrates services (as envisaged by the NIP) provided by government, ECD centres and community structures is provided below. The model is currently being developed by TREE7 and is supported by the United Nations Children’s Fund (UNICEF) and the South African government. This model is being developed in the Ikandla area, a rural area in KwaZulu-Natal that has been severely affected by HIV and AIDS. The aim is to demonstrate a model that can build the capacity of community-based ECD sites so that they can act as resources in AIDS- affected communities. (It reflects the model outlined by the conceptual framework paper produced by the DoSD and the DoE and supported by UNICEF, titled Early Childhood Development Centres as Resources of Care and Support for Poor and Vulnerable Children and Their Families, Including Orphans and Vulnerable Children (July 2006.) The focus is on the pre-school and family facilitators are firmly located within the ECD site. The capacity of ECD sites to be centres of support to vulnerable families is built into this model, and to cater for children beyond those registered with ECD. The ECD site is linked to a childcare forum that works with 10 to 15 families. These ECD sites have also acted as outreach centres for the DoH for its immunisation drives, as the reach of community-based ECD is broader than that of the clinics themselves. An additional critical component of this programme has been the buy-in from the Ikandla Municipality. Funding for the development of this model will end after a two-year funding period from UNICEF and unless it is incorporated into government’s programmes and funding model, it is likely to come to an end. This is an example of the type of project that could benefit from government funding in scaling up ECD, but the lack of funding to complete the testing of the model and to conduct a thorough evaluation (including looking at monitoring data) means that the benefit of the piloting process might be lost.

7 TREE is an RTO in early childhood education in South Africa. It employs 60 full-time staff members, while part-employment and community volunteers add another 300 people. TREE Head Office is responsible for project management, monitoring and supervision, fundraising, distribution of resources and materials, training and advocacy, and facilitates networking, partnerships and co-operation with government departments at local, provincial and national levels, as well as other stakeholders, on all issues that affect young children.

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Figure 5 – Model where the ECD centre is central to support for vulnerable children at community level

. Intersectoral stakeholder forum on children incl. LG . Immunisation at ECD sites . Social Welfare Support to families Government

. Receives training NQF 1 & 4 UNICEF . Resources & toy kits . Link to home-based children ECD Tree through parenting workshops . Incentive to take home-based kids 2 x per month

Community

. Strengthen / establish ECD forum . Train family facilitators . Establish childcare forum

Once piloted, this model could be used as part of the strategy to scale up ECD. The question is what type of supervisory structures could be used for co-ordinating the role-players. We suggest that there are three main ways to organise support structures – social franchising, networks and associations, and capacity building and resource organisations.

Another such model that has been designed for replication and that could be used for social franchising is that developed by CARE, called the 5 x 5 model, which focuses on the child and caregivers.8 (Promising Practices: Promoting Early Childhood Development for OVC in Resource Constrained Settings: The 5x5 Model).

The following section outlines the various models or methods (supervisory structures) that could be used to scale up ECD provision in South Africa.

8 This model has been piloted in other sub-Saharan African countries, but not South Africa.

33 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

3. Models or supervisory structures for scaling up ECD provision in South Africa

The crux of the NIP is integration of a package of services to improve quality and reach of ECD service provision in South Africa. While the NIP mentions mechanisms for integration (see section 1.1.2 on page 16), it does not spell out how these should be achieved. One possible role of the suggested support organisation(s) would be to provide the particular co-ordinating mechanisms that will facilitate the above processes and can be seen as providing implementation support to the national, provincial and municipal inter-departmental committees. Where these committees do not exist or need strengthening, support organisations could also be tasked with this. There is some concern, however, that Government should remain responsible for inter / intra -governmental coordination. This concern stems from the unequal power relations between Government and the non-state sector, where some argue that the latter, particularly NGOs do not have enough clout to coordinate government officials.

In this paper, we consider a number of different organisational formats that are and can be used in the ECD sector to support organisations and assist with scaling up. The first is social franchising, which implies degrees of replication of a model. The second is networks and associations and the third is capacity building, resource and mentoring NPOs.

It should be noted that social franchise models contains elements of the other formats and usually uses different techniques for delivering on the various aspects of the franchise. For instance, the franchisees are all members of the network, and they are provided with capacity building and resources to help with implementation of the model. What distinguishes social franchising from these other models is a common brand and the implementation of a standardised model (to degrees).

3.1 Social franchising

3.1.1 What is social franchising?

Business-format franchising (also described as the “carbon-copy” format by Castrogiovanni and Justis, 1998, cited by Du Toit, 2003) involves an agreement between two legal entities, the franchisor and the franchisee whereby “The franchisor is a parent company that has developed some product or service for sale; the franchisee is a firm that is set up to market this product or service in a particular location”. Franchising involves the replication of a proven business formula and system, and can be seen as a business relationship with mutual benefits to franchisor and franchisees. Well-known examples in South Africa are fast-food outlets such as Nandos and St Elmos Pizza, and property retailers such as Seefe.

Social franchising is mostly defined as franchising with social rather than profit- making goals (Du Toit, 2003). Montagu (2002: 129) defines a social franchise as “…a

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franchise system, usually run by a non-governmental organization, which uses the structure of a commercial franchise to achieve social goals”.

Franchising typically includes a range of techniques, as discussed by LaVake (2003). These are promotion and marketing (creating brand awareness and demand), training to deliver on the product or model and to run the organisation, quality assurance and standardisation of services, information sharing and referral mechanisms, cost recovery mechanisms (if possible), and a franchise agreement or contract. ‘Social franchising’ is used fairly loosely in the literature to describe a number of different methodologies related to scaling up delivery of a particular social programme concept.

BOX 2 – Typical franchising techniques

1. Promotion and Marketing – Targeting a product to a market niche, such as an age or ethnic group, is important for social franchising projects, as selling a product or service depends on branding and marketing. This is relevant to the ECD sector in that the training programmes can be branded (for example, programmes developed and branded by the well-established RTOs such as ELRU, TREE, Ntataise and Kululeka for instance would be highly esteemed and in demand by practitioners and also attract donor funding). On a larger scale, the whole ECD concept and programme could be branded, such as the Bright Child Campaign in the Philippines. 2. Training – The franchisor trains staff, volunteers and others involved with the franchising venture, ideally with a certification programme and an emphasis on quality of service. (Training is normally linked to on-site visits and mentoring to ensure that what is learned in the classroom is transferred into the site of work.) 3. Quality Assurance and Standardisation of Services – Clients (practitioners or ECD sites, and parents / caregivers and funders / government) are encouraged by predictable service quality, which will meet norms and standards of ECD provision and can be monitored and evaluated to measure child outcomes. 4. Information Sharing and Referral Mechanisms – Referral forms are used in most franchises to direct clients to resources, both within the franchise and to other organisations that provide more specialised services. This type of networking serves specific client needs and also expands links between collaborative community groups. 5. Cost Recovery Mechanisms – The cost of services can be reduced by economies of scale such as centralised purchasing and fee schedules. Charging a fee, even if it is nominal, is important to have the client value the service, to be able to monitor client use through financial records, and to provide for cost recovery to the extent possible. Fees may be charged on a sliding scale based on the client’s ability to pay. A modest initial or annual ‘franchise membership fee’ may also charged to the provider. Unless networks are large enough, franchises are unlikely to benefit from economies of scale. The costs of fixed overhead, brand advertising and training can be reduced by spreading them over a large number of service sites, or the provider must accept that cost recovery will only be partial. In the South African examples, it is almost universal that there is no expectation of cost recovery at all in donor - or government - funded social franchising models. Not only is there likely to be no cost recovery, but it is the franchisor that needs to direct resources to the franchisee. 6. Franchise Contract – Formal agreements can clarify goals and directions for the franchise, helping to expand and sustain programmes. Such an agreement should outline the respective obligations of the franchisor and franchisee. Culturally appropriate, relevant and mutually understood formats, coupled with an interview or screening and preparation programme, including a business plan, add value in the application of contracts. Organisations that are part of the Ntataise network sign an agreement to adhere to certain conditions of being a Ntataise organisation (in effect a training franchise model).

35 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

These programmes can be very broad, for example, poverty alleviation programmes as administrated by global organisations such as UNICEF, World Vision, etc., or they can be very specific, for example, fertility clinics distributing condoms produced by a particular medical company using a model (or blueprint) for birth control or HIV education at the local level. Social franchising facilitates a situation where an organisation has developed a blueprint model, and then seeks financial assistance to scale-up or ‘scale out’ their models9.

Other models take social mandates developed at a state level and look at how to diffuse these social goods to widely disbursed communities throughout an entire country. This approach normally requires the use of intermediary organisations (usually NGOs), which are trained and capacitated to deliver social goods and services with the use of state funds (either raised through taxes or through international donor agencies). In this case, the state acts at the top of the organisational structure, providing oversight, branding and advertising of the concept, while the NGOs and their partner CBOs must deliver the products or services mandated. In this regard, states look to the franchise model concept to best standardise delivery of the programmes and ensure equality of delivery.

3.1.2 How social franchises roll out

Franchisees can either start up from scratch and offer only the products and services of the franchisor (for example, McDonalds), or they can add the franchise products and services to an existing business or organisation, known as fractional franchising (for example, a clinic that agrees to offer a particular reproductive health model as part of its package of services). While in the for-profit sector the market may indicate demand, in the social sector, governments and donors normally address market weaknesses and step in to scale up quality programmes and identify where the services should be delivered through franchising. The metaphor of a ‘hub and spoke’ model is useful for understanding social franchising. It refers to a situation where there is a central hub where the product or service originates. The hub organisation wants to reach a target and beneficiary group in another location, and usually, instead of opening a site of its own, partners with an entity that already exists and that can carry the product or service. The hub then supplies the social programme (including resources and methodologies) and all of the promotional materials, capacity building and marketing support to the spokes. ‘Hub and spoke’ models are generally regarded as more cost-effective alternatives to get products or services more widely distributed (or scaled out), and are scaled up using social franchising techniques. This is because they avoid the costs of model development, avoid duplication and benefit from scale of delivery.

9 Much of the literature on social franchising is based on experiences in the reproductive health sector, which are more likely to be driven by the distribution of products (but also provide social goods, for example, reproductive health products or contraceptives by large medical companies) than in other sectors.

36 Support Structures

For instance, a programme that has been developed for a pre-school, together with products that can be used to support it, such as toy kits, could be distributed to existing ECDs as part of a franchise that will help meet the government mandate in terms of rapidly scaling up quality ECD.

Some of these organisations (spokes) may have existing facilities (for example, offices, training centres or ECD sites) from which to work. In other cases, facilities are provided, or franchisees are provided with assistance in setting up the required physical infrastructure to provide their services (for example, Safe Parks as part of Isibindi).

Social franchising can also work in the home-based and community setting. Home visiting programmes can be franchised where job descriptions are standardised, methods and materials are provided, and supervision and monitoring structures are in place. An example of this is the Home Interaction Programme (HIPPY), an international home visiting and school readiness social franchise, which also operates on a small scale in South Africa but could expand if sufficient funding can be realised (interview)10.

There are also a number of franchises in the private playgroup sector in South Africa, including Moms and Tots, Clambour Club (used by NOAH) and Kindermusic.

The requirements franchising organisations set for providers entering their networks vary. Preferred criteria for franchisee selection specified by some franchisors include motivation, business skill, past business success, ties to the community and personal characteristics, all aimed to improve retention and increase franchisees’ chances of success (Stephenson et al., 2004).

Identifying suitable franchisees may be a challenge and there may be limited organisations to work with in many geographical locations in South Africa, particularly in rural areas. At the same time, it is the exactly for these reasons that social franchising may be appropriate in under-resourced areas – a model can be implemented fairly quickly and the necessary systems put in place to support it, and the franchisee immediately becomes part of a broader network of support. This situation increases the importance of the mentoring and capacity building aspects of the franchise agreement11.

3.1.3 Monitoring and quality assurance

The importance of monitoring in social franchising is emphasised by Montagu (2002), who argues that where the franchised brand represents a service, this must be

10 The Federal Labour Government in Australia recently announced that it plans to give $35-million to an NPO to roll out the HIPPY programme in 50 disadvantaged communities across Australia with the intention of reaching 8,000 children who are at risk of falling behind (Media release, 15 August 2007). 11 The question of the selection of franchisees is critical and could be an area for further research to see how this has occurred in South Africa, and how the recruitment, selection, training and contracting of franchisees has taken place. Further research questions could cover who accepts the risks of investing in these organisations and what occurs when franchises fail.

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highlighted in advertising and the monitoring of the programme must assure the quality of the service.

Some of the case studies, such as Green Star, show that quality can be affected negatively by rapid expansion of the franchise because the franchisor can no longer conduct the necessary quality assurance. The design of the social franchise is thus critical and one may consider smaller networks linked to different franchisors.

The Planned Parenthood Federation of America (PPFA) is used as an example in the literature to illustrate an active emphasis on evaluation to ensure compliance with the quality standards of a franchise.

BOX 3 – Monitoring at the PPFA

The PPFA conducts extensive evaluations and re-certifications of its local affiliates every four years. This is done to ensure that service quality, pricing and financial management are properly managed at each affiliate so as not to hurt the Planned Parenthood brand. The evaluation focuses on quality assurance methods: are there certification requirements for all medical staff, are there codes of conduct and regulations to assure board accountability, and is there a mix of funding sources to assure financial stability? The PPFA has an advantage in that its affiliate programme is akin to a stand-alone franchise system, not a fractional franchise system. This means that the PPFA does not need to distinguish between branded and unbranded services when evaluating members. This matters because one of the most difficult aspects of fractional franchising is the separation of franchised services from other provider-offered services that share the same facility (Montagu, 2002: 126).

3.1.4 Forms of social franchising – standardisation

Social franchises vary in the degree of standardisation of the model. Montagu (2002) emphasises the importance of standardisation of services in franchises for a number of reasons, including the preservation of the notion of quality of the brand or service. Another reason for standardisation is ease of monitoring and evaluating outcomes. Monitoring is crucial to social franchises, and the central tool of affordable, replicable monitoring is standardisation (Montagu, 2002). Protecting the rights of those who benefit from the service is important, as they are expecting a specific quality standard by associating with that brand. (for example, if one attends a Ntataise-branded course, one expects the quality of service delivery to be as good as if Ntataise was offering the course itself.) Standardisation also helps to attract funding, as stakeholders can be assured of the quality of provision and outcomes. On the other hand, flexibility may allow for regional or context-specific peculiarities, resources and capabilities. HIPPY, for instance, allows adaptation of programme materials to local cultural contexts; this has been completed in South Africa and is ready for rolling out. In other instances, resource constraints and expertise may mean that some elements of the blueprint can be implemented while others can not (for example, NOAH has only been able to raise funds for some elements of their model in some provinces and not in others).

Since social franchising is used broadly, it is useful to conceptualise it on a continuum where the degree of standardisation is the key variable. The continuum ranges from pure franchising (at the top end) to adaptive franchising at the bottom end.

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Pure franchising requires a high degree of standardisation and includes strict supervision and control. The franchisee adopts the blueprint or format with a strict set of implementing procedures and policies (Royle, 2001), and this model can be replicated again and again, as long as there are sufficient resources to fund the blueprint.

Adaptive franchising provides for more flexibility and allows a franchisee a fair amount of autonomy in how it implements the model. In this case, the franchisor blueprints a social development concept that can be handed over to other organisations, which can use and adapt the model as appropriate (within broad guidelines). There may be core and elective elements in adaptive franchising.

For example, the loveLife programme is a widely replicated HIV awareness and educational campaign with rigid guidelines in terms of how the programme is established and delivered. By contrast, NOAH is a less widely replicated programme of ECD (in limited geographic areas) with clear guidelines and deliverables but with flexible models of delivery mechanisms. In this regard, loveLife could be said to be a pure franchise model while Noah would fall further to the right on the continuum as a more flexible blueprint model. In both cases, however, the brands are widely recognised due to their adherence to specific development goals and objectives.

