FranchisingFranchising toto increaseincrease accessaccess andand useuse ofof LTFPLTFP andand SASA inin GhanaGhana

Cynthia Eldridge, Global SF Manager, MSI International Conference on FP Kampala, Tuesday November 17, 2009 The global view of franchising

NewStart,

Dushishoze New Start, S.Africa ProFam, Well Family Midwife Centres, Clinic, PSI, Uganda ProFam, GreenStar, Blue Star, Janani, Top Reseau, ProFam, Amua, Blue Star, Congo 1994 1996 1998 2000 2002 2004 2006 2008

Smiling Sun PSI,

PSI, Suraj, MSS Pakistan

SEWA/PSSN/Sangini, Blue Star, PSI, Blue Star, New Start, New Start, Swaziland Blue Star, Philippines MSI Honduras Blue Star,

MSI Nicaragua SkyHealth Centers (WHP), India

Source: Slide from Montagu and Montagu, D., et al. (2009) Clinical Social Franchising: An annual Compendium of Programs, 2009. San Francisco: The Global Health Group, Global Health Sciences, University of California San Francisco. Strengthening Health Systems

Outreach Outreach Outreach

Outreach Centers Centers Centers

Outreach MSI Partner

rt Pro po gr up am l S me ica S hn u ec pp T ort Implementing BlueStar

2. Develop Brand, 3. Supply Side: Services and Products. Training Charge Franchise Fee Commodity Supply

Increased access 4. Demand Side Activities: 1. Analyse market and Branding and uptake of services Local Demand Generation conduct research

5. Supervision and Monitoring A System of Quality for BlueStar 1

A. MSI Medical Development Team • Set clinical standards for franchised services • Conduct competency based training • Conduct annual quality technical assistance • Include 1-2 franchisees in global medical development team quality technical assistance A System of Quality for BlueStar 2

A. Medical Development Team • Implement minor and major incident reporting system through Medical Advisory Team

B. Procurement and Logistics Team • Ensure appropriate commodities and equipment Ghana Health Context

Countries Non-public sector Bolivia (2003) 41% Burkina Faso (2003) 46% Ethiopia (2005) 20% Ghana (2003) 56% Kenya (2003) 45% Malawi (2004) 33% Mali (2001) 45% (2003) 30% (2003) 72% Senegal (2005) 28% Tanzania (2005) 31% Uganda (2006) 64% (2002) 38% Zimbabwe (2006) 31% BlueStar Ghana

• Started April 2008 • Greater Accra Region • Service delivery channel for MSIG • 42 clinics, 26 pharmacies, 32 chemical sellers • LAFP and SA services Ensuring quality of service delivery through BlueStar Ghana Continuity of Care through BlueStar Ghana Outreach at Catchment Govt Clinic MSIG Centre

R e f e Area r r a ls l s rra fe e Outreach R

Referrals

CHW CHW CHW CHW Lessons Learned

1. Evidence-based decision making is vital 2. Pilot allows for “teething problems” 3. Demand generation activities must be strategic, start early and be local 4. Franchise fees are part of the business partnership model 5. Integration with other MSI core delivery mechanisms is essential SF MSI Team

Dr. Rehana Ahmed – Head of SF (L) Cynthia Eldridge – Global SF Manager (R) Jamshaid Senanu Arkutu Ferdinand Moseh Amua Kenya Le Thi Kim Yen Asghar BlueStar Ghana BlueStar Viet Nam Suraj Pakistan

Frank Francisco Manty Tarawalli Ranja Rakotomahanina BlueStar BlueStar Sierra Girma Minasnote BlueStar Madagascar Philippines Leone BlueStar Ethiopia Felistas Sibweza BlueStar Malawi