The scale therefore moves from ‘pure franchising’ to ‘adaptive’ models of franchising. Defining social franchising according to this spectrum helps to locate the different organisational forms it takes. The common denominators for all social franchising models are that all franchisees agree to a) carry the brand; b) adhere to quality requirements and norms and standards; c) work towards the same development goals and objectives; d) implement a core model; and e) collect data for monitoring, evaluation and reporting purposes.

In social franchising situations, institutions or organisations are able to step into a social franchise-type model quickly without having to bear the development costs of designing the model. In addition, because the model has already been proven to be effective, this allows the organisation to tap into funding resources on its own account without necessarily having to rely only on the central organisation to access these. The continuum is described in figure 6.

39 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

Figure 6 – Continuum of social franchising

3.1.5 Funding franchises

The research highlights that franchising programmes in developing countries are predominantly donor funded, and may receive government funding as well (Stephenson et al., 2004). In contrast to commercial franchising, franchisers and donors, instead of franchisees, bear the financial risk involved in setting up a site or establishing services in social franchises (Smith 1997, cited in Stephenson et al., 2004).

The appropriateness of pursuing a franchise approach depends to a large extent on the level of government funding and/or donor support available. Some donors find franchising attractive because of its potential to mobilise the private sector to deliver services, control the quality of care and offer some hope of sustainability through the use of fees to recover some costs. “Balancing sustainability with meeting social goals is challenging, however, and involves issues such as capacity building, organizational strengthening, and business management skills training” (LaVake, 2003: 11). Initial funding for franchising is usually provided in the form of a loan or grant, according to Frost (2006). In the case of a loan, franchisors need to develop realistic financial planning and make this clear to the franchisee in a written contract. The franchisee may be required to place some form of deposit with the franchisor to ensure that initial funding is not completely

40 Support Structures

lost if sustainability or repayment is not achieved. Financial assurances for the franchisor in what is referred to as the “boilerplate franchisee model” include:

. The initial franchise fee payable by the franchisee to the franchisor; . Ongoing royalty or management services fees; and . Mark-up on the sale of products (Frost, 2006).

The chance of cost recovery in the ECD sector is low in South Africa, although some elements of the model may be able to recover partial costs; for example, people or organisations may be willing to contribute small amounts towards training or materials. ELRU, for instance, is able to recover about 10% of the cost of its training provision in some cases. Ntataise has 12 organisations in its training franchise, which each pays a R10,000 per year membership fee that entitles them to training and support. The membership of a few organisations in the network has had to be terminated in the past, as they were unable to pay the annual fees, even though they themselves were providing training using the Ntataise model and materials. This shows either poor financial management or poor cost recovery in the value chain. Funding is thus likely to come from either government or a donor or a combination of both.

3.1.6 Making franchises sustainable

A franchise’s ability to become financially sustainable depends on the target population it hopes to serve and its positioning in the market. Services targeted at the poor and/or rural populations are unlikely to ever become financially sustainable through franchising or any other market-based programme (Harvey, 1999, cited by Montagu, 2002). Urban programmes can potentially become financially sustainable over time, “depending upon the market size, potential demand for the service and structure of the private… sector” (Montagu, 2002: 127).

Continued participation in a franchise network is determined by the extent to which the benefits of membership outweigh its costs. A franchise fee and the potential for improvements in service provision should sustain commitment to the franchise network. Stephenson et al. (2004) note, however, that mandated franchise fees in a low-demand setting may compromise a franchising organisation’s ability to establish a large network of service delivery points. In very low-demand settings, cost recovery from franchised services (for example, a family planning or crèche facility) may not always outweigh the cost of franchise membership.

Clients at franchised health establishments in Mexico and the Philippines were found to benefit from consistent standards of care at affordable prices, while franchisees benefited from subsidies and support in running their businesses. Both franchises were, however, dependent on significant start-up funds, ongoing support from US-based agencies and donor-subsidised contraceptive supplies (Marie Stopes International, 2002, cited by Stephenson et al., 2004).

Appendix 1 contains more detailed case studies of social franchises from local and international experience. Some of these do speak to massive upscaling, such as Green Star, which by 2002 had franchised a range of family planning services through its

41 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

network of 2,000 private doctors (Montagu, 2002). The network grew to include more than 11,000 private health providers in more than 40 cities during its first five years of operation (1995-2000), receiving more than 10 million client visits per year (Stephenson et al., 2004). The Green Star experience, however, highlights the quality problems that could arise with a rapidly expanding network as supervision structures become stretched. Decentralising training to local NGOs allowed the programme to support local capacity for service.

BOX 4 – loveLife case study of a pure social franchise model

loveLife was launched in September 1999 to address the growing need for a dedicated HIV prevention programme. It was established by a consortium of leading South African public health organisations, the South African government, and major South African media groups and private foundations in partnership with South Africa’s national HIV prevention programme for youth, which is a coalition of more than 100 community-based organisations. loveLife has established a very strong brand and uses a highly visible awareness campaign to gain pubic attention. It has also established a countrywide network of adolescent-friendly outreach and support programmes for youth. Its partnership with media groups has led to its innovative use of marketing approaches to get its message ‘out there’. This includes a sustained multi-media education and awareness campaign using television, radio, outdoor media and print – educating young people about HIV and promoting dialogue about sexual health issues. loveLife has developed an evaluation programme regarded as one of the most comprehensive of its kind in the world, and partners with local and international academic and research institutions on the programme. loveLife is very well funded by major international and local donors and the South African government. . The main replicated model of loveLife is the countrywide programme of community-level outreach and support to young people (called loveLifestyle). The loveLife social franchising system loveLife positions itself as a healthy lifestyle brand for young South Africans. There are 130 community-based organisations associated with the brand through the ‘loveLife franchise’ system. loveLife uses an approach that leverages its community development expertise. In turn, it is assisted to implement a systematic HIV prevention programme for teenagers using a co-branded theme and product, loveLifestyle. Each franchise holder implements loveLifestyle in at least five schools. This enables loveLife to delegate responsibility to the franchisee for the successful transference of the model to the communities. A youth serving organisation which has applied to loveLife and meets basic criteria in terms of governance, programme and financial management can be eligible to become a franchisee. A ‘loveLife line manager’ is identified in each organisation and provided with training in HIV prevention, loveLife-style. Franchisees then recruit two ‘loveLife groundBREAKERS’ from their community each year who are trained to implement loveLifestyle in schools. ‘groundBREAKERS’ are paid a stipend of R880 per month. Each ‘groundBREAKER’, in turn, recruits five mpintshis (‘buddies’) who are also given in- service training by loveLife. Mpintshis receive no stipend. Outside of this, franchisees receive resources and promotional materials each quarter, as well as monthly distribution of loveLife’s lifestyle magazine UNCUT. Once a loveLife franchise has been established successfully, it becomes a loveLife ‘hub’. There are currently 710 of these hubs, including clinics and youth centres. Young people at these franchisees are entitled to participate in the loveLife leagues (debating, sports and recreation), which are regarded as a special privilege by the participants. Franchisees commit to specific targets in terms of youth participation (both in- and out-of- school youth). Line managers are expected to supervise and support ‘groundBREAKERS’ and ‘mpintshis’ and to create the loveLife hubs that become a part of the youth lifestyle.

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BOX 5 – Isibindi as an example of a pure social franchise model with core and elective components

The NACCW has developed a model of care called 'Isibindi' that develops child and youth care workers to care for vulnerable and orphaned children in their own homes. The Scale-up of the Isibindi Model (SIM) is a project designed in response to the success of the piloting of the Isibindi project in the Umbumbulu and other areas. The Isibindi model was developed in partnership with the regional and district offices of the DoSD in KwaZulu-Natal and was funded by First Rand Foundation. Isibindi is funded as part of the DoSD Youth Development Strategy in KwaZulu-Natal and is funded through the HIV and AIDS sector funding stream. The model has been designed to be easily replicable, without standards being lost but allowing for contextual adaptions. By May 2008 the NACCW had successfully facilitated the development of 40 functional Isibindi projects in eight provinces, which have together serviced over 19,797 vulnerable children and orphans who would otherwise not necessarily have had access to social services. A further seven projects are in various stages of the initiating process and will be servicing an additional 4,500 children or so by the end of 2008. In this social franchise, the NACCW sets standards for service delivery to vulnerable and at- risk children being serviced by agencies replicating the Isibindi Model. The NACCW maintains ‘ownership’ of the Isibindi Model, the standards for training and deployment of workers and the standard of child and youth care practice in the projects as articulated and measured by the Monitoring and Evaluation system. SIM works actively to facilitate the development of community capacity to create the locally owned infrastructure to intervene effectively with at-risk children youth and families. ‘Ownership’ of each project remains in the hands of those most closely connected to the project – the implementing organisation (usually a local NPO or children’s home), donors and provincial DoSDs. The NACCW, through the SIM project, accesses funding for the initiation of the project, trains unemployed community members in the Further Education and Training (FET) Certificate in Child and Youth Care Work, supports community-based and other organisations to deploy and mentor workers efficiently, monitors and mentors the childcare workers, and connects workers to a professional entity. In terms of the hub and spoke concept, the NACCW is the hub. Locations for establishing spokes are identified together with the DoSD and based on requests from communities. The SIM process is as follows: 1. NACCW receives an approach from an interested party (implementing partner) to implement the model. 2. NACCW identifies funding for replication. 3. NACCW approaches provincial or regional DoSD to establish whether it will be involved (in provinces where it is a partner). 4. NACCW conducts broad stakeholder consultation regarding choice of community and other service delivery aspects. 5. A local community meeting is held to see if the community wants the model. 6. If the community agrees to participate, NACCW advertises widely within the local community for people who want to train as Youth and Child Care Workers. 7. NACCW establishes an interview panel (made up of local community members, implementing organisations, the DoSD and the NACCW) and selects 25 to 30 trainees. 8. All trainees are trained in the three foundation modules, and following further interviews the top 13 are selected to be employed as Child Care Workers and are deployed to families in the community and receive further in-service training, supervision and mentoring. The others continue with training and form a resource pool (a cadre of trained volunteers) in the community. From this group of 13, one project manager and two team leaders are identified, and their professional development is fast-tracked. Each team leader works with five child care workers, and is mentored by the NACCW.

43 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

9. The capacity building of the implementing partner organisation is supported by the NACCW. 10. Learning and sharing network meetings of all the implementing partners are convened by the NACCW periodically. Specialised components There are also elective elements of the model that are not compulsory but are integrated as much as possible. These include a disability programme, a caring for caregivers programme, a safe parks programme, a delaying orphanhood programme and the girl child programme. Core non-negotiable principles of the model are the development of a local leadership team, community development principles, accredited training, legal contractual arrangements with implementing partners, development of child and youth care workers and the promotion of youth and child care work as a profession, a child rights culture and constitutional basis for programme delivery, mentorship, financial systems, and a monitoring and evaluation system. Challenges faced in scaling up 1. The DoSD is only a partner in some provinces and other funders have to be found in other provinces to scale up nationally. 2. Some community structures are not well developed and may be hastily established to receive these services. The NACCW seeks funding to conduct interventions to support them. 3. There are such limited resources in rural areas that the NACCW has to work with existing structures and they thus have to develop what exists, which requires additional funds. 4. In some areas, community structures are hastily established and thus have teething problems of their own. Issues of political divisions and control over resources have to be overcome. Financial mismanagement and diversion of resources have also occurred and the NACCW has had to step in to sort these issues out. 5. Implementing organisations have different capacity levels and levels of involvement, and also need to be supported by the NACCW. 6. The Isibindi model relies on distance supervision and the NACCW has had to find ways to track people’s work ethic and delivery. It has thus developed a very structured monitoring and supervisory system to support this. 7. Some funders (particularly corporate) prefer to fund projects directly that then has to pay the NACCW for services, which is problematic for the NACCW as they lose an element of control and do not always see their money.

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BOX 6 – NOAH as an adaptive approach to social franchising

NOAH was started by a South African philanthropist using private and corporate funds to support its goals and objectives in providing disadvantaged communities with the tools to protect its orphans. It receives a third of its funding from USAID (the President’s Emergency Plan for AIDS Relief [PEPFAR] programme), and thus also relies heavily on support from the private sector and government funds for which it qualifies. The project is now supported somewhat by various government departments. The programme works best where communities have already demonstrated a willingness to provide care and assistance to its children. This is usually in the form of some kind of formalised ECD or health care where some kind of infrastructure is in place. NOAH then focuses on helping the community to provide assistance to children from the ages of 2 to 6. NOAH endeavours to provide support using partner NGOs with expertise in these areas. Rather than hiring and training volunteers or staff themselves, NOAH leaves this to organisations that have already formalised an ECD approach. NOAH thus plays more of a facilitatory role and assists with acquiring resources and training administrative personnel to manage and run the ECD centres. NOAH starts out by consulting with a community and developing a basic framework for implementation of its particular franchise methodology. The first step is to find a community that is already motivated to help its children, either through health care or education. The next step is to set up an ‘ark’, which normally ‘piggy-backs’ on the structure that the community or an existing ECD service provider is using. It currently has 117 arks in Gauteng and KwaZulu-Natal. Implementation follows a modular approach, and as the community completes one, it is assisted with technical expertise and funding to move forward to the next until an ark is fully fledged. Community members are provided with a field guide to the implementation of the module. NOAH assists with establishing appropriate infrastructure where necessary, either through outside resources or through its own fundraising initiatives. It also assesses the resources required, the staff needs, etc., to ensure that the franchise model can be implemented appropriately. Once NOAH has determined that the model will be viable, it seeks outside organisations to implement the facets of the model that it does not have the expertise to do itself. Organisations it presently works with are Ntataise (network of accredited training providers) and the Clambour Club (playgroup model). NOAH employs assistants, usually volunteers from the community or those who it can pay a small salary. NOAH works out a budget for the assistants and then trains them to work within it. NOAH prefers that the entities become self sufficient, so it encourages the community to establish the entity as a community-based organisation so that it can access government funds. NOAH provides administrative support and guidance, as well as financial assistance to sustain the entity. It also provides computers and training of assistants to capture data so that it can track how the centre is used. This approach is difficult to use in the rural areas, however, since many people are illiterate and most, if not all, computer illiterate. In addition to providing support for ECD, NOAH also provides for a feeding scheme and an assessment process that ensures the child is being given proper care at home. If not, NOAH refers the child for psychological, social or other support. The biggest challenge for NOAH as an organisation is financial sustainability. The NOAH model allows the organisation to establish a consistent approach to setting up its arks, but gives flexibility to the service providers who are appointed to deliver the different programmes to the beneficiaries. This allows NOAH to mobilise resources more effectively for the specific outcomes desired. NOAH does the monitoring and evaluation, which allows it to improve upon its model and to continuously look for better solutions. (http://www.noahorphans.org.za/NoahArks/tabid/1756/Default.aspx and interviews)

45 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

Figure 7 – The NOAH model

Source: http://www.noahorphans.org.za/NoahModel/tabid/8271/Default.aspx

3.1.7 Crucial considerations and lessons learnt in choosing a franchise model

Franchises reduce the element of risk to the funder and the franchisors, as they are usually based on tested models that have been shown to work in particular contexts. Risk is also reduced by the fact that the franchisee belongs to a support network and receives ongoing support from the franchisor and possibly also from other franchises in the network (if it is set up in this way).

The blueprint also builds on the strength of other working copies of the blueprint, creating credibility for the model and giving donor funders more confidence that the programme will work.

Some advantages to the franchise model are:

. The franchisor can offer assistance to market the product or service and with the branding of materials and outputs. . Franchisors will offer professional, organisational and managerial development assistance, as well as assistance with products and materials, so that the franchisee can quickly offer a going concern at the appropriate standards. The franchisor can also distribute funds to the franchisee directly or through arrangements with lending institutions or government, which makes it easier for the franchisee to access the funds it needs to operate and/or expand.

46 Support Structures

. Supervision and quality control is usually built into the franchise concept (to differing degrees, depending on whether it is first- or second-generation franchising). This, again, builds confidence in the service provided and facilitates better outputs and outcomes.

There are some disadvantages to operating a franchise. For franchisees, the main disadvantage is a loss of control. While they gain the use of a system, trademarks, assistance, training and marketing, the franchisee is required to follow the system and get approval for changes from the franchisor. This can be frustrating for organisations with a long history of service delivery and for those with a strong innovative spirit. In South Africa, there are examples where NGOs are fiercely protective of their individual identities and domain. For instance, in the Ntataise network, the NGOs that belong to the network purchase the right to use Ntataise’s training programme for one year, (they have to purchase the Ntataise materials such as handbooks separately), yet they remain independent in terms of how they operate and run their organisation. Likewise, the GoLD Peer Education Programme is being delivered through implementing NGOs that resisted the standardisation of their existing programmes to fit the GoLD model, even though they wanted to be part of the GoLD network, receive the training and use the GoLD Manuals and methodology in the way that they saw fit. This is where the associative form of franchising may be useful. Here organisations can associate with a brand and receive the benefits of belonging to the franchise, but are able to implement the programme in ways that match their organisational culture and competencies.

Starting and operating a franchise business also carries expenses. In choosing to adopt the standards set by the franchisor, the franchisee often has no further choice than to buy materials, kits, training programmes and so forth (these can, however, be funded as part of the model).

Another issue is that the franchisee may not be allowed to source less expensive alternatives or source service providers of their choice. Added to this, the franchisee must still pay costly franchise fees and ongoing royalties and advertising contributions. The contract may also bind the franchisee to such alterations as demanded by the franchisor from time to time.

The franchisor/franchisee relationship can easily cause conflict if either side is incompetent (or acting in bad faith). For example, an incompetent franchisee can easily damage the public's goodwill towards the franchisor's brand by providing inferior goods and services, and an incompetent franchisor can destroy its franchisees by failing to promote the brand properly or by poor administration of the franchise. Franchise agreements are unilateral contracts or contracts of adhesion wherein the contract terms generally are advantageous to the franchisor when there is conflict in the relationship.

Further, public perception has to be driven by consistent and equal distribution of the concept. If an NGO, particularly in the South African context, is seen to be only benefiting a few (for example, in communities where there may be divisions along cultural, religious or political lines), this may affect the overall take-up of the programme.

47 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

It may be difficult to get NGOs to scale up delivery of their models for a number of reasons.

. While they may be well aware of the replicability and adaptability of their blueprint, they may simply not have the know-how or the ability to scale up. . Competition for scarce funding may lead some NGO leaders to believe that keeping an innovative and replicable project to themselves will give them an edge over similar NGOs approaching the same limited number of funders. . Unwillingness to give up control: creators of great blueprints for social change sometimes fear that other NGOs will not be able to replicate their blueprint as successfully as they could on their own.

Du Toit (2003) cites the following critical factors to consider in the implementation of a social franchise programme:

1. “Consumer demand is a prerequisite for the initiation of a social franchising programme. There must be a demand for the specific product or service in diverse geographical areas to make franchising a suitable expansion mechanism.” In the ECD sector, this means that NGOs must want to be engaged in helping to improve ECD, and ECD centres, home- and community-based stakeholders must want to improve standards and methods of ECD. In Brazil and the Philippines, the scaling up of ECD was combined with a large public awareness campaign to build an appreciation of the importance of ECD participation.

2. Even though generally it is desirable for consumers to pay for the product or service, even if it is a nominal amount, it is not always feasible in the context of abject poverty. The child support grant in South Africa is only R210 per month, which is not enough to cover education provision and should be used for the basic needs of the child (food primarily). For some families, this is the ONLY income they receive. Although ideally the franchisor should aim to be financially sustainable and reduce its reliance on funding over time, in the context of community poverty and low government subsidies, this is unlikely in the South African context. Organisations should rather try to diversify their funding sources, including those coming from government subsidies, other forms of cost recovery and fundraising (from community efforts and donors).

3. A pool of suitable potential franchisees must be available and they must be motivated by the apparent benefits provided by the franchisor to join the network. There are many NGOs or NPOs who work in fields related to ECD in South Africa, but they tend to be regionally concentrated. One will typically find that there are few NPOs in rural areas that can be drawn into a support structure. Where they do exist, they often have very limited capacity. Similarly, ECD sites and child minders may not see the benefits of joining a franchise. Other more established NGOs or ECDs may not want to participate in a franchise or standardised approach for fear of losing their organisational integrity and independence.

4. A suitable franchisor must be available and willing to commit to the programme over a long-term period. Continuity and longevity of the franchisor are essential

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to the sustainability of a social franchise. Franchisors may be government-, private sector- or NPO-based, depending on the geographical location or the type of social programme being delivered. Sustainability may be an issue with regard to funding of the franchise, and one would need to accept that the franchise will not be self-funding.

5. Piloting of the concept prior to franchising is critical. Only tried and tested concepts should be franchised and the franchisor must ensure that franchising is applicable to the needs of the target and final beneficiaries. Socioeconomic, political, cultural and commercial contexts affect the ability of a franchise system to work effectively and these should be noted in the piloting phase.

6. Franchisees need to have the correct level of skill to be able to operate the franchise, and often the franchisor will have to provide training in management as well as ECD to provide the administrators, trustees and practitioners or caregivers in the home context with the necessary skill to implement the programmes and services.

3.2 Networks and associations

Networks and associations refers to the situation where organisations join a network which typically facilitates information exchange, collaboration, mutual support, capacity building, research and/or distribution of funding to member bodies. Membership could include NGOs, CBOs, relevant government departments, representatives of local government and/or faith-based groups. Groups may be:

. Formal organisations with a secretariat and full-time staff; . Informal networks of organisations that meet periodically; . Semi-formalised organisations with a secretariat that rotates among members or is a part-time responsibility for one of the members; or . Independent community-based networks or networks associated with a particular NGO or programme.

Some networks receive funding from donors so that they can provide grants to member organisations. Others play an advisory role by linking donors to legitimate grant applicants. In this regard, they may assist the donor in assessing the quality of grant proposals and the consistency of proposals with relevant national policies and plans. Donors may also contract with a network to monitor the use of granted funds and ensure accountability (Williamson & Lorey, 2001).

Networks also take the form of groups that work in similar arenas such as a network of groups working for children.

In the ECD sector, there are good examples of networks of ECD organisations. One prominent example is the ASHA, which supports a network of 40 pre-schools.

49 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

BOX 7 – The African Self Help Association

ASHA is the co-ordinating body for 40 pre-schools in Gauteng. It is not a true franchise model, although the strategy is to empower the communities in which the pre-schools are situated to a point where the schools could be licensed to operate under the ASHA name. At a later stage other schools could also come into the support network. The model centres around administrative, educational, health and nutrition, and infra- structural support. ASHA provides shared services for financial management, reporting, administration, placing orders and leveraging discounts. Fundraising and marketing are managed as a group activity. ASHA also provides training for ECD practitioners. School support officers employed by the association interact with each pre-school in the network, and also conduct regular monitoring and evaluation using a prescribed evaluated tool. Pre-schools also conduct self-assessments using the tool. ASHA is invited by stakeholders to come in and offer support in particular communities. Existing ASHA schools were built by the organisation from donor funds and on land made available by local government. In return for their support, ASHA expects adherence to best practice indicators and pro-rata payment towards the shared services that are provided. Pre-schools are funded through school fees, government grants and donations. The challenges faced by schools in the network are: . Capacity to access government support, whether it be for registration to operate or for subsidies. Applications require a sophisticated language capacity. . Cash flow is an issue of concern as there is little assertiveness around fee collection. . Problems of full accountability at school level remain.

Another example is that of Ithemba Labantwana (which is supported by Ikamva Labantu), and another is the Ntataise Training Network (that also has a franchise component, the training course). (See the case studies for more detail on these.) Neither of these disburses funds, but they do provide other forms of direct support to members, such as information and sharing sessions, distribution of donations such as materials, on-site mentoring and so on. The ECD Forums can also be considered networks of ECD sites at community level.

Cape Action for People and the Environment (C.A.P.E.) is an example of a managed network that co-ordinates the partnership of key stakeholders to deliver on certain goals related to protecting biodiversity in the Cape Floristic Region.

For example, in the ECD sector, government has set norms and standards and has determined specific minimum outcomes12. A partnership can be formed with role- players in the sector who agree to adhere to these norms and standards and to work towards these outcomes. Funding, capacity building, mentoring, branding, opportunities for learning and sharing, and resources could be provided to the partners, yet these partners can still deliver on the objectives as they see fit. In this

12 Currently there are minimum standards in the Guidelines for ECD services, but norms and standards under the Children’s Act of 2005 as amended are currently in the process of public comment prior to revision and promulgation. Curriculum guidelines for Children under 4 from the Department of Education will be available by the end of August 2008.

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regard, they will receive funding to work with their own preferred service providers as long as they follow certain procurement procedures.

BOX 8 – Ithemba Labantwana

Ithemba Labantwana is a network of about 350 member ECD sites, has been in existence for 30 years and is supported by the NGO Ikamva Labantu. The network has its own constitution and governance structure. The ECD practitioners meet monthly as a support group and to share information and learning, and at times to distribute donations received through Ikamva. Ikamva Labantu assists with some of the secretariat functions of the network, and supports the members in a number of ways: it distributes food to all the network members and Ikamva’s ‘footsoldiers’ provide on-site mentoring and monitoring to the ECD sites. The network allows Ikamva Labantu to support and access a group of ECDs in a geographic region. With more funding, Ikamva would be able to hire more ‘footsoldiers’ and intensify its on-site support and monitoring of the ECDs.

BOX 9 – Ntataise Network Support Project

Ntataise – meaning to lead a young child by the hand - is an independent, non-government organisation founded in South Africa in 1980 to help women in disadvantaged rural communities gain the knowledge and skills to establish effective ECD programmes for children in their preschool years. Ntataise Network Support Project is a network of organisations that implement the Ntataise training and support model. The members pay a membership fee of R10,000 per year to join the network and get the right to use the materials for one year. The network Support Project provides ongoing professional development for network members. In this regard, the training and support programme can be seen as the franchisor, while the franchisees belong to a network of support that enhances the delivery of the programme in the long run. The Ntataise Network has 16 members and does not want to grow bigger than this. Through its members the network has trained 15,000 practitioners in 13,000 pre-schools and has been in existence for 30 years. Networks also take the form of groups that work in similar arenas such as a network of groups working for children. In contrast to a multi-layer committee (described below), the ‘coverage’ of member organisations is not comprehensive but determined by the service areas of the member organisations. It is an example of how social franchising and networking inter-relate.

BOX 10 – C.A.P.E.

C.A.P.E. is a multi-lateral, multi-sectoral partnership to preserve the Cape Floristic Kingdom. It receives Global Environment Facility (GEF) and government funding. C.A.P.E. has agreements signed with partners at the highest levels of government, for example, with the Department of Water Affairs and Forestry (DWAF), CapeNature, the Department of Environmental Affairs and Development Planning (DEA&DP), the Department of Environmental Affairs and Tourism (DEAT), the Department of Agriculture (DOA), the Botanical Institute, the Table Mountain Fund, the Development Bank of Southern Africa (DBSA), South Africa National Parks (SANParks), etc. A Memorandum of Understanding established the C.A.P.E. Implementation Committee, which represents government departments, municipalities, statutory bodies and accredited non-governmental organisations that carry out C.A.P.E.’s vision. The partners implement the C.A.P.E. strategy

51 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

and work towards the same goal using their own programmes and methods. There is no replication of any model, but partners do associate with the C.A.P.E. brand. C.A.P.E. task teams, led by the various partner organisations, oversee various aspects of the strategy. C.A.P.E. is operated by the South African National Botanical Institute (government) through a small Cape Co-ordination Unit that does the following: . Co-ordination and networking; . Communication and conferences; . Monitoring and evaluation; . Branding; . Learning and sharing; . Advocacy and lobbying on behalf of the partnership; . Grant making; and . Capacity building of partners.

3.2.1 Advantages

Potential advantages of networks as channels for donor funding and support to individual member organisations include:

. “Strong networks include key national and local NGOs and, in some cases, CBOs engaged in work with especially vulnerable children, HIV/AIDS, emergency response, etc. Some have developed training capacity and, in addition to channelling financial resources, can build the capacity of their member organisations. Members of networks also form Consortia to tender for a range of government services . Member organisations, collectively, are often in a good position to assess the legitimacy and capacity of NGOs or groups that may seek funding” (Williamson and Lorey, 2001: 5). . Grassroots networks can assist to draw the home-based child minders into the model.

3.2.2 Limitations

Potential limitations include:

. The possibility of inducing competition for funding among member organisations, particularly if the network was formed for information exchange and seeks to take on a new role of funding intermediary. . It can be difficult for a network constituted by its member organisations to effectively supervise the use and management of funds allocated to those members. . Some more influential member organisations may receive priority over other members in the allocation of funding. . Networks can give the appearance of providing greater coverage than is often the reality in practice. ‘Coverage’ of member organisations is not comprehensive but determined by the service areas of the member organisations.

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. Membership of some networks may be limited to established NGOs and not include grassroots community groups engaged in direct assistance efforts. Some investment in the capacity of the networks themselves may be necessary if they are to take on new responsibilities (Williamson and Lorey, 2001: 5).

3.3 Capacity building and resource models

Capacity building is used in this document as incorporating a combination of training (including on-site, in-service and follow-up support), mentoring and monitoring.

Mentoring is a process-based capacity-building method and is based on a combination of training, facilitation/coaching and continuous evaluation. Mentoring is thus divided into two aspects – the ‘hard skills’ training as well as ‘soft’ coaching and continuous evaluation.

There are a number of well-established capacity building (or more narrowly defined as training) and resource organisations in South Africa (RTOs). They typically provide capacity building (including on-site, in-service training and follow-up support) and resources to pre-schools or other support NGOs. Often the training is based on a specific model that has been developed by the organisation. RTOs such as TREE and ELRU fit this bill, as do the members of the Ntataise network. Yet these organisations are not able to offer the scale of services necessary to upscale ECD on their own. NGOs also offer a range of ECD services aimed at primary carers which they are piloting or have piloted and may train other NGOs to offer these.

This type of mentoring and capacity building model is also being piloted in the HCBC sector, and both the DoH and the DoSD have management, mentoring and capacity building models at various stages of development, which allow them to scale up HCBC services. The DoH works through the Mentoring Resource Network (MRN) and the DoSD is piloting the HCBC Management, Capacity Building and Mentorship model in a number of provinces (interview with Johan Loate, MRN and presentation from tender briefing in June 2007). Both of these use an intermediary organisation, such as MRN, to manage and operate the model. They then use a cascade approach and work with NGOs that have a regional base to conduct training and mentoring to the DoSD District Offices and to more community-based NGOs to help them improve their capacity to support the even smaller HCBC organisations (which could be equated to the ECD centre).

53 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

Figure 8 – Example of a capacity building model

3.3.1 Advantages

The advantages of capacity building and resource organisations as support structures are numerous:

. They can focus on building the capacity of both government (particularly at District level) and civil society organisations, as well as strengthen the linkages between them. . A layer of capacity building organisations can be built that will remain in under- resourced areas and can extend their scope to assist organisations in other sectors. . The capacity building organisations themselves are also mostly NPOs and understand the challenges and struggles faced by the not-for-profit sector, and have stronger community linkages than government departments. . Small, local organisations that offer valuable community-based services often need assistance prior to seeking funding, and can benefit from ongoing mentoring during their project cycle. Without this, these local organisations might inevitably remain at the margins of the sector without access to funding (an HIV/AIDS capacity building and mentoring programme for community-based organisations, Rasego, 2002). . Capacity building and resource organisations can maintain a strong focus on their core business and really develop specialist skills for the sector. Through research, monitoring and evaluation they can gain an in-depth understanding of what works and what does not, and can apply lessons learnt directly in their services. . They can tailor-make their interventions depending on the stage of the organisation’s development (for example, emerging, established, etc.) and to the context in which they operate.

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3.3.2. Challenges . NPOs and communities need to be more actively involved in setting the agenda for capacity building and in evaluating its outcomes (Thomas E. Backer, 2001). . Sometimes capacity building and mentoring organisations themselves are not all that sustainable and do not practice what they preach, which increases vulnerability in the sector (ibid).

According to Johan Loate, former Director of the MRN, there are a number of challenges that mentoring organisations have experienced in South Africa, as listed below.

. As mentoring is a very personal process, personality differences between the mentor and mentee do occur. It is a challenge to match people correctly, and for the mentor to understand the learning style of the mentee. . It is a challenge to find good mentors, as it is a specialised skill. . A culture of dependency can occur whereby the mentee relies on the mentor too much and is not willing or able to stand on his/her own feet. This reverts back to the quality of the mentor. . As mentoring organisations grow, it becomes increasingly difficult for them to maintain community links. . As personnel become more skilled, they tend to move on to better paid sectors. . The impact of professionalising a community-based organisation such as an ECD centre is not always positive, as creating systems and structures often brings organisational development challenges and disrupts the historical allegiances in the organisation. New power relations emerge and what was a well-functioning, happy team, if not highly professional, may begin to fall apart.

In sum, having looked at these possible models of support, it can be seen that they often employ similar techniques and methods (for example, social franchisees can also form networks, and typically also employ capacity building for their members). Further, they are not mutually exclusive and a franchisee could belong to a community-based network and benefit from the services of a capacity building and resource organisation. The key, however, is that despite some challenges (no development initiative or enterprise will be without challenges), each of these models provides inherent support and co-ordinating mechanisms that could be useful to assist government with the integration required to extend the reach of quality ECD on the ground. Government is familiar with each of these models, as it supports a number of different initiatives already. For example, the DoSD in KwaZulu-Natal is involved in supporting Isibindi, which is a social franchise model, the DoH is part of the implementation of the ThuthuMela Care Centres which also follows a blue-print (franchise) type model and supports the MRN in the HCBC sector, the national DoSD is involved in piloting the HCBC management and capacity building model, the DoH funds the MRN in HCBC provision and networks such as those in the Kictim Empowerment Sector are supported in the Western Cape, and so on.

55 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

In the next section we highlight briefly the importance of community participation and the use of partnerships, irrespective of the model employed. Various approaches to social franchising are also covered.

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4. Approaches to service delivery

How one approaches service delivery can be based on a combination of different approaches. It is important in the South African context that scaling up is done with the participation of local communities and that local role-players and stakeholders are introduced first to the concept, as they can otherwise either assist or block success. In a number of local examples, such as Isibindi and NOAH, one of the first steps when starting a new project is holding a community meeting where the model is explained. This also assists with identifying the issues in a particular community. For example, the NACCW has had to explain to community leaders that political allegiance is not a criterion for benefiting from this project. This is also important because one may need to rely on traditional leaders or municipalities to provide land and/or facilities to allow the model to operate.

A partnership approach is also necessary, as one organisation can not be expected to be good at everything. In the case of Isibindi, one of its partners is Childline, which can provide support to children who have been abused or raped. One may also partner with a training provider such as ELRU or an FET to deliver the training components, or an organisational development (OD) practitioner to help mentor the organisation in terms of OD issues.

There are also different approaches in terms of owning and operating social franchises. The ‘hub and spoke’ concept is a typical way for a franchisor to expand into different geographical locations. The selection of the site for the spokes may be determined by government policy (for example, poverty nodal points), especially where government is using franchising to scale up service delivery, as market demand is not a factor. Franchises can be developed in a partnership between the franchisor and the franchisee, which is typically an NGO. They can also be community driven where community groups get together to develop a service delivery model that can be replicated. In some cases, franchisees are private providers, such as FET colleges, and in others they are government driven.

Some examples of this are as follows:

Joint venture or partnership approach – In this model a central organisation (the franchisor) works to create a joint enterprise with private providers or other NGOs (the franchisee). The franchisee should have the capacity to reach the target community. The franchisor may rent equipment, provide training and supplies at subsidised rates, and offer other support, including branding for the overall programme. Franchisors and franchisees jointly own and co-develop the rights to a brand, technology or some other form of intellectual property. Franchises are businesses that have been systematised for replication. Most franchise networks create a long-term mentoring relationship between and among the franchisor and the various franchisees.

Private provider model – This model involves expanding access to and use of services to additional facilities, typically by the use of logo branding, training of the

57 Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa

new franchisees, monitoring of quality, and other techniques through a formal franchise arrangement.

Governmental – Governments may also operate social franchises themselves. Such efforts by ministries use social franchising techniques, especially quality standards, logos, training and referrals, as well as incentives and subsidies, without involving the private sector. Governmental franchises are rewarded by incentives and subsidies similar to profits awarded to successful private franchises (for example, ThuthuMela Care Centres, Child Courts, etc.), but they do bring in some private providers for specific services.

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5. Conclusions and considerations for model(s) of support

The contribution of this paper to the broader series is to explore whether support organisations as intermediaries between government and CSOs could assist with the rapid scaling up of quality ECD in South Africa. In this paper the role-players and linkages in the sector are presented in relation to the three levels of service provision as foreseen in the NIP – family, community and formal. Understanding the role players, linkages and constraints in the sector helps to define the role that support organisations could play. A full sector and situation analysis was, however, beyond the scope of this paper, and would be a beneficial exercise when planning the roll out of the NIP. The purpose of support models or intermediary organisations would be to facilitate integration in the ECD sector between government, state and the civil society sector. It should be noted that ‘intermediary support’ does not necessarily refer to the establishment of new institutions, but rather to mobilising the support of existing organisations and service providers to the sector. The aim therefore has been to look for models of supervisory structures (franchise approaches, networks and associations, and capacity building and resource organisations) that can pull together and assist service providers so that more consistent delivery of agreed programmes of ECD can be effected. Further, the use and strengthening of support organisations does not preclude the bolstering of government’s own capacity to scale up ECD. Rather, models of support should be seen as enablers, and used to unblock some of the constraints that arise from the structural gaps between government as a large bureaucracy and the CSOs working at community level. Support structures should facilitate the integration as envisaged in the NIP, particularly between government and civil society and between CSOs, and build a stronger, more cohesive sector to allow government to meet its policy obligations as contained in the NIP and take quality ECD up to scale.

Support organisations could assist with integration

The inter-departmental structures envisaged in the NIP should co-ordinate the co- operation between government departments. The NIP speaks about the important role of the non-governmental sector in helping to deliver on its objectives, and says that CSOs will be included, consulted and co-opted through appropriate legal procedures to assist the state with service delivery. However, it does not suggest any concrete mechanisms for doing this. The role of support structures, whichever form they take, could primarily be to provide this mechanism, to facilitate the work of the inter-departmental committees and to structure the relationship between the state and civil society so that the ECD can be delivered in an integrated manner with true intersectoral collaboration. The aim will be to facilitate ‘NIP in action’.13

13 The KwaZulu Natal Provincial Programmes of Action with Children has established the Provincial Advisory Councils for Children which in turn has an ECD technical task team, which has government

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Support organisations could assist with the pace of scaling up

Given current capacity, government alone is not likely to cope with the pace of scaling up, and the CSO sector and caregivers in the communities need assistance to be able to take advantage of the opportunities that the NIP provides. As such, support organisations could be instrumental in assisting with the pace of scaling up, noting, however, that setting up the systems for support structures will in itself require some time and lessons will be learnt along the way. In addition, there is the need to develop and test models of service provision for all three of the NIP sites (family, community and formal).

Models will need to be 100% funded, as cost recovery will be low

As the budget for ECD at provincial level is already stretched (Streak, 2008) and the DoSD is engaging in a play-off between quality and reach, the provinces alone can not be expected to fund these supporting mechanisms from existing budgets. If intermediary organisation(s) are deemed necessary, the feasibility of including them in the funding stream needs to be considered. Further, a National Funding Window should be considered, as this would allow for the roll-out of national programmes and avoid being restricted to applications for funding to provincial departments (this would also interfere with the replication of social franchises).

The main current funding mechanisms include tendering and service level agreements.

As there is very little information available at present on the actual costing of models, there is a need to get more information first. Whatever approach is chosen, the correct process for project cycle management and project design should be followed. This means that situation analysis, feasibility studies, and project development and design need to be conducted and proper monitoring and evaluation systems put in place.

Since cost recovery would be low, the level of sustainability that can be expected should be determined and the corresponding commitment from government needs to be sought.

What model would be most appropriate, relevant, sustainable and feasible?

The feasibility studies would be able to answer this question; however, this paper does highlight some considerations. The paper presents three main models or forms that support organisations could take. In all forms, the package of services as envisaged in the NIP would be provided by government and CSOs, but the co-ordinating mechanisms and obligations would be different:

and non-governmental representation. According to Pam Picken, if this body had more funding and more clout, it would be the right kind of structure to coordinate this type of integration.

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1. Social franchising – where a model is replicated in different geographic locations, and is supported and controlled by a centralised hub. The degree of replication (or the amount of flexibility) that will be required is a point to consider.

Should the package of services as envisaged in the NIP be implemented in a standard way in each site (for example, like a Kentucky) or would a greater degree of flexibility be more desirable?

The main determining factors will be:

a. The extent to which there are sufficient funds to replicate the model, as the case studies suggest that standardised franchising requires a very significant investment in marketing and supervision. b. Whether there will be a strong enough intermediary organisation (or hub) that can manage the roll-out of a highly standardised model. c. Whether there will be receptivity in the sector at all levels to standardisation. d. Whether standardisation is realistic and can accommodate regional and local contextual concerns. e. Whether standardisation will in fact be beneficial for scaling up quality ECD. 2. Networking – where organisations form a network of service provision around the package of services contained in the NIP, but there is no requirement for association with a particular brand or methodology. The network would rely on the integrity of the member organisations to adhere to the norms and standards, as it is unlikely that there would be any other way to compel network members to do so.

Should networks be used as mechanisms for implementing the NIP? In this model one should consider whether:

a. A network is a strong enough cohesive force that can ensure quality delivery. b. Networks are powerful enough co-ordination mechanisms. 3. Capacity building and resource models – where an intermediary organisation(s) would facilitate the provision of capacity building and resources to the sector in an ad hoc manner in relation to the needs identified by the inter-departmental structures.

Would a capacity building and resource model help to deliver ECD services as envisaged by the NIP?

In this case, one should consider whether capacity building and resource organisations could play enough of an integrating and co-ordinating role or whether they should be used in combination with social franchising or networking techniques.

The fact that networking, capacity building and mentoring have existed in the ECD sector for many years may mean that this could be more easily introduced as a means of scaling up. On the other hand, evidence shows that social franchising methods can be excellent for facilitating reach and quality in a fairly rapid manner.

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This paper suggests that all models could be useful in different situations. Considering the large numbers that are intended to be reached, government could make use of a number of different models or modalities, depending on the circumstances, geographical location, type of service to be delivered and so forth.

Government can draw lessons from existing modes of implementation

It should be noted that government is familiar with all of these support formats, as it is already involved in either directly piloting or funding variations of these models, thus there is a strong base of evidence to draw on from within the Departments.14 Those responsible for ECD should harness current experience that has been developed in other sectors (for example, HCBC) in support of delivering the NIP. Government could consider facilitating a learning network/conference on models of provision and draw lessons from this.

Proper strategy and planning presupposes the selection of appropriate models

The NIP suggests a three-phased approach, and different models could be appropriate in different stages and for different purposes. The NIP needs to be followed by a strategy for scaling up, as well as an implementation plan that can then be translated into annual performance plans and operational plans. Through strategy and planning it will become clearer which models will be well suited to assist with delivery. The situation analysis and feasibility studies will be useful to inform planning.

14 For example, the DoSD in KwaZulu-Natal is involved in supporting Isibindi, which is a pure social franchise model, the DoH is part of an inter-departmental management committee on the anti-rape strategy and the implementation of the ThuthuMela Care Centres which follow a blue-print (franchise) type model, the national DoSD is involved in piloting the HCBC management and capacity building model, the DoH funds the MRN in HCBC provision and networks such as those in the Kictim Empowerment Sector are supported in the Western Cape, and on and on.

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Gopalakrishnan, K., Prata, N., Montagu, D., Mitchell, B. and Walsh, E. (2002). “NGOs providing low-cost, high quality family planning and reproductive heath services. Case study. Janani-India”. Monograph Series Vol. 1 No. 3-4. Bay Area International Group (BIG), University of California, Berkeley.

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Habid (ed.) (2002). “The size and scope of the non-profit sector in South Africa”. Swilling and Russell.

Harvey, P. (1991). “In poor countries, ‘self-sufficiency’ can be dangerous for your health.’’ Studies in Family Planning 22 (1): 52-4, cited by Stephenson et al., 2004.

Harvey, P.D. (1999). Let every child be wanted: how social marketing is revolutionising contraceptive use around the world. Westport, CT: Auburn House, cited by Montagu, 2002.

IUD Toolkit (2005). Social franchising as strategy for expanding access to reproductive health services. A case study of the Green Star Service Delivery Network in Pakistan, USAID’s Maximising Access & Quality Initiative. Available online at www.iudtoolkit.org.

Janani website http:eewww._anani.orgeoverview.htm. Accessed on 15 March 2008.

Koller, S.H., Lazzaretti de Souza, A.P., De Aquino Morais, C., De los Angeles- Bautista, F., Dawes, A. and Biersteker, L. (2008). Scaling up Early Childhood Development (ECD) (0-4 Years) in South Africa: International case studies: ECD services in Brazil and the Philippines. Human Sciences Research Council.

Lagman, J.R. (2001). The franchising project of the Integrated Maternal Child Care Services and Development Inc.: Insights on lessons learned. Alternative Business Models Evaluation Project. Carolina Population Center. University of North Carolina at Chapell Hill.

LaVake, S.D. (2003). Applying social franchising techniques to youth reproductive health/HIV services. Youth Issues Paper 2. Family Health International, YouthNet Program. Arlington, USA. Available online at http:eewww.fhi.orgeNRerdonlyreseei_al2kvvmtaMwubnkobk4hbxmdaMuanMwo_v5 5tghflkma7s_2k2gusgfv6276emct5uxnwl6iamceYI4.pdf.

Lomofsky, D. (2007). “Job creation in the social service sector: unpublished paper produced for the African Institute for Policy Analysis and Economic Integration (AIPA) on behalf of the DTI.

Marie Stopes International. (2002). “Social franchising reproductive health services: can it work? A review of the experience.” Research in Focus, No 5. London: Marie Stopes International, cited by Stephenson et al. 2004.

Marie Stopes website (2008). http:eewww.mariestopes.org.uke, accessed 18 March 2008.

McBride, E. and Ahmed, R. (2001). Social franchising as a strategy for expanding access to reproductive health services: a case study of the Green Star Service Delivery Network in Pakistan. Washington, DC: Commercial Market Strategies, 2001: 71, cited by DaVlake, 2003 and Stephenson et al., 2004.

Montagu, D. (2002). Franchising of health services in developing countries. Bay Area International Group. University of California, Berkeley. Available online at http:eerepositories.Cdlib.orgebigefranchising.

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OneWorld (2007). The Mobile for Good (M4G) social franchise model – an investment opportunity. Available online at www.mobile4good.com.

OneWorld website (2007). http:eeuk.oneworld.netesectionemobile. Accessed on 18 March 2008.

Partners In Practice (2008). Examining the mentoring relationship and ways to support, enrich and encourage that relationship in early childhood practice. PARTNERS IN PRACTICE mentoring in early childhood practice in Canada: reflection, caring & sharing. Accessed from http:eewww.partnersinpractice.orgewho.html on 6 February 2008.

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Procedure guidelines for the implementation of the policy on financial awards to service providers. (2005).

Rasego, B. (2002). International Conference on AIDS. Int Conf AIDS. (2002 Jul 7- 12); 14: abstract no. MoPeG4187. “An HIV/AIDS capacity building and mentoring programme for community-based organisations”. The Policy Project, Cape Town, South Africa.

Royle, T. (2001). Working for McDonald’s in Europe, the unequal struggle. Routledge.

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Scott, R. and Wadee, H. “South Africa: study of non-state providers of basic services.” for DFID.

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Singh, M. (2000). “Combining work and learning in the informal economy: implications for education, training and skills development”. International Review of Education, 46, 6, pp.599-620.

Smith, E. (1997). Social franchising for EU member states experts meeting on HIV/AIDS. Summary. London: Options/Department for International Development, cited by Stephenson et al., 2004.

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Thomson, I. and Walter, C. (2005). “Adult education in the field of early childhood development: sustainable results through empowerment in a community context.” Totswana Papers. Centre for Research and Development in Adult and Life-long Learning. University of Glasgow. Accessed from http:eewww.gla.ac.ukecentres ecradalledocseBotswana-paperseThomsonfinalp87.pdf on 6 February 2008

Tsui, A.O., Creanga, A.A. and Myint, Y. (undated). The impact of franchising reproductive health services on client service use in Ethiopia, India and Pakistan. Population and Family Health Sciences Department. John Hopkins Bloomberg School of Public Health. Maryland.

Wachs, P.C. (2007). “The case for social franchising”. EFFECT – Foundations in Europe Together Vol. 1, Issue 3I, Autumn 2007. Accessed from http:eewww.efc.beeftpepubliceCommunicationseEFFECTeAutumn2007eEFFECTau tumn2007.pdf on 14 March 2008.

Williamson, E. and Lorey, M. (2001). Mechanisms for channelling resources to grassroots groups protecting and assisting orphans and other vulnerable children. Draft for discussion and comments. Displaced Children and Orphans Fund of USAID & Geoff Foster, Family AIDS Caring Trust, Mutare, Zimbabwe, 20 September 2001. Accessed from http:eewww.synergyaids.comedocuments e3025pMechanismsp_williamson.doc on 6 February 2008.

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Appendix 1 – Case studies

6. International case studies

International case studies of social franchises considered are described below. Information from the case studies is presented to address the following specific research questions:

1. How do they introduce themselves into communities;

2. How are they staffed;

3. How do they set themselves up from an infrastructure perspective;

4. How do they run their programmes;

5. How do they ensure that their standards are the same at all sites;

6. How do they monitor and evaluate their programmes;

7. How are they funded; and

8. How are they sustainable.

Case studies following the basic social franchising model are presented, followed by specific examples of case studies adopting Joint Venture, Community, Private Provider and Governmental models of franchising.

6.1 Social franchise model

6.1.1 Green Star – Pakistan

Green Star is used as an example to illustrate a social franchise that provides: . Marketing and branding of services; . Training and capacity building of staff (including doctors and clinic staff); and . A defined package of services to be offered according to specified standards.

The Green Star Network was designed by Population Services International (PSI) and its local affiliate, Social Marketing Pakistan (SMP) to contribute to the government of Pakistan’s family planning strategy by complementing its rural-based public services expansion with an urban-based private sector strategy (IUD Toolkit, 2005). By 2002 Green Star franchised a range of family planning services through its network of 2000

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private doctors (Montagu, 2002).The network grew to include more than 11,000 private health providers in more than 40 cities during its first five years of operation (1995-2000), receiving more than 10 million client visits per year. (Stephenson et al., 2004).

How do they introduce themselves into communities

The Green Star network incorporates private sector health providers who are willing to upgrade their knowledge and skills in order to add family planning to the services they offer (IUD Toolkit 2005: 2). The network uses advertising over local television and radio to generate demand, leading to a dramatic increase in clinical services. (Agha & Ahmed, 1997, cited in Lavake, 2003)

How are they staffed and capacity building of staff

The Green Star franchise provides capacity-building for existing doctors and midwives in the private sector who provide services to low-income populations. (Stephenson et al, 2004). Green Star trained 300 doctors and paramedics in two urban areas as a pilot project in 1995, based on a curriculum used in Indonesia to train private-sector providers in family planning delivery. (Agha & Ahmed, 1997, cited by Lavake, 2003). The franchise was subsequently launched on a larger scale in 1997. Franchise membership is open to private doctors (of either gender) and private clinics of lady health visitors. (Tsui et al, undated). Studies show that the increased skills and competency levels of Green Star providers has improved quality of care. (IUD Toolkit, 2005). Montagu (2002) notes the most important benefits to providers, in their view, is the start-up training and monthly visits from Green Star doctors to provide support ongoing.

Challenges encountered by the Green Star Network related to staffing include:

. The need for immediate results – maintaining provider motivation without a perceived reward, e.g., increased number of clients and maintaining provider skills, can be difficult; and . The network has to develop a formal mechanism to ensure that franchise members can practice the skills they acquire in training. (IUD Toolkit, 2005).

How do they run their programmes

The franchising concept was used in the design of the Green Star network to provide functioning service delivery points with a standard package of high-quality reproductive health services. SMP (the franchiser) and selected providers (franchisees) form partnerships, agreeing that providers would integrate a defined package of services, to be delivered according to the high-quality standards established by SMP. In return SMP offers the provider/ franchisee specialised support, training, and rights to the franchise brand for as long as the franchisee maintains minimum quality standards. Benefits to the franchisee include association with the brand equity, indicating quality and reliability, created by the franchiser. (IUD Toolkit 2005)

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Keys to the success of the franchising concept are:

. Business format – including a standard care package and an understanding of the costs and income associated with the service. . Brand promotion and development – advertising and promotion of franchise outlets and products marketed under Green Star logo and brand name. . Quality assurance – staff trainings, facility upgraded, field support, management information systems, monitoring quality of care, and referral through selective recruitment (IUD Toolkit 2005).

How do they ensure that their standards are the same at all sites

A review of the Green Star health establishments found variations in quality-of-care standards as well as the pricing of some family planning methods among participating establishments (Stephenson et al., 2004).

Challenges the Green Star franchising network faces with regard to standardisation of services include:

. Compliance with quality standards. For example, many doctors lack confidence in applying new skills they are trained in. Client follow-up is also weak. . Mechanisms to control prices. Prices charged for contraceptives are often higher than those recommended by the SMP recommendations. . Managing a rapidly growing network. As monthly supervision is not possible with a large network, focus is placed on learning from high- and low-performing outlets to synthesise lessons. Decentralising training to local NGOs allowed the programme to support local capacity for service.(IUD Toolkit, 2005).

How do they monitor and evaluate their programmes

While the Green Star project demonstrated the capacity for social franchising to support a very rapid scale-up in the delivery of health care services. an analysis of the project by Commercial Market Strategies concluded that “On the opposite side of this coin are the great difficulties encountered in monitoring outlets and managing information from a large number of franchises brought on board quickly” (McBride & Ahmed, 2001, in DaVlake, 2003: 10).

Green Star was one of three franchise programmes (along with Janani and Biruh Tesfa, see below) that sponsored standardised and systematic survey data collection for a clustered evaluation requested by the David and Lucile Packard Foundation. The probability sample surveys of health facilities, providers and clients were conducted in two rounds, once between January-September 2001 and the second between January- June 2004. (Tsui et al, undated)

How are they sustainable

Green Star’s aims to achieve and sustain positive public health impact over time through minimising its financial vulnerability. This is done by:

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. Maximising efficiency and controlling costs through sound financial management; . Developing a diversified funding mix; and . Maximising sales revenues from socially marketed products in a manner consistent with serving the poor (IUD Toolkit, 2005).

Sustaining provider involvement continues to be a challenge for the Green Star Network. “The key is keeping providers involved in the development of the network, through protocol development, referral systems, and support” (IUD Toolkit, 2005: 4).

6.1.2 Green Key – Pakistan

Green Key is used as an example to illustrate a social franchise that provides: . Training and capacity building of staff; and

. A referral network for additional support to frachise members.

The Green Key network was launched after Green Star and is implemented by the Futures Group, providing training in various reproductive health care services as well as access to contraceptives. (Stephenson et al, 2004).

How are they staffed and capacity building of staff

Green Key offers technical training in reproductive health care, counselling and contraceptive use to physicians, paramedics, and pharmacists interested in expanding their family planning services. Trained service providers are further assisted by a referral network of hospitals to which franchise members can refer clients for more extensive counselling and service support (Key Social Marketing 2002, cited in Stephenson et al., 2004).

6.1.3 Biruh Tesfa – Ethiopia

Biruh Tesfa is used as an example of a private sector social franchise that provides: . Training and capacity building of staff (qualified doctors only); and . A defined package of services to be offered according to specified standards.

The Biruh Tesfa or ‘’Ray of Hope’ franchise network in Ethiopia is implemented by Pathfinder International. Biruh Tesfa is a private sector franchise for family planning and reproductive health services that began in January 2000, operating in three regions: Addis Ababa, Oromia, and Amhara. Franchise members are existing clinical community-based health care providers. By 2004, 92 clinics, 150 community health agents, 100 trained birth attendants, 48 marketplace providers, and 120 workplace providers had joined the network. (Stephenson et al, 2004)

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How are they staffed and capacity building of staff

Biruh Tesfa membership is limited to private qualified doctors. (Tsui et al, undated). The Franchise provides members with training in sexual and reproductive health treatment and family planning, as well as referral procedures. Franchise members may also receive training in financial management, procurement support for supplies and equipment, and supervision depending on their clinical capacity. (Stephenson et al, 2004)

How do they monitor and evaluate their programmes

The Biruh Tesfa programme in Ethiopia was one of the three franchises that sponsored standardised and systematic survey data collection for a clustered evaluation requested by the David and Lucile Packard Foundation. (also see Green Star and Janani above (Tsui et al)

How are they funded

Biruh Tesfa is funded by the Packard Foundation (Stephenson et al, 2004)

6.1.4 Mobile for Good (M4G) – Kenya

M4G is used as an example to illustrate a social franchise that provides: . Support in setting up cell phone networks to distribute information; . Technical training and assistance; . Links to other service providers (telecom operators); . Marketing support and branding; . Monitoring and evaluation; and

. Ongoing consulting support.

Mobile for Good (M4G) is a social franchise project implemented by OneWorld.net. The project uses mobile phone technology to help alleviate poverty in the developing world. It delivers vital health, employment and community content via SMS on mobile phones to inform and empower disadvantaged individuals, thus hoping to help bridge the ‘digital divide’. (Oneworld website, 2008)

How are they staffed and capacity building of staff

The Mobile for Good Network looks for social entrepreneurs who are educated and experienced professional with proven business experience, to help roll out their network in developing countries. The network is already in operation in Kenya, and planning is underway in Tanzania, Cameroon, Nigeria and Nepal (OneWorld, 2007).

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How do they run their programmes

Mobile for Good offers two investment routes depending on the country in question and one involving more counties at the same time. While some countries are ready for a full-scale investment, others are still in development in terms of percentage of population that uses mobile phones. In these cases it is thought wiser to employ a more cautious approach and a low cost entry to market (OneWorld, 2007).

The franchise costs for both options cover:

. Carrier grade SMS-technical platform and full technical training; . Technical & Business assistance during the set-up phase; . Linkage to the national telecom operators; . Full marketing support; . Full franchise pack including the M4G Manual and Monitoring and Evaluation tools; . Ongoing consulting; and . Use of the M4G brand (OneWorld, 2007).

How are they funded

OneWorld started a pilot project in Kenya in 2003 with support from the Vodafone Group Foundation. M4G Kenya, which has helped connect people to over 60,000 jobs, is now a locally owned, self-sustaining business. The commercial launch in 2006 resulted in a positive cash flow and annualised revenues of over US$100,000.

With backing from Accenture Corporate Citizenship Council, OneWorld has developed a franchise model based on the Kenyan success, offering social entrepreneurs across Africa and other developing countries the opportunity to run their own business with support from the franchise package (OneWorld, 2007).

To further fund its initiatives M4G seeks investors such as venture philanthropists, venture capitalists, foundations or telcos to team-up with local entrepreneurs. These investors are to share risks and provide the financial base required to succeed. Various options are provided to tailor the collaboration with a combination of equity and loan. These range from investment in one country with a small market potential (investment of about US$70.000) to a bulk investment in five to 10 countries (an investment of about US$1-milion) (OneWorld, 2007).

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6.1.5 NFTE – New York to Global

NFTE is used as an example of a private sector social franchise that provides:

. A model for teaching entrepreneurial skills to students from troubled backgrounds; and

. Fexible guidelines that can be adapted based on local circumstances.

The Network for Teaching Entrepreneurship (NFTE) was founded in New York in 1986. It aims to teach students aged 15 to 17 who come from difficult social backgrounds (Wach, 2007).

How are they staffed and capacity building of staff

NFTE involvement starts with the training of teachers who are then provided with tested curricula and manuals. Students subsequently develop a business idea that would fit their environment, drawing up the necessary requirements of financing, costs and prices. Prizes are awarded for the best business ideas (Wach, 2007).

How do they ensure that their standards are the same at all sites

More than 120,000 young people in 17 countries have taken part in the NFTE school curriculum since 1986. While the basic goal and principles remain constant target groups vary: “In China, students are younger than those in the US; in Germany, Belgium and the Netherlands, the programme is used for ex-convicts and exceedingly difficult youngsters from problem areas; and in India, it is directed at young adults with breakfast provided during class” (Wach, 2007: 4). The NFTE manual was translated for use in German schools in agreement with the American licensers. The structure was also partly changed to accommodate Germany’s more conservative approach to entrepreneurship. NFTE is furthermore establishing a curriculum for German vocational schools and is working on a micro- credit prototype (Wach, 2007).

6.1.6 Mary Stopes International (MSI) – Honduras and Nicaragua

NFTE is used as an example of a social franchise that provides: . Assistance to service providers in communities that are not as successful as they could be; and . Different forms of assistance in setting up new franchises; . Training; and . Follow-up support.

Marie Stopes International is a registered charity working in 38 countries around the world. Surplus funds from its UK centres help to support vital sexual and reproductive healthcare programmes in some of the world’s poorest regions (Marie Stopes website, 2008).

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How do they introduce themselves into communities

A review of Marie Stopes International projects in Nicaragua and Honduras showed that most successful franchisees to be those who were already known within the community. These are established entities who have an existing client base but whose businesses are not as successful as they could have been. In the absence of a high level of awareness of the franchise brand name among the target population an existing client base can be crucial. The commercial and legal relationship (including brand ownership and conditions of use) must be clearly defined and understood by franchisee and franchisor. Ensuring that the financial and legal guarantees supplied by franchisees are properly in place was found by MSI to be vital in order to recoup any portion of the initial investment costs, as was gaining full commitment from franchisees at an early stage. (Frost, 2006)

How are they staffed and capacity building of staff

Training packages are offered in both full and fractional franchising models provided through MSI Nicaragua and MSI Honduras. These include clinical management, client care and small business management, as well as updates in SRH issues and family planning (FP) practice. In addition MSI initially provided Information, Education and Communication (IEC) materials and marketing services, as well as guidance to franchisees on how to sustain such materials and marketing themselves. Franchisees also receive general follow-up support (Frost, 2006).

How do they set themselves up from an infrastructure perspective

Box 11 shows how Marie Stopes International franchise networks were set up in Nicaragua and Honduras.

BOX 11 – Setting up of franchises

In Nicaragua, fractional franchisees had access to additional funds through interest-free loans for centre improvement and the purchase of equipment. Through MSI Nicaragua, full franchises had the initial investment costs of renovation of premises and equipment met, as well as the cost of franchise management provided through the project itself, with a soft loan to subsidise operating costs. The cost of rental, medical supplies, etc. was channelled through MSI and the cost debited to the franchisees’ loan accounts. In the case of franchised clinics in Honduras, the donor (UNFPA) purchased medical equipment and MS Honduras distributed it to the franchisees, who had use of the equipment for the duration of the project. MS Honduras also provided a credit to both franchise types to cover clinic improvements, equipment and local marketing costs. A portion of this loan could be used for operating subsidies. (Frost, 2006: 10-11)

How are they funded

MSI secured funding to pilot a full franchising model in Nicaragua before they were able to secure further funding to expand the pilot by adding fractional models. Funding for MSI projects implemented in Nicaragua and Honduras came from the European Commission, a private trust, and the UN Foundation (Frost, 2006).

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How are they sustainable

Without external funding, neither of the franchise models adopted by Marie Stopes International franchises in Nicaragua and Honduras could reach populations with severely limited or no capacity to pay for services (Frost, 2006).

MSI benefited as franchisor by achieving greater recognition of its brand, through increased market penetration. A network made up of service providers aligned with MSI’s mission and goal and complying with MSI’s established standard of high quality service provision was established with this aim. “However, neither the full or fractional franchise models allow a franchisor to recoup investment costs. Although a revolving fund to receive credit repayments was in place, as a finite resource, the support of the networks over the medium to long term was not possible without funding from external sources” (Frost, 2006).

6.1.7 Integrated Maternal Child Care Services and Development Inc. (IMCCSDI) Philippines

IMCCSDI is used as an example to show: . Detail on how this particular social franchise was introduced into communities; and . Factors that are crucial for sustainability, learning from the IMCCSDI’s experience which was not sustainable. The example highlights the importance of: . Sufficient funding from the franchisor; . Ongoing support; . Monitoring and evaluation; and . Methods to address non-compliance with standards.

The IMCCSDI was a traditionally donor-dependent non-profit organisation before deciding to become a self-sustainable organisation providing a broad range of healthcare and family planning services in 1992. The first franchises were awarded in March 1993. Between 1993 and 1994 a total of 47 IMCCSDI-affiliated clinics were converted into franchises. No further franchise was awarded in succeeding years. Of the initial 47, only 27 were still known to be operating in 2001. Most of the 25 closed clinics ceased operation because they could not pay off loans they took to renovate or relocate their franchises or continue to pay monthly membership fees (Lagman, 2001).

How do they introduce themselves into communities

Box 12 shows how the IMCCSDI introduced itself into the community.

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BOX 12 – Introduction into the community

Towards the end of 1992, all the clinic [IMCCSDI] operators/managers affiliated with IMCCSDI were briefed at a conference on the concept of franchising and its benefits and the implications of foregoing the franchise opportunity. IMCCSDI's regional supervisors then began presenting to pre-selected midwives and nurses operating IMCCSDI clinics and to certain physicians with access to IMCCSDI clinics the idea of a franchise relationship between them and IMCCSDI. A franchise offer kit, a specially designed coloured folder containing the pro-forma franchise agreement and basic information about the franchising relationship, was given to each of them. They gave a verbal presentation of the content of the folder making observations and/or comments that related to the particular circumstances of each prospective franchise. After allowing enough time within which the prospective franchisee could consult third parties (a lawyer, spouse, or business adviser), the regional supervisor then went back to the clinic operator in her region to convince her to agree to a franchise agreement. The regional supervisors also sought maternal and childcare or family planning clinics not affiliated with IMCCSDI that would make good franchises. The supervisors approached the clinic operators and presented IMCCSDI's franchising concept. Those who were receptive to the idea were given the franchise folder. When and where possible, prospects were invited to see and observe the operation of a franchise and encouraged to interview the franchisee. IMCCSDI officers attending inter-organizational conferences talked, whenever possible, about the franchising operation either during the regular sessions and workshops or in formal conversations outside the session hall or conference rooms. Their purpose was to get people from other organizations to refer IMCCSDI to potential franchisees or refer potential franchisees to IMCCSDI. The first franchises were awarded in March 1993. The first franchisee was X .Her clinic, located behind the public market in Agdao, Davao City was inaugurated on March 17, 1993. The following day, W's FamilyCare clinic, in the heart of downtown Davao City, was formally opened to the public. On the same day, Mercuria Calma opened her franchise clinic in Sta. Cruz, Davao del Sur. Fourteen more franchises were awarded in the month of May alone, mostly in the Mindanao provinces. A total of 35 former IMCCSDI-affiliated clinics were converted into franchise clinics in 1993. Another twelve FamilyCare clinics were inaugurated in 1994. No other franchise clinic opened after that as half of the IMCCSDI-affiliated clinics did not qualify or were not interested in becoming franchises. (Lagman, 2001: 12)

How are they staffed and capacity building of staff

IMCCSDI sent its key operating officers to various management-training programmes in order to strengthen its management capabilities. However, the programme did not hire anyone with substantial knowledge of franchising operations or business experience to bolster its management complement (Lagman, 2001).

“The IMCCSDI officers did not refocus their attention to include the business aspects of the operations. They went through some of the orientation and training programs perfunctorily. They did not take to heart the familiarization programs on the accounting and reporting systems. They did not apply their mind to the content of the training program on the management of a clinic. Thus, the monthly reports were not given their due importance” (Lagman, 2001: 21).

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How do they run their programmes

IMCCSDI started entering into franchise agreements with clinics that previously depended on the private volunteer organisation (PVO) for commodities and salaries of clinic operators in 1993. The arrangement required IMCCSDI to strengthen the revenue-generating capabilities of the clinics by extending financial, training, and logistical support and providing equipment and materials. The clinics in return were to provide services to the beneficiary targets for modest fees, operate in accordance with the manual of operations for clinics, and pay a regular franchise fee to IMCCSDI (Lagman, 2001).

How do they ensure that their standards are the same at all sites

An important factor leading to the demise of the IMCCSDI venture related to the total lack of disciplinary action against franchisees who failed to make their loan repayments, pay monthly royalties, or adhere to minimum standards laid out in the procedures in the manual of operations (Lagman, 2001).

How do they monitor and evaluate their programmes

Lack of sufficient and efficient monitoring is cited by Lagman (2001) as one of the factors preventing the IMCCSDI from achieving sustainability. Field officers did not monitor franchisees’ performance, nor even checked compliance with the provisions of the manual of operations. Although a monitoring manual was in place complete with inspection reports, it was not used by the regional supervisors. “The overall result was that the clinics, except for their more presentable physical appearance, did not differ significantly from other FP clinics outside the IMCCSDI network” (Lagman, 2001: 21).

IMCCSDI clinic operators had no formal accounting and reporting system. “The money in the cash box served as their accounting system. What was left in the cash box or drawer at the end of the day was the indication on how they were faring” (Lagman, 2001: 10). Lagman notes that revenues and expenses were not recorded, and that clinic operators were unconcerned about trends in these.

How are they funded

The fact that IMCCSDI itself did not have adequate funds to support its own operation is emphasised as a key constraint to the project’s success. Franchise fees and royalties were insufficient for IMCCSDI to operate as a franchisor, which resulted in a decline of support offered to franchisees (Lagman, 2001). Lack of access to funding was exacerbated by the fact that “no one among the operations directors and supervisors of IMCCSDI was capable of coming up with new ideas on how the clinics could generate greater revenue. They did not have the creativity or the initiative” (Lagman, 2001: 21). Although staff were hard working and good in their field of technical expertise they were unable to cope with the business demand of franchising. Lagman believes that “[t]heir responsibilities should have been confined to those aspects of the clinic operations and people from the business world or the franchising field should have been hired to handle the business aspects” (Lagman, 2001: 21).

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How are they sustainable

Concerns expressed by IMCCSDI’s deputy director for Field Operations regarding the shift from donor dependency to a self-sustaining operation included the following: i. Most FP clients were used to free supplies from government agencies. As clients of self-sustaining franchise clinics, the clients had to pay for supplies. ii. The franchising project required a paradigm shift from donor-dependency to a business undertaking for both the IMCCSDI officers and the clinic operators. Officers of IMCCSDI and the clinic operators were mostly technical people with extensive experience in maternal and childcare but no meaningful exposure to business operations. Neither group had even the most basic training in management. iii. Clinic facilities and the types of services midwives were allowed by law to perform were limited, preventing the addition of other revenue-generating services to the offering of the clinics. iv. Clinic operators had very limited resources. They would have difficulty in raising funds to augment the money provided by USAID to make the clinic operations really viable. v. IMCCSDI itself had inadequate financial resources to provide financial support to the clinic operators. vi. Different private volunteer organisations competed for the same clientele. vii. Government clinics provided for free some of the services offered by the IMCCSDI clinics (Lagman, 2001: 10).

The collective Post Evaluation comments of six IMCCSDI franchisees that provide some reasons into its demise were as follows:

. Cost of operating a clinic rose; . Competition from government health units and other PVOs increased; . Lack of business experience told on franchisees' effectiveness; . Technical support, like training, from IMCCSDI waned; and . Management counsel by IMCCSDI was almost nil (Lagman, 2001: 15).

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6.1.8 Janani – India

Janani is used as an example of a public-private network social franchise that provides: . Training and capacity building of qualified doctors as well as community health practitioners; . A referral network system between doctors and rural practitioners; . Hierarchical but inclusive management practice whereby responsibility and accountability is devolved to all levels of staff; and . Participatory monitoring and evaluation in which the community is involved to ensure quality standards. The Janani programme has various financial schemes and partnerships with different types of clinics and role-players involved, which are outlined in the example. Illustration of commitment is required through membership fees.

Emphasis on communication is cited as a critical success factor of the Janani Programme.

The Janani franchise network is implemented by Janani/DKT International (Tsui et al., undated) It was first piloted in the Bihar region of India, and is today among the largest public-private networks delivering family planning and reproductive health care in India, including Bihar and Jharkhand and 10 districts of Madhya Pradesh in central India (Janani website, 2008). Surveys conducted with clients and potential clients in the villages in 2001 showed that the community view the association with Janani as an important indicator of RMP service (Montagu, 2002). By 2004 more than 11,000 health providers were participating in the network (Stephenson et al., 2004).

How do they introduce themselves into communities

Providers in India were shown to be unlikely to sign up for a franchise whose business plan is based on volume without an established brand and developed market. Heavy subsidies or initial targeting toward more affluent urban dwellers were used as alternatives in the Janani programme (Montagu, 2002).

How are they staffed and capacity building of staff

The Janani system is based on Surya clinics that are fewer in number and restricted to private qualified doctors, and Titli centres which involve less formally trained rural medical practitioners (Tsui et al., undated).

The Janani franchises private doctors and Rural Medical Providers (RMPs) to provide branded contraceptives and clinical family planning services. (Gopalakrisnhnan et al, 2002). Janani works with RMPs who are untrained and unofficial medical practitioners providing almost all health care to the 80% of Biharis living in rural areas (Montagu, 2002). Two RMPs selected from each panchayat (village council), receive four days of training at a franchise called a ‘Titli (Butterfly) Centre’ (the franchise brand). In addition to the two RMPs selected from each panchayat, another two individuals are held in reserve (Gopalakrisnhnan et al., 2002).

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Of approximately one hundred employees at Janani’s Bihar office, ten provide clinical services and training at the central Surya Clinic. Prospective franchisees complete their required training at this Janani operated clinic. Other Bihar employees work in accounting, training, materials production and advertising. They are also responsible for general corporate administration, as well as the shipping and receiving and other support services (Gopalakrisnhnan et al., 2002).

Janani promotes gender-sensitive service provision by only selecting RMPs with literate wives (or close female family members) who are trained along with the men. RMPs chosen to operate Titli Centers are not Janani employees, but rather private contractors in a long-term franchise relationship with Janani, whereby they provide a set of services and commodities controlled by Janani in exchange for a membership fee. The programme intends to train one doctor for every twenty RMPs. Doctors are not charged a franchise membership fee although this may be instated in the future (Gopalakrisnhnan et al., 2002).

How do they run their programmes

After establishing subsidised contraceptive shops in 1996, the Janani network started working with existing private providers and expanding into rural areas in early 1997. Six training centres located throughout Bihar are operated as independent businesses increase incentives. Patna-based staff provides the centres with regular support and supervision (Gopalakrisnhnan et al., 2002).

The Urban Social Marketing component of Janani is organised in a traditional hierarchical management system whereby the General Sales Manager directs the entire urban social marketing system, assisted by one Regional Sales Manager, who supervises four Field Sales Executives. Each Field Sale Executive directs five Sales Officers who sell contraceptive commodities from the wholesaler to the individual retail outlet shop (Gopalakrisnhnan et al., 2002).

One of the key features that contribute to the efficiency of Janani is keeping all employees involved in the management process. Janani keeps everyone informed of the programme’s progress, new initiatives, and completion of work towards programme goals through monthly structured meetings with the entire staff organisation (Gopalakrisnhnan et al., 2002).

Janani devolves risk at each point of its operation to the person or subcontracting company responsible for that job. This has been done by operating through contracted private trainers, distributors, supervisors, and sales representatives, and by using multiple layers of oversight with incentives at each level for uncovering fraud. Losses have been minimised in this way so that the programme has been able to operate efficiently. Because each person in the system has a financial stake in the performance of his/her duties, the effort and quality of output has been consistently high (Gopalakrisnhnan et al., 2002).

The structure of the Janani Social Franchise is depicted below:

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Figure 9 – Structure of the Janani social franchise

Source: Du Toit, 2003: 21

Box 13 provides an overview of how the Janani network is run, looking at financial schemes applicable to Surya clinics, partnerships formed with qualified doctors, means to promote entrepreneurship and partnerships with Titli rural clinics.

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BOX 13 – Janani financial schemes

Financial schemes applicable to Surya clinic The Surya network is moving toward exploring entrepreneurial energies among providers to ensure optimal levels of efficiency. The network of Surya Clinics are grouped under two broad categories: . Franchisee Surya clinics; and . Janani-owned Surya clinics The franchisee Surya clinics are those in which the doctors own the clinics. They follow norms set by Janani and enter into a legally binding contract. Each franchisee pays Janani an annual membership fee of Rs60,000 (US$1,300), which is collected quarterly. In return, the doctor gets a range of services and manpower. The Janani-owned clinics started with the organisation bearing all costs; the doctor and support staff were salaried employees. This has now undergone fundamental changes due to inefficiencies in the clinics caused mainly by the absence of entrepreneurial energies among the providers. Now Janani enters into partnerships with either doctors or local entrepreneurs with a long-term exit plan once the clinics are established and streamlined. Doctor partnership Janani has a partnership arrangement in which the doctor contributes part of the establishment cost for the clinic. Janani sets up the clinic and retains management control. In most cases, the doctor is paid a salary till the clinic achieves profitability. Janani runs the clinic till its investment, which includes the operational losses during the formative stages, is recovered fully. After this, Janani turns the clinic over to the doctor who runs it as a franchisee under the standard franchisee contract. Entrepreneur In places where the doctor is not keen on a business partnership, Janani ties up with a local entrepreneur who invests part of the costs, and also assumes the responsibility of bringing in a qualified doctor. Janani undertakes to upgrade the skills of the doctor. The rest of the partnership is similar to the doctor partnership. Once the investment is recouped, Janani deals with the clinic as it does with other franchisees. STC / Janani partnership Janani has also initiated a dialogue with rural centres to generate partnerships. Under this, Super Titli Centres, either individually or collectively, enter into a contract with Janani. The management is under Janani’s control. The doctor at the clinic is identified by the STCs, and is a partner on a profit-sharing basis.

How do they ensure that their standards are the same at all sites

Janani can be distinguished from other social marketing or social franchising programmes by its rigorous use of economic incentives throughout the organisation in order to maintain efficiency (Gopalakrisnhnan et al., 2002).

RMPs have complete freedom to set prices for services beyond uniformly priced branded oral contraceptive pills and condoms, although they are under contract to follow certain standards and protocols (Gopalakrisnhnan et al., 2002).

How do they monitor and evaluate their programmes

Du Toit (2003) attributes the success of the Janani group to monitoring and oversight levels that are built into the programme at all levels. “Each person in the system has a

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financial stake in the activities of the group, from sales and training personnel to the franchisees themselves” (Du Toit, 2003: 22).

Monitoring and follow-up safeguards have been designed into the JANANI programme at all levels. The ‘reserve RMPs’ selected from each village act as monitors who visit the RMPs every three months to evaluate aspects such as cleanliness and the availability of basic equipment. An RMP who scores poorly on two consecutive occasions is replaced by one of the back-up RMPs. Information is made available to stand-by RMPs through the Titli Center newsletter. Influential people in the village also have all the necessary information about the programme and help monitor the RMPs’ performance. The monitoring system thus aims to ensure that the trained RMP provides quality service at reasonable prices (Gopalakrisnhnan et al., 2002).

Gopalakrisnhnan et al., (2002: 11) regard the central lesson to be learned from the Janani programme the fact that a family planning NGO can be operated virtually anywhere “if sufficient care is taken to assure that monitoring and oversight incentives are built into the program at all levels”.

Janani was one of the three franchises that sponsored standardised and systematic survey data collection for a clustered evaluation requested by the David and Lucile Packard Foundation (also see Green Star and Biruh Tesfa) (Tsui et al., undated).

How are they funded

Janani is an affiliate of DKT-International, a Washington D.C.-headquartered charity that is one of the largest and most cost-efficient social marketing organisations in the world. Donors and sponsors include AusAid; The David and Lucile Packard Foundation; DKT International; Sir Dorabji Tata Trust; the Ministry of Health and Family Welfare, Government of India; the Department of Science and Technology, Government of India; Industrial Credit and Investment Corporation of India (PACT- CRH); The John D. and Catherine T. MacArthur Foundation; and The Population Foundation of India (Janani website, 2008).

How are they sustainable

While the Indian government still subsidises contraceptives, Janani intends to start covering its operating expenses through its operations and thus to increase its sustainability on an ongoing basis (Gopalakrishnan et al., 2000). Du Toit (2003) cites the continuity of the programme, acceptance by the market and the potential to achieve sustainability as evidence that social franchising can succeed using commercial principles of effective resource allocation and management.

Factors that contribute to Janani’s sustainability, according to Gopalakrisnhnan et al. (2002: 4), include the fact that 60% of Janani’s budget is earmarked for communication, and the annual membership of Rs500 (US$12) the RMP must pay to demonstrate commitment.

The fact that Janani is alive and well in 2008 can be seen from its website, http://www.janani.org/overview.htm. Describing its drive for sustainability, the site notes that Janani has adopted a two-pronged strategy to increase resources:

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. Add more products to raise revenues and to spread distribution costs; and . Increase prices without compromising the interest of poor clients.

The programme is challenged by franchisees’ pressure to increase prices, which must be offset against the danger of leaving out some very poor and needy clients from its scope. (Janani website, 2008)

6.1.9 Planned Parenthood Federation of America (PPFA)

The PPFA is used as an example to illustrate an active emphasis on evaluation to ensure compliance with quality standards of a franchise. The advantage of a ‘stand-alone’ as opposed to a ‘fractional’ / part- franchising agreement is highlighted with regard to evaluating the services offered.

The PPFA comprises 860 affiliate health centres, providing quality family planning and reproductive health care to women, men and teens across America. The Federation continues to expand by offering online health services, opening express clinics in shopping malls, and using xmobile clinics to reach underserved communities (Planned Parenthood website, 2008).

How do they monitor and evaluate their programmes

The PPFA (see Box 14) is considered by Montagu, (2002) to represent one of the best examples of monitoring of a social franchise.

BOX 14 – Monitoring at the PPFA

The PPFA conducts extensive evaluations and re-certifications of its local affiliates every 4 years. This is done to assure that at each affiliate service quality, pricing and financial management are all being properly managed so as not to hurt the Planned Parenthood brand. The evaluation focuses on quality assurance methods: are there certification requirements for all medical staff, are there codes of conduct and regulations to assure board accountability, is there a mix of funding sources to assure financial stability? PPFA has an advantage in that their affiliate programme is akin to a stand-alone franchise system, not a fractional franchise system. This means that PPFA does not need to distinguish between branded and unbranded services when evaluating members. This matters because one of the most difficult aspects of fractional franchising is the separation of franchised services from other provider-offered services that share the same facility. (Montagu, 2002:126)

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6.1.10 The STRIVE programme – USA

STRIVE is an example of a franchise that caters for private and public service providers, providing: . Training and support; and . Monitoring and evaluation for quality control. The STRIVE programme is funded by various sponsors.

STRIVE was founded in 1984 as a public-private initiative in New York. It involved a training programme for hard-to-place unemployed people between the ages of 17 to 40 years. The programme’s immediate success could be evidenced by 80% of those signing up finding placements. STRIVE initially provided thorough schooling and supervision and a steady level of training. The system later expanded in a similar manner to other American cities (Pittsburgh, Chicago, Boston and Philadelphia). Public and private providers adapted the core of the STRIVE programme to local circumstances. By 2007 STRIVE had placed almost 17,000 ‘graduates’ in regular jobs throughout the 15 locations throughout the US in which it is run (Wach, 2007).

How do they monitor and evaluate their programmes

A permanent control of quality and checking the number of jobs arranged was implemented by the STRIVE Programme (Wach, 2007).

How are they funded

Various sponsors, many of them locally based, have taken part in financing the STRIVE project in the various cities in which it operates (Wach, 2007).

6.1.11 MS Society – London

The MS Society was founded in London in 1953 as a non-profit organisation providing assistance to victims and families of those with multiple sclerosis. Today, 350 branches supervised by the central office are managed by volunteers. (Wach, 2007).

How do they ensure that their standards are the same at all sites

A uniform catalogue of services was established, along with a constitution setting up rules and practices for the whole organisation. The central office explains its assistance for branches in the organisation’s ‘Suggested Good Practices’. Good ideas from individual branches which have become part of the organisation’s work are also discussed. The ‘Suggested Good Practices’ thus set the standards of structure and quality developed in conjunction with the branch offices, and can be used use for guidance (Wach, 2007).

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How are they funded

MS Society is primarily funded through donations, legacies and sponsorships (Wach, 2007).

6.2 Joint venture model

6.2.1 Fundacion Mexicana para la Planeacion Familiar (Mexfam) – Mexico

Mexfam is an example of a joint venture franchise model mobilising the private sector to improve quality of services offered by: . Linking community and private doctors; . Providing training and support; . Marketing and branding; and . Assisting franchisees to raise funds.

. Mexfam was founded in 1965 to address family planning, sexual education and care for young persons. The venture initially worked through a number of unprofitable hospitals which were closed down before the foundation launched its Community Doctor’s Programme in 1984. This programme provided work for unemployed doctors, and has become established in communities where it offers assistance to the rural poor (Wach, 2007).

In 1994, Mexfam initiated the Gente Joven (Young People) programme, which has grown into a system of centres throughout the country working through clinics, schools, and community outreach (LaVake, 2003).

How do they introduce themselves into communities

The Community Doctors programme launched by Mexfam in 1984 provided a starting point for large number of unemployed young Mexican doctors, simultaneously securing medical care in remote rural areas. The programme also assisted Mexfam to disseminate family planning information in schools and other community institutions. Most of the Community Doctors established themselves quickly. Today they form an integral part of their community (Wach, 2007).

How are they staffed and capacity building of staff

Franchisees in Mexfam were unemployed or underemployed doctors who would manage viable private clinics that provided a reasonable income (Frost, 2006).

How do they set themselves up from an infrastructure perspective

In addition to its own Gente Joven centres, Mexfam promotes the Gente Joven programme through clinics already owned by a private party, where costs and income from fees are split with Mexfam, and with community clinics, where the owner rents

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equipment from Mexfam. Mexfam provides contraceptives, educational materials, logos and signage, and some advertising in community clinics in return for using the clinic as an intake and referral site for youth. (La Vake, 2003: 13)

How do they run their programmes

In the 1990s, Mexfam joined 475 community doctors with another 290 private doctors to form a new franchise system focusing on maternal and child health and family planning services in low-income urban areas. The franchise system has mobilised the private sector and controlled the quality of care provided in accordance with the Joint Venture approach noted by LaVake (2003).

Gente Joven provides comprehensive information on family planning for youth. The programme currently reaches around 250,000 young Mexicans. It has also been adopted by several other Latin American countries. (Wach, 2007)

“Mexfam’s strength appears to be its educational services, such as providing information on condoms and training on decision-making skills, which are conducted by a Mexfam/Gente Joven staff member. Collaboration with schools is particularly strong. Mexfam provides curriculum development, pedagogical and communication materials, class demonstrations, and teacher training.”

According to LaVake (2003: 12), the franchising techniques that appeared to be the strongest assets for the transition to franchise management are:

. “Marketing and logo branding of the Mexfam and Gente Joven name; . Sharing of information between Mexfam and Gente Joven centres on all aspects of service delivery; and . Training and quality assurance of technical services, notably the involvement with peer educators, schoolteachers, and other community groups”.

How do they ensure that their standards are the same at all sites

To avoid the risk of ‘clouding associations’ noted above, Mexfam avoided using the Mexfam brand when they decided to create a rural network of clinicians using new medical school graduates, in part to avoid possible risks to their existing brand (Montagu, 2002).

LaVake (2003) notes that community-wide quality standards have not been established for youth services in Mexfam’s Gente Joven programmes. “Providers follow their own organisation’s standards, which may or may not be tailored to youth. Gente Joven is developing such standards and planning to introduce them through the network. Ideally, standards for youthfriendly services and youth participation, as well as a uniform certification or review process, should be established and enforced for community organisations participating in the collaborative network” (LaVake, 2003: 14).

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How are they funded

In reviewing the Mexfam experience, Frost (2006) notes that Mexfam retained ownership of tangible and intangible assets, as well as initial start-up investment in the case where the franchisee opted to hand over the franchise. Mexfam has received no external funding for the social franchise since the end of the funding period, although some overhead costs are funded in part by external donors. LaVake (2003) noted that Mexfam’s Gente Joven franchise had not yet demonstrated financial sustainability.

How are they sustainable

Mexfam has had to support Gente Joven centres with private donations, foundation grants, and fees as funding by USAID and other donors has diminished. Mexfam hopes to make many of the 25 centres self-sustaining, establishing what can be thought of as a joint-venture franchising approach. Mexfam hopes to pass administrative and financial responsibilities for these centres to private doctors and NGOs who administer them (LaVake, 2003: 12).

As part of the move to greater independence for the Gente Joven centres, Mexfam plans to provide training in programme and financial planning. Mexfam also hopes the centres can develop diversified funding sources and private-sector involvement to help them achieve sustainability. “Believing they lack some of the skills and training for functioning more independently, local clinic staff and the youth committee at the new youth-only clinic appear concerned with the approaching deadline to become self-sustaining franchises” (LaVake, 2003: 14).

More training is needed in budget and management operations, as well as support in diversifying funding for the centres. This will involve decentralising budgeting and other management functions to regional managers. (LaVake, 2003)

6.3 Community model

6.3.1 FAD, Teens Healthquarters – Manila, Philippines

FAD is an example of a community franchise model that provides: . Marketing and branding; and . Links with other community structures. In addition to donor funds, FAD also involves the private sector in funding its programmes.

. The Foundation for Adolescent Development (FAD) was launched in 1988 in Manila, the Philippines, by advisers to a youth centre who wanted FAD to be a multi service programme for youth that provided information and services on health and sexuality. (LaVake, 2003)

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How do they introduce themselves into communities

Starting from a community centre, FAD has expanded to include a campus-based programme to mobilise student leaders and peer facilitators, a telephone hotline providing counselling, an extensive referral programme, a website that provides information on sexuality, and entertainment for educational programmes using videotapes and other techniques. Disadvantaged teens are targeted by a life-planning educational and vocational skills training programme consisting of nine modules targets. The community model used involves working with multiple supporters outside the strict franchises. “FAD works extensively with a variety of community organisations such as schools, youth centres, and other NGOs that display the franchise logo and host demonstrations, theaters, counseling, and educational events” (LaVake, 2003: 15).

How do they run their programmes

FAD began a franchise system to help spread the types of services it offered to more areas of the city. Franchisees are referred to as Teens Healthquarters (THQs), which are partnerships between FAD and various types of organisations, including NGOs and a municipality. Each THQ is designed as a community-based centre providing a comprehensive and holistic approach to youth development and sexual and reproductive health. Centers provide medical services, information, education, programmes on forming values, counseling, and referrals. The THQ makes no payment to FAD for services and only partial payment for products and materials received from FAD. FAD offers provider training at the sites in quality-of-care issues as part of the franchise arrangement (LaVake, 2003).

Social franchising techniques used by FAD include promotion through marketing, logo, and branding. It also shares programme information and referral systems, trains staff for technical areas and youth-friendly services, has a franchise agreement, and uses a client fee system. According to LaVake (2003), the organisation lacks management training, centralised purchasing, membership fees, and guidelines as to what constitutes youth-friendly services.

How do they ensure that their standards are the same at all sites

THQs share an eye-catching logo, a youth-friendly branding strategy, as well as information, referral mechanisms, staff training, and ideas generated from FAD’s core services.

Although FAD has quality assurance guidelines for technical areas, these are only minimally enforced. They are seeking to standardise operations, training, promotion, monitoring, and evaluation. According to LaVake (2003), while quality standards exist on paper, monitoring or enforcement of these standards was inconsistent.

How are they funded

FAD’s funding sources include UNFPA, the David and Lucile Packard Foundation, and other private companies and foundations. FAD has also sought to involve the private sector, primarily through fundraising and joint sponsorship of events. In-kind

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contributions, donations of promotional products (t-shirts, audiovisual tapes), endorsement by celebrity spokespersons, newsletter publication, and other forms of collaboration from companies such as Levi Straus, Coca- Cola, Sara Lee, Proctor and Gamble, and Avon have also been obtained. Collaboration is, however, often centred on short-term special events rather than the development of long-term relationships (LaVake, 2003).

6.4 Private provider model

6.4.1 K-MET, Kenya

K-MET is an example of a private provider franchise model that provides: . Branding and marketing; . Training and capacity building; and

. Links with community structures and the private sector. Funding sources include membership fees, fees charged for services, and some donor funds. .

K-MET began. as an indigenous NGO in 1996. The organisation developed and now supports numerous reproductive health networks in western Kenya, operating the ‘Private Providers Health Franchise Network’ as an incubator for reproductive health models and best practices. Its focus is on building effective community collaboration and involvement and creating support networks including strategic partnerships with community leaders and organisations. The network includes around 250 private clinics throughout western Kenya (LaVake, 2003).

How are they staffed

K-MET sites have developed training programmes and curricula for a variety of practitioners from doctors to midwives to peer educators, and many involved traditional healers. “K-MET has consistently pioneered new techniques and models in community outreach and networking, training of peer educators, training of adult volunteers in home-based programmes, research, and policy development” (LaVake, 2003: 20). Some of the K-MET training methodology and community involvement practices have been used by USAID/Kenya.

How do they run their programmes

K-MET is based on a holistic community development approach, with programmes including peer education, primary health care, maternal and child health, nutrition, prevention of malaria and waterborne diseases, community networking, and home- based programmes for people living with AIDS. The social franchising techniques of sharing information, developing referral mechanisms, training staff on technical issues and youth-friendly services, and charging franchise membership fees are used (LaVake, 2003).

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K-MET comprises key elements of the community franchise model (see above) in that it has developed a collaborative community network of schools, churches, government agencies, NGOs, and private businesses that serves to market, publicise, sustain, and enhance the private providers franchise network in parallel with its clinic network (LaVake, 2003).

How are they funded

Revenues are generated from franchise and individual membership fees, through fees from K-MET’s two small private clinics, and with some donor and foundation funding. It functions with only a four-person staff, plus extensive volunteers (LaVake, 2003).

How are they sustainable

K-MET’s franchise efforts are being broadened with help from youth and community groups. LaVake (2003: 21) believes that K-MET should consider these steps in order to continue to develop this franchise:

. “Develop a logo to enhance the franchise, perhaps sponsoring a design contest to get more youth invested in the project. . Utilise the media more and feature youth role models and spokespeople throughout the community network. . Package and document models and innovative practices so that training can be systematised. . Emphasise management and business planning, including research on costs and benefits, financial diversification, and greater earned income or revenue generating activities for both K-MET and related youth organisations.”

6.4.2 TOP Reseau, Madagascar

TOP Reseau is an example of a private provider franchise model focused on developing a peer-education network in collaboration with existing clinics. The franchise provides: . Training (including training manuals developed), capacity building and ongoing support; . A referral system through the network;

. Marketing and branding; and . Monitoring of services offered. . TOP Reseau, meaning ‘top quality, cool network’, was developed by PSI as a franchise . system that involves youth in programme design and development in Madagascar.

The project was launched in 2000, and consists of three well-integrated components: franchising, communication, and research. The project has expanded from the port city of Tamatave where it is based to the surrounding rural areas. It plans to expand to the capital city (Antananarivo) and other regions into the future (LaVake, 2003).

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In the first two years of the project, the 17 clinics involved provided services to some 2,500 clients. Peer educators conducted about 520 information session over this time (LaVake, 2003).

How do they introduce themselves into communities

The clinics involved in the network were invited to join the franchise after interviews and evaluations. Doctors and other staff at these clinics receive training, educational materials, and support services from the core TOP Reseau/PSI staff. The franchise arrangement is specified in a detailed contract (LaVake, 2003).

How are they staffed

Capacity building forms an important component of the TOP Reseau programme, with extensive and continual training provided in technical skills and management issues, with an emphasis on youth-friendly services. PSI compiled a training manual on youth-friendly services, as well as other operational manuals, curricula, client kits, and flip chart visual aids for providers and youth clients (primarily 15 to 24 years of age) (LaVake, 2003).

How do they run their programmes

TOP Reseau offers well-developed franchise techniques, including:

. Training on youth friendly services; . A referral system throughout the franchise network; and . Effective media and branding images.

These can collectively be considered ‘best practices’ for reaching youth. However, project costs are high, and replication of some practices (for example, payment of peer educators) will be difficult on a large scale (LaVake, 2003).

How do they monitor and evaluate their programmes

In collaboration with the clinics, PSI tracks clients served by sex, area, religion, marital status, age, type of service, and other variables. The intention is to use the data thus gathered in ongoing research and monitoring activities. Such data can help to address key questions such as whether the addition of franchising techniques is associated with an increase in youth seeking clinical services (LaVake, 2003: 9).

How are they funded

The programme was launched with a US$1-million, four-year grant from the Bill and Melinda Gates Foundation in 2000.

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How are they sustainable

“Project leaders envision the individual clinics eventually taking over more responsibility for the project themselves, thus ensuring long-term sustainability” (LaVake, 2003: 19). A committee of clinic physicians was established to provide overall project oversight and to extend community relations and support. Revenue from membership fees will eventually go to the committee as it assumes greater responsibility for the project.

LaVake (2003: 20) recommends the following steps to ensure sustainability and expansion:

. “Develop relationships with the private sector and other community organisations – perhaps through a parallel support network or a collaborative community network. . Document the impact of franchising techniques. Program monitoring should document the number of youth seen, the types of services received, and the cost- benefit relationship to the franchise services used. The programme could examine how many more youth are coming to clinics as a result of the logo and media promotion. . Explore ways to diversify funding and generate revenue”.

6.5 Governmental model

6.5.1 Gold Star Project, Egypt

Gold Star is an example of a governmental franchise model which differs from other franchises in that it is operated entirely by the government. The franchise provides: . Branding and marketing support; . A rigid monitoring programme to ensure quality standards;

. An incentive scheme to promote quality standards; . In-service training; and . A referral system. Although funded by government, Gold Star recognises the value of own-revenue generation, which would promote sustainability. .

The Gold. Star project in Egypt was started in 1993-94. The project reflects the traditional social franchising mode in many ways, although it is operated entirely by the government. According to the Ministry of Health (MOH) the project involves around 2,400 clinics, comprising more than half of Egypt’s 4,500 public reproductive health clinics. These clinics are generally publicly owned and locally operated. “The government of Egypt, through its MOH, is the franchisor, and only government- owned or public clinics participate in the program” (LaVake, 2003: 22).

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How do they introduce themselves into communities

Gold Star logo and signage is prevalent around clinics, along with detailed charts with client and community information. The fact that the Gold Star logo has become known as a sign of high-quality services is probably the most important accomplishment of this franchise system. The logo’s indication of quality is emphasised by television spots, promotional and educational materials, and an attractive gold star trophy. The programme highlights the power of status and recognition as a primary incentive to maintain quality standards (LaVake, 2003).

How do they run their programmes

The franchise includes a rigid monitoring component serving as a ‘quality improvement programme’ (discussed below) as well as a requirement for Gold Star clinic staff to attend three days of in-service training annually, and a standard referral system. Other than referrals, communication among clinics is limited according to LaVake (2003).

How do they ensure that their standards are the same at all sites

A modest bonus or incentive is used to encourage Gold Star clinics to meet quality standards (LaVake, 2003).

How do they monitor and evaluate their programmes

Gold Star serves as a quality-improvement programme with an extensive list of standards that clinics must achieve. “Each clinic is evaluated quarterly by the MOH. If the clinic fails to meet 100 percent of the Gold Star standards for two consecutive quarters, it loses its “gold star” and is put on an improvement plan” (LaVake, 2003: 23). Clinic supervisors must monitor that clinic standards which are set nationally are met. This includes documenting the satisfaction of clients according to the programme’s policies and procedures manual (LaVake, 2003: 23).

How are they funded

The Gold Star project was initiated with USAID funding, which was declining by 2003, according to LaVake (2003). Governmental funding had, however, increased and, as an incentive, is tied to performance by individual clinics. In contrast to traditional franchises, revenue from fees charged at MOH clinics is collected centrally and disbursed by district offices back to local clinics (LaVake, 2003).

How are they sustainable

Gold Star had shown only marginal interest in revenue generation, earned income, or private-sector involvement despite concerns over sustainability after donor funding ends. A study on revenue generation was undertaken in the hope of stimulating greater private-sector initiative. Although perhaps constrained for political reasons and as a public clinic, LaVake (2003) believes the Gold Star franchise could benefit from compensation for services provided to commercial enterprises (which at the time of LaVake’s assessment which were provided free of charge). “Such fees for

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services could help strengthen and sustain franchises. Without greater private-sector involvement, Gold Star remains essentially a quality improvement programme for public health with limited potential for private sector linkages” (LaVake, 2003: 23).

7. South African examples

South African case studies of social franchises include NOAH and loveLife. These are discussed below, looking at the social franchise system used, support provided by the franchisor, and benefits as well as pitfalls associated with franchising.

7.1 NOAH

NOAH is an example of a hub and spoke model where the spokes are not exact replicas of one another. In this case the organisation seeks to strengthen existing services according to desired model, but delivery is adapted to the local context. NOAH successfully integrates community services to respond to Orphan care, yet is challenged by limited funding to scale up. .

NOAH was. started by a South African philanthropist using private and corporate funds to support its goals and objectives in providing disadvantaged communities with the tools to protect its orphans. It receives a third of its funding from USAID (the PEPFAR programme), and thus also relies heavily on support from the private sector and government funds for which it qualifies. Noah currently cares for over 33,000 orphaned and vulnerable children within 112 Arks in the provinces of Gauteng and KwaZulu-Natal in South Africa.

The programme works best where communities have already demonstrated a willingness to provide care and assistance to its children. This is usually in the form of some kind of formalised ECD or health care where some kind of infrastructure is in place. NOAH then focuses on providing assistance to children from the ages of 2 to 6.

NOAH regards ECD as broadly focusing on education and health, both physical and mental. It endeavours to provide support to children using partner NGOs with expertise in these areas. Rather than hiring and training volunteers or staff themselves, NOAH rather leaves this to organisations that have already formalised an ECD approach. NOAH thus plays more of a facilitatory role and assists with acquiring resources and training admin personnel to manage and run the ECD centres.

7.1.1 The NOAH social franchising system

NOAH starts out by consulting with a community and developing a basic framework for implementation its particular franchise methodology. The first step is to find a community that is already motivated to help its children, either through health care or education

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The next step is to set up an ‘ark’, which normally ‘piggy-backs’ on the structure that the community or an existing ECD service provider are using.

Each ark is supported by an Ark Manager from the community who makes operational decisions on a daily basis, and an Ark Builder who is a Noah head office employee, who helps to problem solve and oversees events.

Central to the process is skilling of volunteers from the community thus enabling the community to take care of its own children. The following services are provided by Community Leadership and trained volunteers at each of the arks:

. Registration; . Home visits; . Accessing grants; . Food gardens; . Feeding schemes; and . Resource centres providing day care and after care.

NOAH assists with establishing appropriate infrastructure where necessary, either through outside resources or through its own fundraising initiatives. It also assesses the resources required, staff needs, etc., to ensure that the franchise model can be appropriately implemented.

The process of the Noah model is represented in figure 10.

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Figure 10 – NOAH model

Source: http://www.noahorphans.org.za/NoahModel/tabid/8271/Default.aspx

Once NOAH has determined that the model will be viable, it seeks outside organisations to implement the facets of the model that it does not have the expertise to do itself. Organisations it presently works with are Ntataise (network of accredited training providers) and Clamber Club (playgroup model).

The Ntataise ECD programme is run in 16 NOAH’s Arks in Gauteng and 8 in KwaZulu-Natal. The programme aims to help arks to plan a more stimulating learning programme for young children within the context of the national curriculum framework. Themes such as five senses, clothing, transport, my family, etc. is used as a planning tool to allow for the integration of learning. The arks make their own resources to assist them in achieving the outcomes.

The Clamber Club gross motor development programme for young children is used in all the Gauteng Arks recently started to role out in KwaZulu-Natal. Clamber Club runs movement programmes for children aged 4 months to 6 years. They train NOAH child minders, and also run an independent franchising venture (http://www.clamberclub.co.za/franchise.html).

7.1.2 Support provided to NOAH franchisees

NOAH employs assistants, usually volunteers from the community or those who it can pay a small salary. NOAH works out a budget for the assistants and then trains them to work within it. NOAH prefers that the entities become self sufficient so it

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encourages the community to establish it as a community-based organisation so that it can access government funds.

NOAH provides administrative support and guidance, as well as financial assistance to sustain the entity. It also provides computers and training of assistants to capture data so that it can track how the centre is used. This approach is difficult to use in the rural areas, however, since many people are illiterate and most, if not all, computer illiterate.

In addition to providing support for ECD, NOAH also provides for a feeding scheme and an assessment process that ensures the child is being given proper care at home. If not, NOAH refers the child out for psychological, social or other support.

The programme has a comprehensive monitoring and evaluation system in place whereby the services offered by the Arks and the children impacted on are counted, evaluated and recorded on a central data base which is reviewed monthly. The data is captured by the ark personnel themselves in many of the arks, which gives them a sense of ownership and control over their own activities.

Each Ark Manager is accountable for providing the central Research Department information captured, as well as information on their budgets and how they have allocated and spent money over the month. This ensures that effective and appropriate support is given to the children through a range of services provided and that money is handled appropriately, and prevents over or under spending, or mismanagement of funds.

7.1.3 Benefits associated with this franchising model

The NOAH model allows the organisation to establish a consistent approach to setting up its Arks, but gives flexibility to the service providers who are appointed to deliver the different programmes to the beneficiaries. For NOAH, this allows it to mobilise resources more effectively for the specific outcomes desired. NOAH does the monitoring and evaluation, which allows it to improve upon its model and to continuously look for better solutions.

7.1.4 Some pitfalls of social franchising and lessons learned

NOAH frequently suffers from a shortage of money. Their model relies heavily on volunteers, who are difficult to retain. It is also very difficult to nurture an organisation to be self-sustaining financially, particularly given the growing numbers of children in need of ECD, which puts a further drain on the infrastructure and resources required to go on from year to year.

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7.2 loveLife

The loveLife case study highlights a highly replicable model that has taken HIV and AIDS peer education to scale in a fairly short space of time. loveLife shows the importance of a very strong brand and a lot of money. . loveLife was launched in September 1999 to address the growing need for a dedicated HIV prevention. programme. It was established by a consortium of leading South African public health organisations, the South African government, major South African media groups and private foundations, in partnership with South Africa’s national HIV prevention programme for youth, which is a coalition of more than 100 community-based organisations. loveLife has established a very strong brand and uses a highly visible awareness campaign to gain pubic attention. It has also has established a countrywide network of adolescent friendly outreach and support programmes for youth.

Its partnership with media groups has led to its innovative use of marketing approaches to get its message ‘out there’. This includes a sustained multi-media education and awareness campaign using television, radio, outdoor media and print – educating young people about HIV and promoting dialogue about sexual health issues. Other key elements of its programme include:

. The National Adolescent-Friendly Clinic Initiative, a major drive to establish adolescent health services in South Africa’s 5,000 public clinics. . A national network of 16 multi-purpose youth facilities, known as ‘Y-Centres’, providing recreation and skills training, as well as sexual health education and care in non-clinical settings. . A countrywide programme of community-level outreach and support to young people (including 3,500 schools) led by a national volunteer corps of more than 1,500, 18-25 year-olds known as loveLife groundBREAKERS. . A nationally accessible toll-free telephone helpline for young people providing specialised sexual health information, counselling and referrals averaging 300,000 calls per month. . The loveLife Games, the largest school sports competition in South Africa, promoting healthy living, self-motivation and personal achievement to more than 400,000 school students annually. loveLife has developed an evaluation programme regarded as one of the most comprehensive of its kind in the world. This programme combines a large-scale national surveillance study (repeated at two year intervals) with in-depth surveys at 33 sentinel sites. The aim is for loveLife to track its impact on not just attitudes and self- reported risk behaviour among teenagers, but also on HIV, other sexual transmitted infections and teenage pregnancy. This evaluation programme is lead by the Reproductive Health Research Unit of the University of the Witwatersrand in partnership with the Medical Research Council of South Africa. The Center for AIDS

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Policy at the University of California at San Francisco provides independent external reviews. loveLife also has a system of on-site training, linked to supervision and monitoring. There are 130 area co-ordinators who provide first-level support and monitoring, and 22 regional teams (of three each) who provide next-level support. Data from each site (down to individual programme registration) is collected monthly and collated quarterly.

Major funding for loveLife is provided by the South African government and the Henry J. Kaiser Family Foundation. Additional support is provided by the Anglo American Chairman’s Fund, the South African National Lottery, the South African Broadcasting Corporation, the Independent Newspaper Group and the Vodacom Foundation.15

7.2.1 The loveLife social franchising system loveLife positions itself as a healthy lifestyle brand for young South Africans. There are 130 community-based organisations associating themselves with the brand through the ‘loveLife franchise’ system. Day-to-day management of loveLife is directed by the loveLife Trustees and implemented by the staff and volunteers of loveLife together with a countrywide network loveLife franchises. loveLife uses an approach which leverages their community development expertise. In turn, they are assisted to implement a systematic HIV prevention programme for teenagers using a co-branded theme and product, loveLifestyle.

Through a system of peer-motivation, each franchise holder implements loveLifestyle in at least five schools. This enables loveLife to delegate responsibility to the franchisee for the successful transference of the model to the communities.

A youth serving organisation which has applied to loveLife and meets basic criteria in terms of governance, programme and financial management can be eligible to become a franchisee.

7.2.2 Support provided to loveLife franchisees

A ‘loveLife line manager’ is identified in each organisation and provided with training in HIV prevention, loveLife-style. Franchisees thereafter recruit two ‘loveLife groundBREAKERS’ from their community each year. These individuals are then trained to implement loveLifestyle in schools. groundBREAKERS are paid a stipend of R880 per month.

Each groundbreaker, in turn, recruits five mpintshis (‘buddies’) who are also given in- service training by loveLife. Mpintshis receive no stipend. Outside of this, franchisees receive resources and promotional materials each quarter, as well as monthly

15 loveLife website (www.lovelife.org.za).

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distribution of loveLife’s lifestyle magazine UNCUT. Once a loveLife franchise has been successfully established, this becomes a loveLife ‘hub’. There are currently 710 of these, including clinics and youth centres. Young people at these franchisees are then entitled to participate in loveLife leagues (debating, sports and recreation), which is regarded as a special privilege by the participants. loveLifestyle is a structured modular interactive programme for young people. Franchisees commit to specific targets in terms of youth participation (both in- and out-of-school youth). Line managers are expected to supervise and support groundBREAKERS and mpintshis and to create the loveLife hubs that become a part of the youth lifestyle

7.2.3 Benefits associated with this franchising model

. Association with loveLife brand which drives demand by young people. . Direct association with media components of loveLife (print and radio programmes in particular). . Significantly enhanced capacity for outreach. . The value of loveLife’s direct contribution is about R200,000 per franchisee per annum. Indirect contribution (in terms of training, etc.) is also significant.

7.2.4 Some pitfalls of social franchising and lessons learned

Maintaining the balance between programme integrity and organisational autonomy can be difficult. loveLife found that direct interaction and support for groundBREAKERS can lead to bypassing and disempowering of line managers. It also found that this kind of social franchising requires a high level of support and monitoring and that social franchising needs a strong ‘brand’. There also needs to be a very clear replicable implementation unit: loveLife uses a ‘hub and spoke model’ with defined programme inputs and outputs.

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